ІV. STATE-OWNED PSYCHIATRIC HOSPITALS AND METAL HEALTH CENTRES 11 psychiatric medical establishments were visited in 2013. The problems found during the inspections carried out are identical to those already described in the NPM Annual Report for 2012. Despite the published data from the inspections carried out last year, the NPM found that the Ministry of Health has not undertaken any measures to eliminate the problems found. Therefore the NPM is obliged to emphasise once again the same problems and shortcomings related to the provision of psychiatric help. No actual assessment of the competency level in accordance with the requirements set in Ordinance No 24 of 7 July 2004 on the approval of the "Psychiatry" Medical Standard has been made in any of the state-owned psychiatric hospitals. The conditions to carry out medical activities related to the medical equipment and furnishing available and in working order, the number and distribution of medical specialists, the hygiene and living conditions the patients are placed in, etc., have not been met. During the inspections carried out in 2013 the NPM team once again found that most state-owned psychiatric hospitals do not avail of the conditions required under the "Psychiatry" Medical Standard, such as: possibility to use X-rays machine, scanner, EEG, NMR and clinical laboratory of II or III level of competency (all with 24-hour access for the hospital), as well as possibility for consultations with other medical specialists – all of that in the same settlement, as well as ECG, ECT and oxygen feeding installation on the territory of the hospital. Despite these findings, which were also confirmed by the inspections carried out jointly with the Executive Agency Medical Audit, initiated by the administration of the Ombudsman of the Republic of Bulgaria, the MH did not launch a procedure in any of the inspected psychiatric hospitals to bring them in line with the requirements of the Law on Medical Establishments. They continue their operations only based on Decree No 20/22 February 2000 on the determination of the ME under art. 5, para 1 of the HEL and their specific function, but they do not hold documents with defined levels of competency, obligatory for all medical establishments providing hospital aid in accordance with the provisions of art. 6, para 1 of the HEL. In 2013 the NPM continued the practice adopted in 2012 to carry out inspections jointly with experts from the Executive Agency Medical Audit (at MHC – Veliko Tarnovo and at SPH – Tserova Koria Village). In the course of the inspections the experts found that the staff of some psychiatric help medical establishments include units, which are not registered in accordance with the existing regulations, but are functioning despite of this fact. This is valid for most hospital pharmacies and clinical laboratories within the structures of SPH (the SPH – Lovech is an exception and the pharmacy there is registered in accordance with the requirements of the law). A problem for the normal functioning of the psychiatric aid medical establishments and the SPH in particular, is the lack of sufficient number of qualified personnel – doctors, nurses, psychologists, etc. The NPM believes that this makes the timely and quality treatment of the patients extremely difficult and poses a risk with respect to the 16