written by Ivo I. Natsov, Evgeni U. Haritov in September 2018

Ivo Natsov


A National Programme for Mental Health Reform, a Public Health Act concerning the mental health in its fourth part, a National Framework Agreement, determining the status of the psychiatrists in the outpatient  and  hospital  care,  as  well  as  a  Medical  standard  “Psychiatry”[1,2,3],standardizing  the activities of the specialists within the mental-health discourse exist for several years now in Bulgaria. In   general,  tthey  created   real  prerequisites  for  addressing  the  psychiatric  prevalence   in   the community.  These  fundamental  documents  and  the  related  regulations  failed  to  resolve  important problems in the field of mental-health services for the population, but generated more of them.

The psychiatric iceberg in Bulgaria

Beneath the visible part of the regulatory framework remain real organizational and ethical problems:

1.        Discrimination of patients by the indication “mental problem”[4].

•          The patients of the General Hospitals do not have the same level of access to a psychiatrist- consultant, which access they have to the rest of the medical specialists.

•          In the General Hospitals the quality of the medical care for patients with mental problems is not the same to the one provided for patients with somatic diseases.

•          In the General Hospitals the quality of the provided medical care is not the same regardless of age

2.        The public psychiatric hospitals are not able to provide timely consultative assistance on the occasion of accompanying somatic problems[5].

•          The  public  psychiatric  hospitals  function  in  a  risky  situation  when  admitting  an  emergency patient, due to the difficulties they have when carrying out urgent laboratory tests of basic vital signs.

3.        Discrimination of Psychiatry by the indication “profession”[4].

•        The Consultation Psychiatry is excluded from the financing under the Clinical pathways;

•          There  is  an  inequality  in  the  financing  of  the  different  types  of  stationary  psychiatric  care; “budgetary” in the public psychiatric hospitals and “per treated patient” in the mental-health centres and in the small number of psychiatric wards of the general hospitals. This creates a situation, where the budgetary services have no motivation to treat more patients, that cost nothing, and the mental health centres and the hospital wards earn a subsidy from the Ministry of Health in the form of “bed turnover”/ for example 7 days instead of 20/, which is ridiculous in Psychiatry[6].

The result is the marginalization of Psychiatry apart from the other domains of the medicine and the public health.


The creation of  a working group in Psychfsomatic Medicine, Consultation – Liaison Psychiatry and Integrative Care was undertaken on 22.04.2017, in hall “ Georgi Koychev” of Urban Dispensary for mental illnesses “Nikola Shipkovenski” in Sofia under the initiative of Dr Ivo Natsov, discussed /during his lifetime/ with assoc. prof. Georgi Koychev, Dr N. Markov,  prof. L. Hranov, prof. P. Marinov, prof. R. Shishkov, supported by prof. G. Onchev, prof. Dr. Stojanov whose main objectives are:

•          To continue the traditions of the Bulgarian Psychosomatic Society, founded by prof. Vl. Ivanov and managed by prof. Ts. Tsonev.

•          To  promote  and  integrate  the  psychosomatic  /biopsychosocial/  approach  toward  health  and disease.

•          To  promote  the  treatment  and  the  care  in  General  Hospitals,  Specialized  Hospitals  , Diagnostic  and  Consultation  Centres,  Medical  Centres,  General  practices  and  other  outpatient structures for patients with psychiatric disorders and psychological problems, who suffer or not from bodily disorders.

•          To stimulate and support research in the areas of the Psychosomatic Medicine.

•          To  be  a  forum  for  presentation,  spreading  and  discussion  of  the  scientific  problems  and achievements in the Psychosomatic Medicine.

•          To  stimulate  the  fellowship  relations  among  the  participants  in  this  process  and  create conditions for mutual support.

•          To be a meeting place for all specialists related to the medical profession, including students, graduates and young researchers.

•          To advice the public administration about the problems of the Psychosomatic Medicine.

•          To connect the Bulgarian Psychosomatic Medicine with the good theories and practices of the


European and World Psychosomatic Medicine.


•          Organization  of  scientific  meetings,  promotion  of  discussions  and  creation  of  a  network  of adherents.

•          Organization of research projects.

•          Promotion and maintenance of permanent contacts with other professional groups.

•          Development of practical and training guides:

Training  in  “Consultation  and  Liaison  Psychiatry”  is  stated  in  the    programmes    of  all  medical universities with slight differences. The training period extends from 2 months to 0 months, without rotation. Some universities offer training only in the form of seminars. The notion “Consultation and Liaison Psychiatry” finds its /humble/ place in the Medical standard “Psychiatry”, the “National Action Plan  for  the  Implementation  of  the  Mental  Health  Policy  in  Republic  of  Bulgaria  2004-2012.  A suggestion for  the  introduction  of  standardised  training in  Consultation and Liaison  Psychiatry and Psychosomatic Medicine in Bulgaria, that complies with the fundamental European practices and that is adapted to them, was published in the Bulgarian Journal of Psychiatry[7]. This document is the first attempt to discuss a  similar  training programme, because  of  to the lack  of  such,  due to the acute need  for  adaptation  of  the  psychiatric  profession  to  the  changed  social-economic  conditions  of  its functioning in Bulgaria.


The  slow  reform  in  the  Bulgarian  healthcare  system,  the  conceptual  lack  of  distinctness  and  the wrongfully  set  goals  led  to  a  healthcare  policy,  administrative  and  professional  segregation  of Psychiatry. That is why we believe, that it is very important for the Bulgarian Psychiatry to express itself through its consultation and liaison functions in times of systemic marginalization of Psychiatry and  super-economizing  of  the  medical  thinking,  and  to  claim  valuation  of  these  functions.  The Ministry of Health must not only finance the psychiatric services by law, but also to create a body, which  has  to  govern  this  process  and  coordinate  the  implementation  of  the  declared  healthcare policies.


1.  National Action Plan for the Implementation of the Mental Health Policy in Republic of Bulgaria


2.  Bulgarian National Health Strategy 2014-2020

3.  Bulgarian National Mental Health Program 2017-2023

4.  Natsov  I.,  Consultation  psychiatry  and  its  indirect  discrimination  by  sign  of  “profession“.

Bulgarian Journal of Psychiatry.2017, Vol 2(1) :85 – 88

5.  Natsov  I.,Consulting  patients   in   general   hospital   and   emergency  units   by  a   specialist psychiatrist.  Main  components  of  the  activities  and  functions  of  the  consultation  –  liaison psychiatry. Bulgarian Journal of Psychiatry.2016, Vol 1(4): 361-364.

6.  Natsov  I.,Velikova  S.,  The  role  of  the  nurse  in  consultation-liaison  psychiatry.  Bulgarian

Journal of Psychiatry.2016, Vol 1(4):365-368.

7.  Natsov I., Training in Consultation-liaison Psychiatry and Psychosomatic Medicine-a proposal.

Bulgarian Journal of Psychiatry. 2016, Vol 1(3):271-276.

Adresses for correspondence:

1. College of Private Psychiatrists in Bulgaria-Sofia;

2. Department of Pharmacolgy and Toxicology,MU-Sofia;



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