Thursday, December 16, 2010

Hope for Bulgaria's Children Struggling With Mental Illness

Earlier this fall, an article in the New York Times caught my eye. It was about the Bulgarian Helsinki Committee, an international human rights organization based in Sofia, Bulgaria, and their ongoing attempts to bring landmark charges against those whom have fatally neglected the rights and access to care of mentally ill children across Bulgaria.

Since 2000, it is reported that 238 children in Bulgaria’s mental health homes have died. As quoted in the NY Times, “More than three-fourths of the deaths were found to have been avoidable: 84 from physical deterioration caused by neglect; 36 from exposure to cold or long-term immobility; 31 from malnutrition; 13 from infections caused by poor hygiene; 6 from accidents; 15 were unexplained.”

I would have been a lot more likely to bypass this article had I not served as a Peace Corps Volunteer in Bulgaria from 1998 to 2000. While living in a small town tucked away in the central Balkan mountains, I experienced firsthand the legacy that continues from the Soviet era well into 2010. The next train stop over from my town, Dryanovo, was Tsareva Levada, a small village with a population of no more than two thousand people. Every building in Tsareva Levada, like the majority across Bulgaria, let you know by their horrid condition tthat they had endured against all odds. They stood stoically in their often gray and peeling paint, plaster chips dangling like dead leaves, burnt out lights and insufficient heating the norm.

The people living inside these buildings endured as well. Inside some units lived grandmothers who rationed their daily beans to make sure they’d have enough to make their meager pensions stretch to month’s end. In Tsareva Levada stood a large two story concrete structure that housed a number of children and teenagers. I had been told this structure was an orphanage and over the two years I lived in Bulgaria, I took my students there to visit them from time to time and as part of a community service project led by two students I was supervising. I can remember one occasion when we had a spring picnic and had brought bananas. A number of the children were biting right into the peel or scratching at it, unsure of what to do with this odd-shaped yellow object. This was a reflection of the limited budget granted to these institutions to ensure a proper nutritious diet as well as meet other basic needs.

It wasn’t until I was close to completing my time as a Peace Corps Volunteer that I learned this wasn’t an orphanage at all. Many of these children, as it turned out, did have parents and families,and many would only go home only at the holidays. The majority of these children struggled with various mental health conditions and it was for this reason that they were living in Tsareva Levada, and not because they didn’t have homes and families somewhere in Bulgaria. Looking back, I shudder when I wonder how many of their mental health conditions may have been created or further exacerbated by possible lifelong neglect and abuse on so many levels.

Why weren’t they with their families all along? Unfortunately, they were part of a long tradition during the Soviet era where the mentally ill- children and adults alike- were banished to institutions in villages and countrysides where they could be more easily forgotten. As quoted in an article by Oksana Yakushko in the Mental Health Counseling Journal, “Mental illness was typically associated with prison-like mental institutions.” Though there had once actually been a rich tradition of psychotherapy practice in imperial Russia, under Communism there would be no welcome shelter to protect the human rights of the mentally ill.

When the Iron Curtain crumpled to the ground in the early nineties , the neglected plight of many of the region’s mentally ill continued under the crushing weight of historic changes and increasing poverty for many. The Bulgarian Helsinki Committee seems determined to terminate this chapter of their history and to restore accountability of governments and caregivers across Bulgaria. “It’s about ending impunity,” said Margarita Ilieva, legal director at the Bulgarian Helsinki Committee. “This will instill a fear of criminal liability, and that will change the behavior of the executive branch of government.” For its part, the Bulgarian government has announced it will close all mental health institutions housing children within fifteen years.

Fifteen years is a long time away though if you are a Bulgarian child struggling as you and I sit here in Oregon. As the investigations continue, the most crucial impact will only occur with a national awareness campaign that truly educates Bulgarians about the nature and special needs of the mentally ill. Once these institutions finally do close, little will change if these children’s local communities and the families with whom they will permanently reside still do not understand their needs nor embrace their equal rights as fellow human beings. It is the mentality that created and sustained these institutions that will still need to be dismantled long after the last institution’s front gates have been closed for the last time.

For more information, you can visit the Bulgarian Helsinki Committee’s website at
(This is a piece to be published in ORCA's (Oregon Counseling Association) next newsletter but may be of interest to others following the human rights issues of those struggling with mental illness worldwide.)
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