Background: The Bulgarian Ministry of Health invited the European Psychiatric Association (EPA) to evaluate Bulgarian mental health care service provision in 2018. Bulgarian mental health services face very significant challenges including a legacy of historic underfunding, internal conflicts, poor planning, and the emigration of very high numbers of younger skilled staff that had followed accession to the European Union. There were significant disputes between stakeholders regarding the way forward and had been at least two unsuccessful previous external agency interventions that had attempted to find solutions. Method: This EPA position paper describes in detail the EPA mission to Bulgaria including methodology, findings, recommendations, and finally the positive actions and changes that are now underway as a result of the EPA report and intervention aimed at contributing towards improving Bulgarian mental health services. Results: After meetings with multiple stakeholders in the Bulgarian mental health system and analysis of data on service delivery, workforce, funding and configuration the EPA Panel agreed a list of twenty recommendations for change. Conclusions: The EPA mission, with the collaboration of multiple stakeholders in Bulgaria, was successful in stimulating high level government action to improve mental health services. Despite longstanding differences, it was possible to involve the stakeholders in constructive dialogue. The importance of “speaking with one voice” was a key lesson learned.

中文翻译：

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精神卫生保健的转变：欧洲精神病学协会对保加利亚改革的贡献


背景：保加利亚卫生部邀请欧洲精神病学协会（EPA）在 2018 年评估保加利亚精神卫生保健服务的提供情况。保加利亚精神卫生服务面临着非常重大的挑战，包括历史上资金不足、内部冲突、规划不善和移民等遗留问题加入欧盟后，有大量年轻技术人员。利益相关者之间对于前进的方向存在重大争议，并且之前至少两次试图寻找解决方案的外部机构干预均未成功。方法：这份 EPA 立场文件详细描述了 EPA 派往保加利亚的任务，包括方法、调查结果、建议，最后是由于 EPA 报告和旨在促进改善保加利亚心理健康服务的干预措施而正在采取的积极行动和变化。结果：在与保加利亚精神卫生系统的多个利益相关者会面并分析有关服务提供、劳动力、资金和配置的数据后，EPA 小组商定了 20 项变革建议的清单。结论：美国环保局的使命在保加利亚多个利益相关者的合作下，成功地刺激了政府高层采取行动，改善精神卫生服务。尽管存在长期分歧，但利益相关者仍可以参与建设性对话。 “用一个声音说话”的重要性是一个重要的教训。