According to the EPA, Bulgaria's mental health system is falling apart leading to people falling through the net, and often even to human rights violations. People who do not have acute symptoms but have severe disorders very often loose their home and end up on the streets or in prison. FNB supports on average one such person a month and its volunteers struggle despite of their comradery, solidarity and caring approach because of the need of specific skills to motivate treatment.

Sofia, Bulgaria

PACT is a form of community-based mental health care for individuals experiencing serious mental illness that interferes with their ability to live in the community, attend appointments with professionals in clinics and hospitals, and manage mental health symptoms. This is an intensive, integrated approach to community mental health service delivery. What this means is that mental health services are provided in a community setting (rather than a more restrictive residential or hospital setting) to people experiencing serious mental illness.

Secondary goals include reducing homelessness, imprisonment, and unnecessary hospital stays. In this way, ACT offers treatment in the "real world". By training FNB volunteers we will kick off a process of introducing such an approach to Bulgaria.

According to the official statistics (2018), only the registered homeless people in Bulgaria are at least 1887. FNB is the only collective that provides systematic support. At least one person they work with a month has a severe mental health disorder. According to Sotirov and Germanov (2019), organizing daycare programs for people with severe mental illness is one of the areas for which there are not enough well-trained helping professionals in Bulgaria. This is why the establishment of daycare centers and the organization of rehabilitation programs in them represent a challenge. There is no outreach and community-based system at all - this means that a person has to go to a daycare center which they usually do not want. People prefer support within friendly and non-hierarchical spaces

The project will comprise:
0. Coordination and administration by the Orion Grid.
1. Preparatory stage: desk review of relevant policies and gaps, mapping stakeholders, and identifying contact people.
2. One-week site visit by a delegation of FNB, Orion Grid and other stakeholders to Madison, USA to explore and observe the PACT everyday practice and to compare the contexts.
3. Two-week visit of two PACT trainers, including site visits of Bulgarian services, meetings with officials responsible for the mental health reform and a five-day training of FNB volunteers.
4. Follow up networking by the Orion Grid team as well as availability of staff for emergencies.
5. On-line bi-weekly supervision (care for the carers) by the PACT trainers to support the FNB volunteers and to prevent drift.
6. Round Table on introducing community services to Bulgaria as a part of the mental health reform, reporting on the pilot - including testimonials of beneficiaries, volunteers, and other stakeholders.
7. Final analytic report and policy briefings (in addition to those required by the funder).

1. Report on policies and gaps at the intersection of homelessness and mental illness.
2. Exploration of PACT in Madison.
3. Networking, promotion, and lobbying in Bulgaria for the introduction of a community outreach evidence-based approach.
4. Trained 20 FNB volunteers to pilot the program and to provide a core team for rolling out and scaling up in follow-up projects.
5. Supported app. 20 mentally ill people with a severe disorder/substance abuse.
6. Analytical report and 5 policymakers and practitioners' briefs.
7. Round Table with 40 practitioners and policymakers designed as a 5-day future search conference.

One reason why citizens do not engage with homelessness nor with severe mental health issues is simply that they don't know how. By providing volunteers with thorough training and ongoing support will open new avenues for their understanding of managing vulnerability, containing anxiety and healing traumas. In addition, we will ensure that the voices of homeless people and mentally ill people are heard and their perspectives and realities understood better by engaging them at every step and in all decisions to be made.

The project is held together by Milena (Orion Grid) and the Orion Grid contact person in the USA, Jonathan. They both have a long experience and partnership in developing community-based programs, especially the FAST Program (ranked no11 by the UN among the family skills programs). The PACT team comprises Derek and Christine who are not only experienced practitioners and trainers but know Eastern Europe and the post-Soviet systems very well. Galina, Myles and Ivan from FNB are key organizers of the collective who will ensure the non-hierarchical participation of volunteers and end beneficiaries based on their long experience.

Travel and accommodation: 11 000
PACT trainers' fees: 7 000
Orion Grid coordination and facilitation fees: 7 000
FNB expenses: 7 000
Round Table: 1000
Publications: 2000

We welcome all sorts of feedback, as well as requests for partnership from other countries with a similar challenge who may be interested to strengthen together our lobbying for community-based programs, and also if they are interested in the PACT model in particular.