Unlikely Allies in Bulgaria Reveal Fatal Mental Health Neglect

Unlikely Allies in Bulgaria Reveal Fatal Mental Health Neglect

SOFIA — An unusual investigation that brought together prosecutors and human rights lawyers has revealed a grisly picture of neglect at Bulgarian state homes for mentally disabled children: 238 deaths since 2000.

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.


(image: Yana Buhrer Tavanier)

While experts are shocked by the high death rates — the current number of residents in such institutions is 1,296 — the cases appear much like those in similar state care institutions across Eastern Europe since Communism imploded 20 years ago.

But the investigation is different in that the abuses were uncovered by an unusual team: prosecutors working alongside human rights lawyers from the Bulgarian Helsinki Committee, an international human rights organization based in Sofia. The effort represents a strategic break from the familiar pattern of advocates’ naming and shaming governments for appalling standards of care for their societies’ most vulnerable citizens.

Evidence was collected to identify those guilty of crimes and build legal cases to send them to prison.

“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.”

Last month, the Bulgarian prosecutor general announced criminal investigations into 166 of the deaths and 30 more cases of abuse of children still living in the homes. More than 80 percent of the deaths in the homes were not reported to authorities — as required by law — and the bodies were buried without autopsies.

Several legal experts working in the region said they could recall no case of anyone ever going to jail for crimes in state institutions for the mentally disabled.

“It’s allowed to happen because these people don’t count as people,” said Judith Klein, director of the Open Society Mental Heath Initiative in Budapest. “If they did, it would be outrageous and unheard of.”

The Bulgarian prosecutor general, Boris Velchev, said at a news conference where the report was issued last month that his ambition was not to solve the problem but to bring to justice those responsible for the crimes and to exercise prevention.

Advocates say the collaboration represents a new and potentially powerful approach to an old problem. But there is still widespread skepticism about whether any cases will reach court.

“It’s a strategy not without risk,” said Oliver Lewis, executive director of the Mental Disability Advocacy Center, a nongovernmental organization in Budapest that finances part of the work of the Bulgarian Helsinki Committee.

Whether it could work in other countries depends on the independence of the prosecutor, he said.

“The benefits are that the prosecutors have access which the nongovernmental organizations don’t have, while the NGOs have expertise which the prosecutors don’t,” Mr. Lewis said in a telephone interview. “In this context, it works and really is innovative. We have learned a lot of things that we wouldn’t know otherwise about the quantity of mistreatment and the neglect of children.”

The collaboration follows 10 years of conflict between the prosecutor’s office and human rights advocates who have regularly sued the state for failing to protect a wide range of human rights. The current prosecutor general was facing a discrimination lawsuit brought by the Bulgarian Helsinki Committee for not trying crimes committed against the mentally disabled when he decided to change tactics.

The deputy prosecutor general, Galina Toneva, said in an interview, “We as a society have to work together in the same direction and to help each other instead of confronting each other.”

Asked whether opening the investigations was simply a public relations move on the part of the prosecutor, Ms. Toneva pointed out that the Bulgarian Helsinki Committee was participating alongside prosecutors in the criminal investigations. Lawyers from the group have also been appointed as special legal representatives for the living children should the abuse cases reach a courtroom.

“It’s a guarantee that the prosecutor won’t do anything secret,” Ms. Toneva said.

Researchers say the culprit is the entire system. They say popular explanations about the causes of the high death rates are myths created to deflect blame from politicians: the severity of the children’s mental disabilities or malicious caregivers are commonly mentioned.

According to Slavka Kukova, a human rights researcher who took part in some of the inspections, few of the workers in Bulgarian state homes receive training in providing the care that the children need. And there has never been oversight.

“These village caregivers have been doing their jobs in the same way for 20 years,” Ms. Kukova said. “No one in the system has ever cared whether they do it in the right way or not.”

At the Ministry of Labor and Social Policy, which oversees the state homes, Deputy Minister Valentina Simeonova said that the system had failed and that everyone was responsible.

“The government policy toward these children has been criminal,” Ms. Simeonova said in an interview in her office in the Stalin-era ministry building. She added that she supported criminal prosecutions of officials “at the highest levels.”

“There has been no improvement in the quality of care for these children all these years,” she said. “There has only been improvement in the conditions of the facilities.”

The timing of the findings and criminal investigations coincides with the government’s plan to close all state institutions for children within 15 years. Human rights campaigners have pushed for years to shut the institutions and place the children in community-based homes with individual care.

While nongovernmental organizations are working with the government and support the plan, there is broad skepticism about how much will be carried out how soon. Ms. Simeonova notes that the first stage — closing all homes for children with mental disabilities within three years — has funding, personnel and a deadline.

The financing comes from two European Union funds: €20 million, or about $27 million, to build facilities and €23 million for training the caregivers.

The Communist-era state built homes deep in the countryside for the mentally ill to keep them far from public view. Nadya Shabani, head of the state child protection agency, said society also bore responsibility for rejecting people with mental disabilities. “For 50 years, these children have been intentionally hidden from us,” she said. “We have to change our attitudes as well.”

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