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
Birth rate, death rate, natural grouth
Age of the population
Mental health financing State Municipal budget NHIFprivate Psych.hospitals dispensaries Group & individual practices Group & individual practices
Number of mental health facilities 1. Psychiatric hospitals Dispensaries12 3. Psychiatric wards in general hospitals 15
Number of beds 1. Psychiatric hospitals Dispensaries Psychiatric wards1199
Number of patients per year (2001) 1. Psych hospitals Dispensaries Psychiatric wards 10549
Length of stay (days) Psych. hospitals 71 Dispensaries 30.9 Psychiatric wards 33.6
Number of psychiatrists Psychiatrists (2000) 750 Psychiatrists (2001) 646
Doctors/nurses ratio
Lack of information
Psych. hospital hospital Nursing home patient Outpatient service (Dispensary) community Individualpractice
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