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AI Index: EUR 15/010/2002

B U L G A R I A

Arbitrary detention and ill-treatment of people with mental disabilities

Samuil social care home for men and women

We see a varied picture; in some homes there is indiscriminate use of high doses of sedatives to suppress the agitation of the patients. This widespread use is totally unjustified.

Dr. Georgi Bankov, Bulgarian Helsinki Committee

Residents in the Samuil social care home for adults with mental disabilities endure systematic abuse, gross neglect and ghastly living conditions in violation of international human rights standards. Samuil is a mixed institution, housing both men and women over age 18.

When Amnesty International and the Bulgarian Helsinki Committee visited Samuil in July 2002, residents immediately directed representatives to a seclusion room where one woman had been residing for an indefinite period of time. The cell-like room was draped in darkness at mid-day. Windows were boarded up. Iron bars served as a door. The woman, apparently under sedation, could not recall how long she had been there. She only knew she could not leave. Residents described how staff beat them, drugged them and placed them in seclusion to punish them.

All social care homes visited by AI in Bulgaria resorted to the use of seclusion methods, usually imposed as punishments, which were cruel, inhuman or degrading. No detailed records were kept of seclusion and methods of restraint, as required by international standards.

One Samuil resident complained that she was raped when living in a children’s home before placement at Samuil. Several complained that they wanted to leave. Another desperately appealed for AI and BHC representatives to deliver a letter to his wife at a social care home in Kachulka. (The wife subsequently told AI that she had been separated from her husband after they had a child together in 2000.)

Samuil’s residents live in dormitory-style conditions. Often, six people share one room. Most did not have personal items - even clothing or toiletries. Residents demonstrated how staff distributed clothes randomly to them, en masse, after washing.

Toilet facilities were particularly bad. At an outhouse, with six holes in the ground, it was impossible to avoid stepping deep into excrement, which extended onto the path outside. At the time of a January 2002 visit there had been no running water in the institution since May 2001 - an eight-month period that included the whole of summer.

Specialist medical care was rare. There are over 100 women in Samuil, yet no one had been referred for a gynaecological examination in 2001. Labour therapy for some consisted of cleaning floors and performing menial tasks normally required of staff. For the vast majority of residents, the only available activity was to watch television. In the summer, residents roamed outside.

Arbitrary detention and ill-treatment of people with mental disabilities

People with mental disabilities in Bulgaria suffer systematic discrimination and lack of respect for their most basic human rights.

Conditions in social care homes for adults are often cruel, inhuman and degrading. The high numbers of deaths testify to medical neglect and a lack of food and warmth. Residents may be physically restrained with belts or straitjackets or secluded in a small room with no windows or a cage for indefinite amounts of time. Medication is widely administered, often solely to control behaviour.

Like adults, children receive practically no therapy or rehabilitation for developmental disabilities. Those with the most severe disabilities may be left all day in their beds, without toys, organized activities or visual stimulation.

After age 18, residents of homes for children are often transferred to homes for adults. Unable to challenge decisions made about their care by officials or relatives, they are institutionalized for life.

Social care homes located in areas remote from population centres cut residents off from their families and the rest of society. For persons with disabilities, being placed in remote locations, far from hospitals, can put their lives at risk.

On 10 October 2002 Amnesty International launched a campaign for improved conditions and treatment for people with mental disabilities in Bulgaria. The action seeks to strengthen public awareness that people with mental disabilities have the same human rights as other members of the community. The international community is being urged to support comprehensive reform of Bulgaria’s mental health care services.

The culture was one of simply controlling and warehousing people. The residents who had obviously been abandoned by society were left with nothing to do and nothing to hope for. They were herded together- with absolutely no purpose to their days.

Dr Mary Myers, a consultant psychiatrist who visited social care homes

in Bulgaria as an Amnesty International representative.

Please write appeals, using the addresses at the back of this leaflet, calling on the Bulgarian authorities to:

Take immediate steps to ensure that seclusion is not used as punishment and that any method of restraint and seclusion, which should be prescribed or authorized by a doctor, supervised by medical staff and strictly restricted in duration, be used in a manner consistent with international standards;
Review the placement of all residents of social care homes and ensure their rights to due process and freedom from arbitrary detention have not been violated. To establish substantive and procedural legislation which would regulate placement in social care homes and ensure that these provisions are in line with international standards;
Conduct thorough and impartial investigations into all instances of gross neglect or cruel, inhuman and degrading treatment of residents with a view to bringing to justice anyone found to have committed a criminal offence;
Take immediate steps to ensure that residents are treated in a professional and humane way that is consistent with international standards - including the provision of adequate clothing, toiletry items and sanitary facilities;
Initiate comprehensive monitoring with the aim of bringing the Samuil social care home in line with standards of international law and professional best practice. If the authorities determine that the home cannot be reformed to meet these standards, it should be closed permanently and residents moved to facilities that do meet those standards

TAKE ACTION NOW

Send your letters to:

General Prosecutor

Nikola Filchev

General Prosecutor

Vitosha Boulevard 2

1000 Sofia, Bulgaria

Fax: +359 2 989 0110

Salutation: Dear General ProsecutorMinister of Labour & Social Policy

Lidiya Shuleva

Minister of Labour & Social Policy

ul. Triaditza 2

1051 Sofia, Bulgaria

Fax: +359 2 986 1318/ 981 9172

e-mail: mlsp@mlsp.government.bg

inter.coop@mlsp.government.bg

Salutation: Dear Minister

Director of the National Social Welfare service

Nikolai Angelov

Director of the National Social Welfare service

Ministry of Labour and Social Policy

Triaditsa street, 2

Sofia 1051

Bulgaria

Samuil Social Care Home for Adults with Mental Disabilities

Mr. Halid

Director

Samuil Social Care Home for Adults with Mental Disabilities

7454 Samuil

Bulgaria

Amnesty International is a worldwide movement of people who campaign to prevent and end grave abuses of the rights to physical and mental integrity, freedom of conscience and expression, and freedom from discrimination, within the context of its work to promote respect for all human rights.

To obtain a copy of Amnesty International’s report, Bulgaria: Arbitrary detention and ill-treatment of people with mental disabilities(AI Index: EUR 15/008/2002), contact Amnesty International in your country:

[space for sections to add their address/contact details]

or contact: Amnesty International, International Secretariat, 1 Easton Street, London WC1X 0DW, United Kingdom (www.amnesty.org)

B U L G A R I A

Arbitrary detention and ill-treatment of people with mental disabilities

Mogilino social care home for children

Unfortunately, the rehabilitation work here is very weak, almost non-existent. I think there are children here who could walk, but don’t because of the poor standard of the rehabilitation care.

Dr. Georgi Bankov, Bulgarian Helsinki Committee

Children in the Mogilino social care home are grossly neglected, in violation of numerous standards of international law and professional best practice. The lack of adequate rehabilitation, care or treatment for children with mental disabilities - particularly for those with severe impairments - is appalling.

When Amnesty International and Bulgarian Helsinki Committee representatives arrived in July 2002, children with mild disabilities were found huddled in groups or sitting aimlessly outside buildings in which they lived. Inside, children with more severe disabilities sat in corners, on the ground or lay in bed doing nothing. Staff, who are too few in number and inadequately trained, stood by and watched or were busy attending to chores.

After a rushed lunch, the children were separated into groups of 15 to 20 girls and boys per staff member. Children then spent their time sitting on benches lined along dormitory walls. In one room, the only source of stimulation for a group of boys was an English-language play on television. For two and a half hours the children sat, not paying any attention to the television, in silence.

Thirty-five Mogilino children spend their entire lives in dormitories for the "bedridden". Beyond feeding and cleaning, staff did not interact with these children. A number were very active and, in the opinion of a BHC doctor, misdiagnosed.

In 2001, six children died in Mogilino. A nine-year-old boy suffering from cerebral palsy died on 6 November of pneumonia, possibly as a result of feeding practices inappropriate for his condition and observed in the institution.

Although Mogilino had a new rehabilitation room, individualized rehabilitation programs and daily activity necessary for disabled children were virtually nonexistent. When AI and BHC arrived in July, the person responsible for rehabilitation was found painting bed frames during his scheduled working hours. If active and appropriate treatment is not initiated soon, the Mogilino children could be impaired for life.

Gross neglect of children with mental disabilities

The gross neglect of children with mental disabilities in Bulgaria amounts to cruel, inhuman and degrading treatment in violation of international human rights standards.

Children in Bulgarian social care homes receive practically no therapy or rehabilitation for their disabilities - in some instances even when some resources are available for this purpose. Those with the most severe disabilities may be left all day in their beds, without toys, organized activities or any form of stimulation.

After age 18, residents of homes for children are often transferred to homes for adults. Amnesty International found many young people who, having spent their entire lives in children’s homes, had graduated to institutions for adults and were completely unable to communicate with others or to do anything independently of others. Unable to challenge decisions made about their care by officials or relatives, they are institutionalized for life.

Many social care homes are located in areas remote from population centres far from residents’ families and the rest of society. For persons with disabilities, being placed in remote locations, far from medical care and emergency services, can put their lives at risk.

On 10 October 2002 Amnesty International launched a campaign for improved conditions and treatment for people with mental disabilities in Bulgaria. The action seeks to strengthen public awareness that people with mental disabilities have the same human rights as other members of the community. The international community is being urged to support comprehensive reform of Bulgaria’s mental health care services.

Physicians and psychiatrists can help with only one side of the problem. But we need physiotherapists, we need speech therapists, we need lots of specialists to be involved in the rehabilitation of these children who will then be able to rejoin their peers in the community and live a life with dignity.

Ivan Fišer, Amnesty International Researcher

Please write appeals, using the addresses at the back of this leaflet, calling on the Bulgarian authorities to:

Ensure that placement procedures for children in the Mogilino social care home is based on a professional assessment of a child’s impairments and the required level of support;
Ensure that medical care is adequate and that the Mogilino children are monitored and regularly reassessed by a team of specialists as a standard practice;
Ensure that each child has an individualized rehabilitation and training program;
Ensure that Mogilino is staffed by a full complement of required specialists;
Initiate comprehensive and independent monitoring of the Mogilino social care home with the aim of bringing it in line with standards of international law and professional best practice. If the authorities determine that the home cannot be reformed to meet these standards, it should be closed permanently and the children moved to appropriate facilities.

TAKE ACTION NOW

Send your letters to:

General Prosecutor Nikola Filchev General Prosecutor Vitosha Boulevard 2 1000 Sofia, Bulgaria Fax: +359 2 989 0110 Salutation: Dear General Prosecutor
Salutation: Dear Minister
Director of the National Social Welfare service Nikolai Angelov Director of the National Social Welfare service Ministry of Labour and Social Policy Triaditsa street, 2 Sofia 1051 Bulgaria	Mogilino Home for Children with Mental Disabilities Katerina Serafimova Director Mogilino Home for Children with Mental Disabilities Vuzrazhdenie, 43 Mogilino Village 7165 Dve Mogili, Bulgaria

Minister of Labour & Social Policy

Amnesty International is a worldwide movement of people who campaign to prevent and end grave abuses of the rights to physical and mental integrity, freedom of conscience and expression, and freedom from discrimination, within the context of its work to promote respect for all human rights.

To obtain a copy of Amnesty International’s report, Bulgaria: Arbitrary detention and ill-treatment of people with mental disabilities(AI Index: EUR 15/008/2002), contact Amnesty International in your country:

[space for sections to add their address/contact details]

or contact: Amnesty International, International Secretariat, 1 Easton Street, London WC1X 0DW, United Kingdom (www.amnesty.org)

B U L G A R I A

Arbitrary detention and ill-treatment of people with mental disabilities

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Oborishte social care home for men

It is so bad that people die here.

Oborishte resident

Approximately 100 residents in the Oborishte social care home for men with mental disabilities suffer gross neglect, which amounts to cruel, inhuman and degrading treatment in violation of international human rights standards.

At the time of a June 2002 Amnesty International and Bulgarian Helsinki Committee visit, one resident remarked, "It is so bad that people die here".

In June 2002, a 20-year-old man reportedly suffering from epilepsy was found dead in a corridor. In 2001, 10 men died. One died of head injuries suffered in a beating from another resident. Another died of pneumonia. Records showed that the other eight died of ‘heart and respiratory failure’.

Oborishte staff actively use two seclusion rooms, each with steel-barred doors. When AI and BHC arrived in June, they found two men together in one room - one of whom, orderlies explained, was violent towards other residents. In the second seclusion room, holding six men of varying disabilities, five were completely naked. One man lay on his back perfectly still, holding his legs to his chest, with a puddle of urine over one metre in diameter under his bed. Like most in the room, his bed consisted only of a metal frame and springs. Traces of faeces were on the walls. An orderly explained that residents throw it there.

Living and material conditions are extremely poor. Residents’ dormitories are overcrowded. Buildings are dilapidated and in urgent need of repair. Beds are in a poor state. Some mattresses are very thin, with bedsprings bent out of shape.

Toilet facilities are rudimentary and unhygienic. Residents have access to two toilet rooms. Neither has doors. In one toilet room, a man was found, naked from the waist down, squatting on the floor, motionless. An orderly casually explained that he spends most of his time here.

Oborishte’s residents lack adequate medical care or treatment. The number of staff per resident is insufficient. Staff are inadequately trained. In emergency situations, residents’ lives could be at risk.

Arbitrary detention and ill-treatment of people with mental disabilities

People with mental disabilities in Bulgaria suffer systematic discrimination and lack of respect for their most basic human rights.

Conditions in social care homes for adults are often cruel, inhuman and degrading. The high numbers of deaths testify to medical neglect and a lack of food and warmth. Residents may be physically restrained with belts or straitjackets or secluded in a small room with no windows or a cage for indefinite amounts of time. Medication is widely administered, often solely to control behaviour.

Like adults, children receive practically no therapy or rehabilitation for developmental disabilities. Those with the most severe disabilities may be left all day in their beds, without toys, organized activities or visual stimulation.

After age 18, residents of homes for children are often transferred to homes for adults. Unable to challenge decisions made about their care by officials or relatives, they are institutionalized for life.

Social care homes located in areas remote from population centres cut residents off from their families and the rest of society. For persons with disabilities, being placed in remote locations, far from hospitals, can put their lives at risk.

On 10 October 2002 Amnesty International launched a campaign for improved conditions and treatment for people with mental disabilities in Bulgaria. The action seeks to strengthen public awareness that people with mental disabilities have the same human rights as other members of the community. The international community is being urged to support comprehensive reform of Bulgaria’s mental health care services.

The culture was one of simply controlling and warehousing people. The residents who had obviously been abandoned by society were left with nothing to do and nothing to hope for. They were herded together - with absolutely no purpose to their days.

Dr Mary Myers, a consultant psychiatrist who visited social care homes

in Bulgaria as an Amnesty International representative.

Please write appeals, using the addresses at the back of this leaflet, calling on the Bulgarian authorities to:

Take immediate steps to ensure that any method of seclusion, which should be prescribed or authorized by a doctor, supervised by medical staff and strictly limited in duration, is consistent with international standards;
Improve significantly living conditions in Oborishte social care home so that they no longer amount to inhuman and degrading treatment;
Institute standards of treatment and care appropriate for persons with mental disabilities
Ensure that Oborishte is staffed by a sufficient number of medical and non-medical personnel appropriately trained for their role;
Ensure that residents are provided with: a bed with a mattress, blankets and sheets, which are cleaned in an appropriate way and at regular intervals; basic personal hygiene items such as towels, soap, and toothbrushes; personal clothing; ready access to clean and adequate toilets and bathrooms, where they are able to shower at least once a week;
Ensure that all residents’ deaths are thoroughly and impartially investigated and results made public. If credible evidence uncovers that the death has resulted, directly or indirectly, from a criminal offence, those responsible must be brought to justice;
Initiate comprehensive monitoring of Oborishte, with the aim of bringing the home in line with international standards. If the authorities determine that Oborishte cannot be reformed to meet these standards, it should be closed permanently and residents moved to appropriate facilities.

TAKE ACTION NOW

Send your letters to:

General Prosecutor Nikola Filchev General Prosecutor Vitosha Boulevard 2 1000 Sofia, Bulgaria 49 Fax: +359 2 989 0110 Salutation: Dear General Prosecutor

Director of the National Social Welfare service Nikolai Angelov Director of the National Social Welfare service Ministry of Labour and Social Policy Triaditsa street, 2 Sofia 1051 Bulgaria	Oborishte Social Care Home For Adults with Mental Disabilities Radka Lecheva Director Oborishte Social Care Home For Adults with Mental Disabilities 9147 Oborishte Vulchi Dol Bulgaria

Minister of Labour & Social Policy

Amnesty International is a worldwide movement of people who campaign to prevent and end grave abuses of the rights to physical and mental integrity, freedom of conscience and expression, and freedom from discrimination, within the context of its work to promote respect for all human rights.

To obtain a copy of Amnesty International’s report, Bulgaria: Arbitrary detention and ill-treatment of people with mental disabilities(AI Index: EUR 15/008/2002), contact Amnesty International in your country:

[space for sections to add their address/contact details]

or contact: Amnesty International, International Secretariat, 1 Easton Street, London WC1X 0DW, United Kingdom (www.amnesty.org)

B U L G A R I A

Arbitrary detention and ill-treatment of people with mental disabilities

Radovets social care home for men

We have jails but we do not use them frequently.

A Radovets nurse discussing seclusion methods with Amnesty International

Approximately ninety men living in the Radovets social care home for adults with mental disabilities suffer cruel, inhuman and degrading conditions and treatment in violation of Bulgaria’s international human rights obligations. Authorities’ efforts to improve conditions in this institution through a renovation project fail to address serious human rights concerns.

In June 2002, when Amnesty International visited Radovets for the second time with the Bulgarian Helsinki Committee, residents found in appalling living conditions in October 2001 were in a situation worsened by renovation. A sign in front of the home indicated that the program began in November 2001 and was assisted by the United Nations Development Program.

All residents remained in the social care home during refurbishment. Thirty men, provisionally accommodated in a room, shared twenty beds. A dormitory for the most severely disabled contained eight beds for 10 men. Two beds did not have mattresses. Some residents appeared very distressed. Beds were soiled and urine and faeces were on the floor. One elderly man lay prostrate on the ground.

When complete, the project will have significantly improved certain conditions, such as sanitary facilities and living quarters. However, other aspects of the project constitute further cruel and inhuman treatment of residents.

The construction of two new seclusion rooms is particularly disturbing. Each room has a metal door and three beds. Four men occupying one room explained that they were being punished for trying to escape. The other room, holding one man, had no windows.

In June 2002, a dark space below a staircase in an unreconstructed building, where in October 2001 residents pointed out they were regularly detained for days as "punishment", was empty but contained a worn mattress, a soup bowl and a half-eaten piece of bread.

There was little evidence that care and rehabilitation programs for residents would improve as a result of the renovation program. Because resources in the municipality are very limited, a doctor recently assigned to Radovets is able to visit the home less frequently than his predecessor.

Arbitrary detention and ill-treatment of people with mental disabilities

People with mental disabilities in Bulgaria suffer systematic discrimination and lack of respect for their most basic human rights.

Conditions in social care homes for adults are often cruel, inhuman and degrading. The high numbers of deaths testify to medical neglect and a lack of food and warmth. Residents may be physically restrained with belts or straitjackets or secluded in a small room with no windows or a cage for indefinite amounts of time. Medication is widely administered, often solely to control behaviour.

Like adults, children receive practically no therapy or rehabilitation for developmental disabilities. Those with the most severe disabilities may be left all day in their beds, without toys, organized activities or visual stimulation.

After age 18, residents of homes for children are often transferred to homes for adults. Unable to challenge decisions made about their care by officials or relatives, they are institutionalized for life.

Social care homes located in areas remote from population centres cut residents off from their families and the rest of society. For persons with disabilities, being placed in remote locations, far from hospitals, can put their lives at risk.

On 10 October 2002 Amnesty International launched a campaign for improved conditions and treatment for people with mental disabilities in Bulgaria. The action seeks to strengthen public awareness that people with mental disabilities have the same human rights as other members of the community. The international community is being urged to support comprehensive reform of Bulgaria’s mental health care services.

The culture was one of simply controlling and warehousing people. The residents who had obviously been abandoned by society were left with nothing to do and nothing to hope for. They were herded together… with absolutely no purpose to their days.

Dr Mary Myers, a consultant psychiatrist who visited social care homes

in Bulgaria as an Amnesty International representative.

Please write appeals, using the addresses at the back of this leaflet, calling on the Bulgarian authorities to:

Take immediate steps to ensure that any method of seclusion, which should be prescribed or authorized by a doctor, supervised by medical staff and strictly limited in duration, is consistent with international standards;
Institute standards of treatment and care appropriate for persons with mental disabilities;
Ensure that Radovets is staffed by a sufficient number of medical and non-medical personnel appropriately trained for their role;
Until the refurbishment program is completed, ensure that residents are provided with: a bed with a mattress, blankets and sheets, which are cleaned in an appropriate way and at regular intervals; basic personal hygiene items such as towels, soap, and toothbrushes; personal clothing; ready access to clean and adequate toilet and bathrooms, where they are able to shower at least once a week;
Initiate comprehensive monitoring of Radovets, with the aim of bringing the home in line with international standards. If the authorities determine that Radovets cannot be reformed to meet these standards, it should be closed permanently and residents moved to appropriate facilities.

TAKE ACTION NOW

Send your letters to:

General Prosecutor Nikola Filchev General Prosecutor Vitosha Boulevard 2 1000 Sofia, Bulgaria Fax: +359 2 989 0110 Salutation: Dear General Prosecutor

Director of the National Social Welfare service Nikolai Angelov Director of the National Social Welfare service Ministry of Labour and Social Policy Triaditsa street, 2 Sofia 1051 Bulgaria	Radovets social care home for mentally disabled men Elena Porkova Director Radovets social care home for mentally disabled men Radovets 6087 Bulgaria

Minister of Labour & Social Policy

Amnesty International is a worldwide movement of people who campaign to prevent and end grave abuses of the rights to physical and mental integrity, freedom of conscience and expression, and freedom from discrimination, within the context of its work to promote respect for all human rights.

To obtain a copy of Amnesty International’s report, Bulgaria: Arbitrary detention and ill-treatment of people with mental disabilities(AI Index: EUR 15/008/2002), contact Amnesty International in your country:

[space for sections to add their address/contact details]

or contact: Amnesty International, International Secretariat, 1 Easton Street, London WC1X 0DW, United Kingdom (www.amnesty.org)

B U L G A R I A

Arbitrary detention and ill-treatment of people with mental disabilities

Razdol social care home for women

Some of the orderlies beat us and lock us up.

Resident of the social care home for women in Razdol, Bulgaria.

Women with mental disabilities at a social care home in Razdol endure ghastly living conditions, gross neglect and systematic abuse, Amnesty International representatives found during visits to the home in January and July 2002. The cruel, inhuman and degrading treatment of residents violates international human rights standards.

Razdol’s remote mountain location puts its inhabitants’ lives at risk. Far from the eyes of society, the home is unsuitable for long-term care for people with mental disabilities, particularly during winter months.

When snow makes roads impassable to buses and other vehicles, it can take staff three hours to walk to work. Buildings are derelict and dangerous. There is no central heating. In January, barefooted residents walked on icy paths outside their dormitories. To shower, residents walked about 25 metres, often through snow, to another building.

Between January and July 2002, seven residents died. In none of the cases was a post-mortem examination or an independent investigation carried out. In most cases, residents who died were buried below a pig sty, their graves unmarked and overgrown.

Residents have no recourse against ill-treatment by staff. In January, one woman remarked, "Some of the orderlies beat us and lock us up". Because she was afraid staff might see her, she would not reveal the location of the seclusion room. Another woman, who said that she wanted to leave the home, was also afraid staff might overhear her comments.

Bereft of rehabilitation programs or therapy for people with special needs, residents wandered aimlessly around the grounds or lay bedridden in their rooms. Walls were bare and offered no visual stimulation. Some residents complained about the absence of books or other reading materials. Most did not have personal items - even clothing or toiletries. Clothes were distributed randomly after washing, according to staff, because residents did not know the difference.