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Astra Forum Foundation organized a webinar for professional burnout. The participators were Assistant professor Mihail Okoliyski, an expert in mental health and ambassador of the World Health Organization in Bulgaria, and Inna Braneva, who is a member of the Bulgarian Association for Psychotherapy. Braneva is leading one of the therapy groups for medical workers, organized by Astra Forum Foundation.

The webinar about mental health for medical workers was held on 15.02.2023 and over 340 people participated in it, with the following percentage distribution: 60% were medical staff, 30% students from different Medical universities and 10% mental health specialists.


The people who suffer from burnout most often are doctors, psychotherapists, teachers, police officers, social workers and other so-called “helping” professions. This syndrome can also be observed strongly in professions that require high results.

Certainly, there is no such thing as perfect mental health, but there must be an aspiration for achieving optimal levels. Optimal mental health is a vital factor for better physical health as well. Mental health is the foundation, on which feelings of happiness and general well-being are developed. These feelings are important, subjective markers for evaluating the general well-being of society.


That is precisely the reason why Astra Forum Foundation organizes psychotherapy groups, aimed at medical workers (doctors and nurses included). Momchil Baev, MD, founder and chairman of Astra Forum Foundation, strongly believes in the initiative, considering that mental health for medical workers is an important part of public health and the health of the patients.

Anyone, who works in the field of healthcare, lives in Sofia and wants to join in therapy groups for prevention of “burnout”, can apply for membership. Two days out of every month, psychotherapists will lead a therapy group, aimed at the well-being mental health of the people who work in the healthcare system. The therapy sessions can be joined by up to 20 people, who will be split in two groups. There are no age restrictions for the participants.

This is the model of operation for the two organized groups:

Group 1 – Meets on Friday, twice a month. The duration is 2 hours (18:00 – 20:00). The location is near the Parliament, the sessions will be led by Teodora Milotinova (Member of the Bulgarian Association for Psychotherapy).

Group 2 – Meets on Tuesday, twice a month. The duration is 2 hours (18:15 – 20:15). The location is near Sofia University, the sessions will be led by Inna Braneva (Member of the Bulgarian Association for Psychotherapy).

In order to join the groups, you can send an email with information (name, phone number, which group you would like to join) to

Both groups still have available spots, so you can choose which one you would like to join. The cost of the therapy sessions is 50 BGN (30 BGN of them are covered by Astra Forum Foundation, the other 20 BGN must be paid by the member).

In the process of joining a group, you can expect the following:

  • Initial conversation with an ambassador of the Foundation
  • Meeting with a psychologist and filling documents
  • Questionnaire for evaluation of the quality of life
  • Questionnaire for evaluation of the individual performance at the workplace
  • Filling a registration card
  • Declarations for confidentiality and personal data protection
  • Joining the group with a psychotherapist and regular meetings


Assistant professor Okoliyski presented the topic “Why is mental health important for professionals?” during the webinar. He reminded the audience of the primary source of professional burnout – COVID-19. The pandemic created a global mental health crisis. It reinforced short-term and long-term stress and negatively impacted the foundations of mental health for millions of people. The medics were forced to manage a serious shortage of staff, stress, caused by the pandemic, as well as the intense pressure of home-schooling their children, which led to a lot of them quitting their jobs. Another factor for increasing the “burnout” process was the mistrust, lack of information and arrogant attitude of some parts of society. Health workers have been through increased violence and aggression from patients, when they applied the government-imposed restrictions. The long shifts and lack of personal or social life during the pandemic, deteriorated many people’s mental health. Also, new methods for medical care were introduced, often with not enough training or preparation. Due to the shortage of staff, specialists were re-directed to districts with a strong need of healthcare, which led to shortage in other districts. Health workers established that the lack of support, on behalf of the management and the organizational culture, compromised their psychological safety.

The problems in the sector have been building up for years and additionally deteriorate the working conditions for Bulgarian doctors, nurses and other colleagues. The shortage of staff in our country, which is the result of decades of migration of medical specialists abroad, the lack of digital healthcare and the structural reforms, that are unfinished for many years, are directly and indirectly affecting the work of medical specialists. Doctors are developing experiences of reduced personal efficiency, which leads to the idea of insecurity in their personal professional competence.

Assistant professor Okoliyski spoke of the classification of professional burnout as a professional phenomenon by the International classification of diseases (ICD-11) or a well known definition of “burnout” – …syndrome, conceptualized as a result of chronic stress at the workplace, which has been handled poorly. Okoliyski also addressed whether it is a health-related problem, or a social problem. The mental health expert from WHO stated that one does not exclude the other, and even expressed arguments about their mutual relevance. A person who suffers from burnout is incapable of adequate participation in society and achieving professional realization that is beneficial to the public, especially when it comes to medical specialists.

Assistant professor Okoliyski revealed to the audience that, unfortunately, programs for rehabilitation are currently only being discussed. There is a lack of prevention, the media present the issue as more curious, than serious and the only outlet are the balint groups (Regular meetings with professionals in the out-of-hospital medical assistance/ general practitioners for discussion of current topics). A large percentage of people, working in the field of healthcare (20%) show symptoms of anxiety and depression, increased by the COVID-19 pandemic.

In that context, assistant professor Okoliyski emphasized the lack of information platform RCCE (Risk Communication and Community Engagement). RCCE is an initiative by WHO, based on 10 steps that prepare different countries for possible outbreak of a new epidemiological situation. It is created precisely for reinforcing the communication and management of emergency professionals on a national and local scale, in order for the healthcare authorities to be able to organize rapidly and effectively.

“The fading crisis of COVID-19 already showed us that this is something essential, if we want to stand a chance in future pandemics. Not to mention the explosive mine that society is unaware of – the predominantly elderly population of medical specialists and the lack of young recruits”.

Doctors need a safe space to express their fears of everything that is left after clashing with so much troubles, pain and suffering.

Momchil Baev, MD, chairman of the Astra Forum Foundation, presented data from a Bulgarian Medical Association research. In 2020, BMA and Trend Agency held a study “Health problems among the working and medical population”. Over 1000 doctors participated in the research.

47% of the respondents in the research suffer from mental exhaustion, and the problem can also be observed with 36% of people who work in other fields. The data also shows that doctors between the ages of 40 and 60 are the most affected victims of mental exhaustion, with a higher percentage among women.

Momchil Baev revealed additional data by UNICEF. More than 1 in 7 young people in the world, between the ages of 10 and 19 suffer from a mental disorder. Almost 46 000 adolescents lose their lives due to suicide every year. The report by UNICEF makes it clear that on a global scale, only 2% of government budgets for healthcare are spent on mental health.

The webinar came to an end with Inna Braneva, who spoke about her work, the benefits of psychotherapy work in small groups, as well as the importance of prevention. As an example, Mrs. Braneva pointed out one of the most unpleasant and difficult situations for doctors – announcing to a patient the death of a loved one, or a severe illness diagnosis. That caused serious interest among the webinar participants, who later submitted their questions to the psychotherapist. Braneva pointed out other examples from the lives of medical workers that have an impact on their social functioning.

Braneva addressed the question “Can burn out cause a depressive state” by replying: “There comes a difficult moment, when the mental exhaustion of a doctor is so severe, that it becomes an obstacle for communication with loved ones, as well as any kind of social communication. This is something that can not be fixed with medicament, but with change in lifestyle.”

The discussion gave an opportunity to many participants to submit their questions. One of the last ones was also directed at the psychotherapist: What can a doctor do if their patient does not want to leave their home and insists on receiving assistance and referral remotely?

The specialist suggested they should approach individually if a certain patient shows clear signs of anxiety about leaving their home. “That has become an increasingly common occurrence after the pandemic, which is why it is important to estimate how much of their behavior is produced by fear, in order to help the patient to overcome it. Also, it is important to explain to the patient that there is no other way to help them, if they refuse to visit their doctor personally”, Braneva said.

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