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Progress and challenges in mental health reforms: a
governmental view
H. Hinkov, National center for public health, Sofia, Bulgaria
General background
• Reforms in the health care sector
- NHIF
- Privatization and corporatization
- Leading philosophy of the reform
- Implications on the mental health care
Legacy from the past and reasons for change
General population
75000007600000770000078000007900000800000081000008200000830000084000008500000
1992 2002
Birth rate, death rate, natural grouth
-10
-5
0
5
10
15
20
1970 1985 2000 2001 2002
birth ratedeath ratenatural growth
Age of the population
3636.5
3737.5
3838.5
3939.5
4040.5
1990 2001
Mental health financing
State Municipal budget NHIF private
Psych.hospitals dispensariesGroup &
individual practices
Group &individual practices
Number of mental health facilities
0
2
4
6
8
10
12
14
16
1 2 3
1. Psychiatric hospitals 11
2. Dispensaries 12
3. Psychiatric wards in
general hospitals 15
Number of beds
0
500
1000
1500
2000
2500
3000
3500
1 2 3
1. Psychiatric hospitals 3075
2. Dispensaries 1566
3. Psychiatric wards 1199
Number of patients per year(2001)
0
2000
4000
6000
8000
10000
12000
14000
16000
1 2 3
1. Psych hospitals 11653
2. Dispensaries 14607
3. Psychiatric wards 10549
Length of stay (days)
0
10
20
30
40
50
60
70
80
1 2 3
Psych. hospitals Psych. hospitals 7171
Dispensaries Dispensaries 30.930.9
Psychiatric wards Psychiatric wards 33.633.6
Number of psychiatrists
• Psychiatrists (2000) 750
• Psychiatrists (2001) 646
580
600
620
640
660
680
700
720
740
760
2000 2001
Doctors/nurses ratio
0.9
0.95
1
1.05
1.1
1.15
2000 2001
Lack of information
Psych.Psych. hospitalhospital Nursing homeNursing home
patientpatient
Outpatient serviceOutpatient service(Dispensary)(Dispensary)
communitycommunity
Individual Individual practicepractice
Amnesty international reports
The governmental answer to chalenges
National mental health program
Stability pact mental health project
Mental health policy and action plan
PHARE project
Changes in the legislation
1. Act for social assistance
2. Mental health chapter in the Act for health
3. More than 50 regulations to be elaborated
The current situation
1. Outpatient services private
2. Contracts with NHIF
3. Increased number of outpatient psychiatrists
4. Decreased number of beds
5. Changes in the structure of the hospitalized patients
New pharmaceutical products available
Role of the NGO’s
Professionals’ involvement
Public attitude
Conclusion
Recommended