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What Was the Access to Health Care for People With Mental Illness in the First Months of the COVID-19 Epidemic

11 August 2020

The COVID-19 pandemic and the imposed because of it state of emergency, and subsequently the state of emergency epidemic situation, have shaken public relations in almost every part of ​​our lives. Anti-epidemic measures have been the subject of many analyzes in terms of legality and legitimacy and their effect on our daily lives and the economy. Despite the active work on many topics, there seem to be some that did not receive enough attention. One such aspect is analyzed by attorney Marieta Dimitrova in her article "ACCESS TO HEALTH CARE for people with mental illness in the context of the COVID-19 epidemic." It examines the effect of the state of emergency and the anti-epidemic measures, which were introduced by orders of the Minister of Health, on access to health care for a particularly vulnerable group of the population - people with mental illness.

In the article by attorney Dimitrova emphasizes that the imposed anti-epidemic measures, and in particular - the social distancing, affect different groups of people in different ways. This leads to the situation that “the ignorance and neglect by the authorities involved in the management of the COVID-19 crisis of this differentiated impact not only does not help to prevent the further spread of the virus, but also strengthens the existing inequalities in society with regard to health as regards people with mental illness."

According to a study by Dr. Ivo Natsov cited in the article, “people with mental illness are significantly more affected in their emotional responses due to their higher sensitivity to stress and lower degree of adaptability compared to the general population (11% against 38% “in favor” of psychiatric patients)." Despite of that in the months of the state of emergency, two pre-existing problems faced by people with mental illness have worsened - organizational barriers in the mental health care system and the challenges of treating somatic illnesses of people with mental illness.

The limited access of mentally ill people to the treatment of their somatic diseases atty. Dimitrova links to the growing stigma towards people with mental illness caused by the fear of the Coronavirus and the fears of medical staff that a patient infected with COVID-19 could be admitted for treatment in a hospital. To the extent that the pandemic has created the preconditions for restricting certain rights of citizens in order to protect the right to life and the public health (Article 2 of the ECHR), the restrictive measures taken must meet two criteria - to be necessary in a democratic society and as such – proportionate to the pursued legitimate aim. Atty. Dimitrova, however, notes that the emergency legislation does not specify what types of measures can be taken, there are no requirements for deadlines and periodic reviews of the meassures, as well as standards of necessity and proportionality. These shortcomings created preconditions for a free interpretation of the term "anti-epidemic measures" and made it possible for certain administrative bodies and medical institutions to supplement with internal orders the anti-epidemic measures imposed in the country, as well as to change their content.

The same problem was observed with regard to the right of people with mental disorders to have access to treatment for their mental illness (outpatient and inpatient treatment). During the state of emergency, the voluntary admission of persons with mental illness was restricted in several psychiatric hospitals and one university hospital, with only admission of patients based on court decisions (compulsory and involuntary placement) being permitted. These restrictions were imposed by orders of the heads of the respective medical institutions. In the article by attorney Dimitrova analyzes one of these orders - Order No. RD / 19.03.2020 of the Director of the State Psychiatric Hospital - Lovech, which according to the conclusions thrown in the article was not issued on the basis of a valid legal basis. Furthermore, it is established that according to the information provided by the Ministry of Health no methodological guidelines, recommendations, guidelines, instructions and other acts in connection with the COVID-19 crisis were issued addressing separately the directors of the 12 state psychiatric hospitals.

Thus, it turns out that the right of access to health care of people with mental illness has been grossly violated by illegal orders of directors of medical institutions, and the supervisory authorities have not intervened in time.


In conclusion, atty. Dimitrova draws the following conclusions:

  • in a democratic society, restricting access to healthcare for patients, including the mentally ill, in pursue of the legitimate aim to reduce the pressure on the health system or to provide medical services to a wider range of people with COVID-19 , cannot be justified as necessary because it affects the right to life and access of these people to medical services;
  • the achievement of proportionality of the measures could have been achieved by establishing a protocol for persons with mental illness to further guarantee the right of access to medical care;
  • the existing measures were motivated more by the fear that medical facilities would become clusters of COVID-19 infection without taking into account the real rights and needs of patients, and in this sense the restrictions were not proportionate to the pursued legitimate aim.

Download the article here (in Bulgarian).

The photos are part of the I Decide=I am exhibition, illustrations by Nadezhda Georgieva-Nad and texts by Yana Buhrer Tavanie.