monitoring and care for aggressive and auto-aggressive patients. The control and admission regime in the hospitals is poor. Due to the limited human resources in the psychiatric hospitals the night shifts are also minimally staffed, which puts the personnel and the patients in danger. The assessment of the NPM is that the main reasons for this shortage of skilled staff is the low level of remuneration and the poor working conditions. The additional circumstances giving rise to issues within the psychiatric help system are the different principles for the financing of the SPH and the MHC, which is the reason for opposition and tension between the different types of medical establishments and reflects on the quality of the medical services provided. The poor work organisation in some institutions also has negative effect on the quality of the health care provided in the psychiatric medical establishments. An indicative example to this end is the fact that the lack of ordinance on the labour therapy, identified last year, is still a current problem at present. In accordance with the requirements set out in the HL (art. 151), the MH is obliged to draw up such ordinance within 3 months as of the entering into force of the Law. This deadline has not been complied with to date. This makes it difficult to carry out labour therapeutic activities with the patients in need. In the course of the inspections of the patients' documents the NPM found once again that there are many individuals treated repeatedly, with significant periods of stays in the hospital. The team found that a stay of several years (with small interruptions) is frequent practice. The NPM found a case where the patient has stayed in the hospital for more than 20 years without interruption (in the SPH – Karlukovo Village). This fact leads to the conclusion that psychiatric hospitals are forced to take on social functions as well, instead of these functions being performed by the specialised social establishments – metal disorder homes, which are subordinate to the mayors of the respective municipalities and for which methodological management is provided by the SAA with the Ministry of Labour and Social Policy. The lack of adequate communication and implementation of common policy by the two ministries – MH and MLSP – with respect of psychiatric health problems is obvious. With respect to the medical documentation the NPM found several serious problems this year as well. The attitude to the informed consent of the patients related to their treatments is still completely formal. The forms are uniform and incomplete – they do not refer to the specific condition and the specific therapy. In addition to the informed consent form, a form titled "Declaration for withdrawal of a consent to treatment", which the patient may sign voluntarily and cancel his / her treatment in the hospital, is also available in some psychiatric hospitals. During the inspections of medical documentation carried out in 2013 the NPM also found that it is not kept in accordance with the requirements set out in point IV, item 2.3.3.2 and item 2.3.4.2 of Ordinance No 24 of 7 July 2004 on the approval of the "Psychiatry" Medical Standard. Monitoring of the patients is not recorded daily and the condition of admitted suicidal patients and very aggressive patients, the assessment of the suicidal risk and aggressiveness are not documented regularly. The keeping of nurses reports and temperature sheets is identical. Having in mind that some of the patients admitted in SPH should be placed in social institutions, the NPM believes that this problem is more likely part of the problem with the inadequate allocation in the respective establishments 17