By Karen Allen BBC Health Correspondent

As Bulgaria looks set to join the European Union by 2007, it is under pressure to reform mental health care - in particular its notorious social care homes.

These are not psychiatric hospitals but institutions for people with mental disabilities.

In many instances there is barely any heating although there are sub-zero temperatures outside

People who in many other parts of Europe would be cared for in the community.

They are very much a hangover from Soviet times, more akin to Russian labour camps then sancturies of care.

In many instances there is barely any heating although there are sub-zero temperatures outside and the glass from the windows is missing.

There is minimal medical attention (in many homes there is no doctor on site) and nutritious food is in limited supply.

It is perhaps not surprising when those running the homes have a budget of around �30 per person per month.

Widespread ignorance

Conditions are squalid

What makes it all the more worrying is that many people in Bulgaria aren't even aware these places exist - so the political pressure to close them down comes largely from independent monitoring groups which have so far only had limited success.

According to the Bulgarian Helsinki Committee - an internationally respected human rights group - Bulgaria has some 100 social care homes - responsible for around eight thousand vulnerable adults and children.

These people have been abandoned by their families - often since childhood - a throwback to the Communist past when the cultural norm was to hide these people away in instututions far away from view.

Many countries are guilty of doing the same to a lesser degree but the difference with Bulgaria is the neglectful state of these human warehouses.

Once a mentally ill person has been admitted, there is little chance they will get out

Guardianship of the residents rests with the directors of the homes and once a mentally ill person has been admitted, there is little chance they will get out.

There is also little incentive to close the homes down when in many cases they're the main employer in the district.

Mountain unit

I visited one in Western Bulgaria - Pastra situated high up in the mountains not far from the Rila Monestary, one of the most religious spots in Bulgaria.

One in ten residents did not survive the past year - and there is no reason to expect it to be any different this year

But there is nothing spiritual about Pastra. Here men with mental disabilities ranging from severe schizophrenia to what we in the UK would call "learning disabilities"; pace aimlessly around in the snow.

Some have no shoes and socks although it's minus ten degrees outside.

One in ten residents did not survive the past year - and there is no reason to expect it to be any different this year.

All this in 21st century Bulgaria. A country rich in history; religion and culture soon to be a fully fledged member of the European Union.

A country which has met the Copenhagen Criteria which states that "membership requires that the candidate country has achieved stability of institutions guaranteeing democracy, the rule of law, human rights and respect for and, protection of minorities", and a country that has been slow to right the wrongs of the past.

Bulgaria is struggling economically so money is tight.

Reforms in mental health care are in the pipeline - but the focus is largely on practices in psychiatric hospitals (themselves appaulling) - and to date social care homes seems to have been excluded from any proposals.

International standing

Even so, the Ministry of Labour and Social Policy is sensitive to its international reputation and has told the BBC that investment is going into modernising these homes.

It trumpets the fact that it has put more money into modernising it's social institutions and has closed the notorious Sanadinovo children's home.

But when a ministry tells you that at Pastra the heating problems were solved two years ago - and our visit proved that this clearly was no so - one has to be sceptical about how much things have changed.

Human Rights Campaigner Krassimir Kanev sums up the situation.

"Bulgaria strives to reach the European level of economic and social welfare and on the other hand it has 18th century asylums."

Of course, Bulgaria is not alone in continuing the practices of the past.

Romania and Hungary have also had attracted criticism for the atrocious state of their mental health instututions.

But presssure must be brought to bear by the international community.

The fact that a recent report by Amnesty International on the state of Bulgaria's care homes, received barely any press or media coverage - is an indictment of a modern society that has forgotten that it was only 13 years ago, when similar scenes of neglect in Ceaucescu's Romania, caused a global outcry.