1. Progress and challenges in mental health reforms: a governmental view H. Hinkov, National center for public health, Sofia, Bulgaria

2. General background Reforms in the health care sector - NHIF -Privatization and corporatization -Leading philosophy of the reform -Implications on the mental health care

3. Legacy from the past and reasons for change

4. General population

5. Birth rate, death rate, natural grouth

6. Age of the population

7. Mental health financing State Municipal budget NHIFprivate Psych.hospitals dispensaries Group & individual practices Group & individual practices

8. Number of mental health facilities 1. Psychiatric hospitals 11 2. Dispensaries12 3. Psychiatric wards in general hospitals 15

9. Number of beds 1. Psychiatric hospitals 3075 2. Dispensaries 1566 3. Psychiatric wards1199

10. Number of patients per year (2001) 1. Psych hospitals 11653 2. Dispensaries 14607 3. Psychiatric wards 10549

11. Length of stay (days) Psych. hospitals 71 Dispensaries 30.9 Psychiatric wards 33.6

12. Number of psychiatrists Psychiatrists (2000) 750 Psychiatrists (2001) 646

13. Doctors/nurses ratio

14. Lack of information

15. Psych. hospital hospital Nursing home patient Outpatient service (Dispensary) community Individualpractice

16. Amnesty international reports

17. The governmental answer to chalenges

18. National mental health program

19. Stability pact mental health project

20. Mental health policy and action plan

21. PHARE project

22. 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

23. 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

24. New pharmaceutical products available

25. Role of the NGO’s

26. Professionals’ involvement

27. Public attitude

28. Conclusion