There is no adequate follow-up of patients’ condition not only in terms of their mental status, but also concerning problems related to somatic condition. Very often medical records constituting medical history of patients’ disease do not reflect underlying diseases. Descriptions and prescribed medications related to the mental health of patients are only recorded. In the examined history of disease consultations with other medical specialists are not described. Even persons who have laboratory abnormalities were not consulted with experts. Similar approach has been found out by the NPM also in the description of a patient at the admittance in the hospital - psychiatric status is described in details, but the team found large gaps in the somatic status. For example, in medical records of a female patient, who has recently undergone a heart surgery, there is no description of the underlying disease. Therapy that had been assigned to that patient for heart disease is not recorded in the history of the disease. In another case the NPM team found that a woman whose body has many bruises and injuries allegedly resulting from beatings by police officers are not recorded in the documents completed upon her admittance into the hospital. During the inspections the team also found that many patients have been treated repeatedly and their stay exceeded 150-200 days. Meanwhile, some of them had been released on leave from the hospital for 10-20 days. The NPM does not accept such leave from hospital treatment. During the inspection the team found that problems exist also in the treatment of somatic deceases of the mentally ill patients. Patients’ health is often severely impaired – especially those with addictions. Most of them require active treatment of various somatic diseases as well as dental care. In most cases, these medical services are paid either by the relatives of the patient or by the patient himself – even when he/she is a health insured. Such example has been established by the team at the SPH - Radnevo where consultations with specialists are paid, although patients are insured. According to the NPM it is an example of a serious violation of their health rights. Another major problem that has been established by the NPM during their inspections is the frequent refusal of the medical staff of medical institutions and emergency units to work with people who have psychiatric problems. Particular problem for patients with addictions is the lack of long-term remedial programmes for their treatment and socialization. Existing programmes are either private or held by nongovernmental organizations and are rather expensive and therefore inaccessible to most patients. The healing process is often compromised by the lack of mechanisms for socialization of patients with drug and other addictions. Another problem affecting the quality of healthcare is that there is no practice to perform postmortem examinations on persons who died in psychiatric hospitals. Such examination is be made only at the request of relatives, after payment of fees. This practice leads to the practice patients who have no relatives or whose relatives are not interested in them to be buried without such an examination to determine the cause of death. The above excludes the possibility in identification of medical errors in such cases. 25 Annual Report of the National Preventive Mechanism | OMBUDSMAN OF THE REPUBLIC OF BULGARIA