(homes or hospitals). It is impossible to record decursuses on a daily basis in the history of the condition of a patient who has stayed in the hospital for years. In the medical documentation comprising the history of the conditions of the patients – accompanying diseases are often not recorded at all in relation to the diagnostic – treatment activities. There are only descriptions and therapy prescribed related to the mental condition of the patients. No consultations with specialists in other medical areas are not recorded on many occasions in the histories of conditions reviewed. The NPM team found that even individuals with laboratory tests beyond the normal ones have not been subject to consultations with the respective specialists. This finding is also valid regarding the description of the patient's condition upon admission in the medical establishment. The psychiatric status is described in detail, but there are significant omissions in respect of the somatic status descriptions. This is a problem as very often mental patients are suffering very poor somatic health – especially those with various addictions. Most of them need active treatment of such diseases, as well as dental help. All diagnostic and therapeutic medical activities should be recorded and enclosed to the HC of the patients. The NPM team found cases when payment is required for medical services provided in other healthcare establishments either from the patient's relatives, or from the patient himself. Since people suffering mental diseases, being chronically ill individuals, are health assured by the republican budget, such payment and additional payment is illegal. The competent institutions still do not exercise control over this issue. A specific problem with addicts is the lack of long-term therapeutic programmes for their treatment and socialisation. The existing programmes are either private, or are initiated by non-governmental organisations. They are very expensive and therefore – are unaffordable for most of the patients. This is why the treatment is often compromised due to the lack of mechanisms for re-socialisation of drug and other addicts. This is related to the fact that there is no adequate offering of social services in Bulgaria. This is predetermined by financial concerns mainly, rather than the actual necessity. Many patients are hospitalised in various SPH forcefully, by virtue of court decision. A leader in this respect is the SPH in Lovech. Apart from being an establishment for stationary treatment of patients with mental diseases and patients with addictions, it is the only psychiatric hospital in the country with a court ward for compulsory and forced treatment of mentally ill people. The capacity of the ward is 40 patients. At the time of the inspections there were 30 patients in this ward. During the random inspection of histories of conditions from 2013 at the SPH – Lovech, as well as patients, hospitalised at the time of the inspection, no omissions and violations were found. Each newly admitted patient is assessed for suicidal risk and aggressiveness, and once registered they are followed up throughout the period of services in the ME. The documentation at SPH – Lovech is kept in accordance with the effective regulatory framework. A hospital pharmacy is part of the structure of the SPH – Lovech. It is one of the few in the country within the structure of state psychiatric hospitals that has all registrations and licenses in accordance with the currently effective regulatory framework. Due to the unique status of this medical establishment certain specific problems exist: - art. 156, para 1 of the HL provides for a possibility that the cases are heard depending on the place of treatment of the patient, but according to the CPC and CC the cases of these 18

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