Bulgaria has undergone a number of very significant political and social changes over the past 150 years that has also impacted on the delivery of mental health care. There has been a 40% reduction in the number of inpatient psychiatric beds in Bulgaria within the past 20 years leading to the current state of approximately European average bed numbers per 100 000 population. This does not appear to have been accompanied by an increased investment in ambulatory / outpatient mental health services.

Description of the advantages and disadvantages of mental health services in Bulgaria, available staff and distribution in the country. The project RECOVER-E and its activities in Bulgaria are described.

Sources of health statistics of Bulgaria are used and analyzed. Maps and tables were used for visualization.

Taking into account the situation described in this way and the EPA guidelines for change in the system, a mental health strategy has been proposed.

It has a long and significant legacy of underfunding of mental health services, which has undoubtedly caused significant economic damage to Bulgaria through surmountable results increasing health and social care costs, and surmountable loss of economic productivity. A significant increase in the budget allocated to mental health and related social care services.

No significant relationships.

Suicidality is still an understudied problem in Bulgaria especially on a subnational (regional) level.

To collect data on suicidality in two major regions of Bulgaria with a population over 250,000 each (Plovdiv and Pleven) for a six years period (2009–2015).

To analyze demographic, health-related and other characteristics associated with suicidal behavior as well as motives and methods of suicide.

Data were extracted from relevant documentation (medical records, public health reports, etc.) and statistically processed upon collection.

Majority of suicide victims were males between 45 and 64 years while most suicide attempts occurred among 18–29 years old females.

Leading method of suicide was hanging, followed by jumping from high places and use of firearm.

Prevailing suicidal motives were psychotic symptoms, serious somatic illnesses and family problems. Depression accounted for 25% of all suicide cases and in another 25% motivation could not be identified because of insufficient data.

The proportion of unemployed among suicide committers was not significantly higher than that of employed and retired.

Severe mental disorders are a major trigger of suicidal behavior.

Personal relationships should be targeted by suicide prevention interventions.

Somatic illnesses are increasingly important suicide risk factor driven by the ongoing process of population aging.

Frontline healthcare professionals should be trained to explore underlying suicidal motives and actively probe for depression in each case of suicidal behavior.

Unemployment related suicide risk is most likely mediated through an adaptation crisis mechanism induced by the abrupt change of social status.

The authors have not supplied their declaration of competing interest.