patients are heard depending on their place of residence (address registration), and the
tribunal is not specialised. This is related to significant costs for the hospital, which has to
provide their transportation and security to the different regions of the country;
- there is no women's ward in Bulgaria in accordance with art. 89, item „c“ of the CC
("forced treatment in specialised psychiatric hospital or specialised ward in ordinary
psychiatric – neurology establishment “). This is why in order to observe the law when
forced treatment is required for women, it is transformed into treatment in an
establishment in accordance with art. 89, item „b“ of the CC („forced treatment in ordinary
psychiatric – neurology establishment “).
- hospitals are not reimbursed for the costs they incur in relation to court medical
expertises and LEDC. LEDC in all other medical establishments are paid BGN 20 per
person by the Ministry of Health, and at the SPH – Lovech the LEDC payments are covered
fully by the hospital.
Another state psychiatric hospital with specialised ward for patients with tuberculosis
(TBC) visited in 2013 is the SPH – Karvuna Village. Psychiatric disease patients with
active tuberculosis from all over the country are admitted in this ward. These patients are
mainly from homes for elderly people with mental disorders. During the inspection the
NPM team found that most of them are admitted with an advanced stage of active
tuberculosis. This is why the inspection team members observed a big number of patients
suffering grave physical exhaustion and accompanying mental problems. It is obvious that
in these cases it is all about extremely late diagnostics due to the inadequate attitude to
the health of these people by the establishments that send them here. For most of these
patients general practitioners are appointed ex-officio. The duties of these general
practitioners include regular prophylactic exams with the relevant laboratory tests.
However, no such exams in accordance with the rules set out have been made with
respect to the patients admitted to the TBC ward. They are diagnosed when the process is
so advanced that the disease has become very obvious even without specific diagnostic
measures and the patient's condition has already become rather grave.
The conditions in the psychiatric hospital itself are relatively good.
Apart from the problems that are valid for almost all state psychiatric hospitals, at the
HPS in Tserova Koria Village and at the HPS in Byala the NPM experts found that there are
no contracts signed for exams, consultations with specialists, tests and potential
prescription of treatment in relation to the somatic health condition of the patients. All
consultations related to somatic health issues of the patients are provided only by the
teams from the Emergency Aid.
The ratio profile of the different diseases in all SPH visited is as follows: the diseases in
the group of schizophrenic disorders have the biggest share, followed by affective
disorders and the alcohol addiction syndrome.
During the inspections carried out in the mental health centres the NPM found that they
are usually well staffed, and the conditions are significantly better than those in the
hospitals, with the exception of the MHC in Veliko Tarnovo and the MHC in Haskovo
where the conditions are poor.
Most of the MHC are also non-compliant with the requirements set out in Ordinance No
24 of 07 July 2004 on the approval of "Psychiatry" Medical Standard, mainly in terms of
the medical equipment and furnishing available and fit for use.
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