I have been a social worker for more years than I care to remember, working mainly in the field of adult mental health as a social worker, and as a social services training and staff development officer. Here in Bulgaria I am working with two institutions - a small Psychiatric Hospital and a larger Social Home for Adults with Mental Distress.
Few of you should be unaware by now of the poor and sometimes appalling conditions for many of those that live in these institutions in Bulgaria - highlighted in the recent Amnesty International report*.
Mental illnesses are some of the least understood conditions in society. People with mental illness can experience problems in the way they think, feel and behave. Diagnoses include labels such as depression and schizophrenia. For some people they may only have one acute incidence, for others occasional "breakdowns", while others may suffer from a longer-term condition. In the Social Home for Adults with which I work, people with mental illness diagnoses (who have had a short-term incidence of ill health to longer-term illness) and learning disabilities live together. Now learning disability is a life long condition, acquired before, during or soon after birth - that affects an individual's ability to learn. A person with a learning disability can learn and achieve a lot, if given the right support. However the care needs of people with mental distress and those with a learning disability require different responses.
You should know that people with mental health problems are people first and not a category of diagnosis. I have found very few differences between people in the UK suffering mental distress and people in Bulgaria. By and large, despite their fragility, they are remarkably strong people who are surviving difficult systems and circumstances and public stigma. They are open, welcoming, humble and often talented people - and I admire many of them for their courage. In the hospital in which I work, there are a higher proportion of patients who speak English than there are on the staff.
Few people want to live in a hospital or social home for any length of time once their crisis is over. However, something I have learnt here, is that many feel, because of a miniscule pension or lack of family support, that they have no choice. But they live in hopes of family interest and discharge from the institution to a freer life. People with mental illnesses are living successfully outside of institutions but for many it can be a harder life than on the inside. "Whilst we recognise the need to work with professional staff, the support that we give each other is often the most effective, sympathetic support we receive" said members of the Children of Kubrat, Sophia's mental health service user-led organisation. This is a message I have heard from some British service-users, even though community based services have better resources and are more developed in the UK.
Many of the staff I work with are only too aware of the poor conditions and restricted lives of the residents and patients with whom they work and want to provide a freer life for them. At the Psychiatric Hospital, with a little financial help from donors, staff and patients together have created an attractive and cosy "therapeutic kitchen". The patients are delighted and work together in small groups to produce delicious "home-made" meals. A staff member said, "This is something for which we don't have to feel ashamed".
The director of the social home has received many critical letters from abroad following the Amnesty International report. She courageously replied "I am very hurt when I read your letters. I should say with sadness that there are many truths in them." She went on to list the many efforts of the staff to improve conditions in the last year and their future plans, but concluded, "We have done some things, but we are aware that it is like a drop in the ocean." She emphasised the need for material support to carry forward the process of de-institutionalisation - resettling residents in more suitable homely accommodation. The low staffing levels, low pay and the physical remoteness of the home create barriers to progress as do public and political attitudes to people with mental health needs.
Amnesty is usefully promoting the role of minimum standards of care for those living in homes. However an appreciation of the Bulgarian context is helpful here. For example, one criticism in their report is of the ubiquitous hole in the ground toilets, which are difficult for disabled and older people to use. But we need to be aware that most of the staff in the home I work with are from remote villages and their older parents will live in homes with similar toilets, some with more difficult access than that in the home. In these villages bedrooms and living rooms are frequently combined, to save on heating and furnishing, and homes lack the multitude of material possessions of Western Europe. This does not mean that Amnesty's criticisms are not valid, but recognition of living standards of the local population needs to be taken into account.
Essentially what I try to do is to work alongside staff, in a skills sharing capacity, to help them realise their ideas for improving the service to the patients, the residents and their families. I try to support the voice of the patients and residents and to increase their perspective in service developments. Change for the better is very slowly coming because many staff, residents, and patients (the users of services) want and are working for change. But the change is not fast enough. Political and public support both attitudinal and material is needed too.
*The Amnesty International Report October 2002 - "Far from the eyes of society" can be found on www.amnesty.org.
Few of you should be unaware by now of the poor and sometimes appalling conditions for many of those that live in these institutions in Bulgaria - highlighted in the recent Amnesty International report*.
Mental illnesses are some of the least understood conditions in society. People with mental illness can experience problems in the way they think, feel and behave. Diagnoses include labels such as depression and schizophrenia. For some people they may only have one acute incidence, for others occasional "breakdowns", while others may suffer from a longer-term condition. In the Social Home for Adults with which I work, people with mental illness diagnoses (who have had a short-term incidence of ill health to longer-term illness) and learning disabilities live together. Now learning disability is a life long condition, acquired before, during or soon after birth - that affects an individual's ability to learn. A person with a learning disability can learn and achieve a lot, if given the right support. However the care needs of people with mental distress and those with a learning disability require different responses.
You should know that people with mental health problems are people first and not a category of diagnosis. I have found very few differences between people in the UK suffering mental distress and people in Bulgaria. By and large, despite their fragility, they are remarkably strong people who are surviving difficult systems and circumstances and public stigma. They are open, welcoming, humble and often talented people - and I admire many of them for their courage. In the hospital in which I work, there are a higher proportion of patients who speak English than there are on the staff.
Few people want to live in a hospital or social home for any length of time once their crisis is over. However, something I have learnt here, is that many feel, because of a miniscule pension or lack of family support, that they have no choice. But they live in hopes of family interest and discharge from the institution to a freer life. People with mental illnesses are living successfully outside of institutions but for many it can be a harder life than on the inside. "Whilst we recognise the need to work with professional staff, the support that we give each other is often the most effective, sympathetic support we receive" said members of the Children of Kubrat, Sophia's mental health service user-led organisation. This is a message I have heard from some British service-users, even though community based services have better resources and are more developed in the UK.
Many of the staff I work with are only too aware of the poor conditions and restricted lives of the residents and patients with whom they work and want to provide a freer life for them. At the Psychiatric Hospital, with a little financial help from donors, staff and patients together have created an attractive and cosy "therapeutic kitchen". The patients are delighted and work together in small groups to produce delicious "home-made" meals. A staff member said, "This is something for which we don't have to feel ashamed".
The director of the social home has received many critical letters from abroad following the Amnesty International report. She courageously replied "I am very hurt when I read your letters. I should say with sadness that there are many truths in them." She went on to list the many efforts of the staff to improve conditions in the last year and their future plans, but concluded, "We have done some things, but we are aware that it is like a drop in the ocean." She emphasised the need for material support to carry forward the process of de-institutionalisation - resettling residents in more suitable homely accommodation. The low staffing levels, low pay and the physical remoteness of the home create barriers to progress as do public and political attitudes to people with mental health needs.
Amnesty is usefully promoting the role of minimum standards of care for those living in homes. However an appreciation of the Bulgarian context is helpful here. For example, one criticism in their report is of the ubiquitous hole in the ground toilets, which are difficult for disabled and older people to use. But we need to be aware that most of the staff in the home I work with are from remote villages and their older parents will live in homes with similar toilets, some with more difficult access than that in the home. In these villages bedrooms and living rooms are frequently combined, to save on heating and furnishing, and homes lack the multitude of material possessions of Western Europe. This does not mean that Amnesty's criticisms are not valid, but recognition of living standards of the local population needs to be taken into account.
Essentially what I try to do is to work alongside staff, in a skills sharing capacity, to help them realise their ideas for improving the service to the patients, the residents and their families. I try to support the voice of the patients and residents and to increase their perspective in service developments. Change for the better is very slowly coming because many staff, residents, and patients (the users of services) want and are working for change. But the change is not fast enough. Political and public support both attitudinal and material is needed too.
*The Amnesty International Report October 2002 - "Far from the eyes of society" can be found on www.amnesty.org.
