People with mental health problems are among the most vulnerable groups of society. They have the lowest rate of employment in comparison to any other group of people with disabilities; they have a limited number of friends and social contacts; their family relations have often been disrupted and in most cases they do not take part in any social or educational activities. Mentally disturbed persons do not structure their leisure time and tend to spend their days in isolation and solitude. This isolation is very explicit in moments of psychiatric crisis. Many people, who have suffered critical psychiatric conditions, share that they have experienced difficulty getting efficient and timely help due to lack of information on their illness and treatment and the possibilities of providing adequate help in the event of crisis, particularly when the person is out of the place where s/he lives or works. When having a relapse, a lot of users find it impossible to organise appropriate care for themselves. In these moments they are in dire need of support from their relatives, friends, people whom they trust, people who are aware of the peculiarities of their condition and know what is best for them when they suffer a crisis. A crisis card is crucial in such cases because it provides contact information of the “trusted” people, information about the illness and the hitherto treatment and about the so-called “crisis plan”, i.e. what should be done when the person suffers psychiatric crisis. If persons with mental health problems do not receive support from their relatives or friends, it is highly possible that they lose interest, courage and determination to fight against the disease. A crisis card is a document which aims to help people in a critical psychiatric condition alluding to their previous experience. The essence of the crisis card reflects the arrangements which have been made in advance with them - when they were in a stable condition. The introduction of the crisis card will guarantee that in case of hospitalisation due to psychiatric crisis, not only will the treatment and rehabilitation be accordant with the patient’s volition but the social environment of the person in crisis will keep on functioning so as to provide him/her support in the recovery process.
MAIN OBJECTIVES: 1) Reduction of discriminative practices towards persons with mental disabilities through changing the existing negative attitudes of medical specialists and police authorities; raising the competence of the professionals and introduction of an innovative practice aimed to improve the quality of psychosocial rehabilitation and community-based care 2) Improving the quality of life of people with mental health problems through creating conditions for overcoming the negative consequences resulting from a psychiatric crisis SPECIFIC OBJECTIVES: 1) Reducing the gravity of the psychotic episodes at the onset of a psychiatric crisis 2) Building the capacity of medical professionals and police authorities with view to their work with people in a psychiatric crisis 3) Limiting the extent of possible abuse and violation of human rights of people with mental health problems 4) Harmonising the efforts of institutions related to mental health through attracting specialists of various fields in the process of introducing the crisis card and improving their communication in the direction of effecting mental health reform in Bulgaria
Description of the crisis card practice: the crisis card (CC) is issued by an independent organisation and the process of introducing this mechanism into practice encompasses a number of significant moments: 1) preliminary involvement of institutions related to persons with mental health problems experiencing crisis by way of inviting them to participate in a support group, ensuring inter-institutional support by concluding contracts and signing an agreement for recognition and introduction into practice of crisis cards for users of mental health services; 2) training of professionals providing services to people with mental health problems in crisis (police officers, specialists working in the regional dispensaries for mental health, centres for emergency medical help, social assistance directorates, etc.), training of the consultants who are going to prepare the crisis cards; 3) production of crisis cards, starting by advertising the product among the so-called end-users through conducting preparatory meetings with them and dissemination of informational materials, succeeded by three meetings (usually) when the information which should be included in the CC is defined and clarified. The information gathered is consulted and developed also in the course of meetings with family doctors and psychiatrists, with case managers and a trusted person. Then the CC is issued it comprises two parts – a CC with the size of an ID card, which stays with the mental health user (who carries it with themselves all the time) and a crisis plan, containing detailed information on what should be done or avoided during crises. The latter stays with the trusted party. A CC enables its holders to predetermine what would happen to them during crises by previously organising their personal resources and the ones of their environment with view to coping with the affliction of the psychotic episode.
Created mechanism of empowering people with mental health problems with regard to their treatment when a psychiatric crisis occurs through introducing the crisis card (CC) concept; 102 professionals delivering services for persons with mental health problems have been trained to develop their skills in dealing with crisis in a humane and non-discriminatory way; setting up a procedure for institutional interaction with regard to people suffering a psychiatric crisis, which respects their right to participate in the process of their own treatment; a total of 205 crisis cards have been issued and 1197 consultations with mentally disturbed individuals, general practitioners, psychiatrists, case managers and trusted persons have been carried out; as a result of the active work with media and the establishment of fruitful cooperation with reporters, more than 30 journalistic materials related to the project have been be produced; a brochure (with a circulation of 2000 copies) was produced and disseminated; a reader (500 copies) and a manual „Crisis Card for Users of Mental Health services” (700 copies) have been published and circulated
Contact information
Elitsa Petrova, project coordinator
66 Ivan Mihailov Str.; Blagoevgrad 2700, Bulgaria
Tel.: ++359 73 83 59 21
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