As of September 2009, GIP-Sofia got involved in a very innovative for Bulgarian context initiative, named the Missing Link increasing social inclusion by engaging Experts by Experience. The project has been developed on the premise that a person with experience of social exclusion can use that experience to understand and support others with similar difficulties. Often the social and health policies and interventions are just defined by scientists, politicians and professional workers who don´t have any lived experience in social exclusion. In light of this, the role of Experts by Training (professionals) is complementary to that of Experts by Experience (EE).

Courses and training programs for EEs already exist in various countries. For example, there is the program of De Link in Belgium, de TOED in the Netherlands, the EX-IN program in Germany. Since March 2003 the methodology of the Trained Experts by Experience has been recognised by the Flemish government in a decree regarding the struggle against poverty.  The training is accredited and embedded in the regular educational system of Flanders.

The EE concept is a pristine area in Bulgarian practice, particularly pertaining to severe mental illness. For a number of decades most psychiatrists and other mental health professionals have fostered the idea of their own omnipotence and omniscience. The capacity of the client has been completely underestimated. In the field of mental health, attitudes of the experts by training (ET) have undergone significant change over the last 5-6 years. They gradually opened up to the idea that the users of services should be treated as equal partners in the process of their own treatment and recovery. Some of the professionals, though very few, went even further in innovation – admitting their lack of knowledge on some highly specific aspects of the condition of mentally ill patients – such as hearing voices and effects of medication. To date, there are some individual initiatives but no coherent and systematic routine in the direction of involving EEs. This approach can take precedence and be widely accepted in practice through developing educational courses: first, for training mental health users as EEs and then, for training EEs and ETs to work as a tandem. Systematised training of trainers courses on the EE concept are still missing in Bulgaria.  

That is why GIP-Sofia decided to fist start with an empowerment course for users of mental health services. To that purpose, a team of professionals from the Complex for community-based mental health services in Sofia, developed a 92-hour 5-module training, which was conducted in the period 1 October – 10 November 2010. A total of 21 persons with mental health problems, who were not clients of the Complex, completed the educational course and received certificates. The training comprised five major topics: Human Rights in Mental Health Practices; Work and Career; Disease and Symptoms, My personal Story, Work in groups. In consonance with the EE concept, some of the trainees participated as co-trainers in the modules and a person with mental illness was invited as a guest lector in one of the classes.

A significant product of the training was the so-called portfolio, which each participant compiled for himself/herself. A portfolio is a collection of facts with which you indicate what you know and what your capacities are, what you find important and what you like to do. It also includes what approach you prefer, what you would like to learn and what developments have already taken place.  

The World Health Organisation (WHO) has encouraged the participation of EEs both as individuals and through user organizations as an important part of the reform process. Ministerial conference stated that the participation of EEs improves the quality of services and care provided.  They should also be actively involved in the development and delivery of education, to give professionals a better understanding of their needs (European Ministerial Conference in 2005, WHO).  

On European level in 1995 all leaders of government acknowledged that poverty/ mental illness is not an individually based problem, but a created social phenomenon of social exclusion. In 2000 in Geneva there was a World Summit on social cohesion in support of the idea that socially excluded people should be involved in all policy decisions on the micro, meso and macro level.  

The funding of the Missing link project by the European Union is a clear demonstration of a commitment to developments that take the above commitment further; to develop roles for Experts by Experience as service providers, and to develop an education that is not just user to professional, but also user to user.

By Anelia Zaharieva