CAT/C/BGR/CO/6 (c) That admission procedures and systems of guardianship continue to include officials from the institutions in which the persons with disabilities are confined, which may result in a conflict of interest and de facto detention; and that the placement is done at the request of other persons and not the person with a disability; (d) Regarding the excessive use of medication and chemical restraints; the enforced administration of non-consensual and intrusive and irreversible psychiatric treatment and therapies such as neuroleptic drugs; violence among patients, including selfdestructive behaviour; and punitive behaviour by staff based on a person’s impairment; (e) About the material conditions in some institutions that amount to inhuman and degrading treatment and include caged spaces, lack of furniture, poor hygiene and poor access to sanitary facilities; (f) About the non-renewal of agreements by the ministries responsible for health care, for labour and social policy and for education and science with civil society institutions, which reduces their ability to monitor such institutions; (g) That children in accommodation centres for children with mental and psychosocial disabilities have been subjected to negligence, harassment and violence. 16. The State party should: (a) Ensure that national legislation provides guarantees for effective legal safeguards for all persons with mental and psychosocial disabilities concerning civil involuntary hospitalization, including with regard to effective judicial review, as well as concerning involuntary psychiatric and medical treatment in psychiatric institutions, including with regard to chemical and physical restraints; (b) Review the legal status of patients and ensure that patients’ consent is requested both with regard to hospitalization and in relation to psychiatric medical treatment, and that they are allowed to avail themselves of the right to appeal against the decision in the event of involuntary hospitalization and medication; (c) Ensure that the patient enjoys the right to be heard in person by the judge ordering the hospitalization and that the court always seeks the opinion of a psychiatrist who is not attached to the psychiatric institution admitting the patient; (d) Ensure regular visits of psychiatric institutions by a mandated outside body independent of the health authorities, and establish an independent complaints mechanism; (e) Consider less restrictive alternatives to the forcible confinement of persons with mental and psychosocial disabilities; (f) Investigate effectively, promptly and impartially all complaints of illtreatment of persons with mental and psychosocial disabilities hospitalized in psychiatric institutions, bring those responsible to justice and provide redress to victims; (g) Take measures to prevent all forms of ill-treatment in psychiatric and other institutions; ensure that the use of medication strictly complies with medical needs and that there is no excessive use of medication, including through the establishment of internal inspection mechanisms; and take into account the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. Absence of investigations into the deaths of 238 children with mental disabilities 17. The Committee is gravely concerned by the reply of the State party concerning the absence of investigations into the deaths of 238 children with mental disabilities who died during the period 2000–2010, three quarters of whom died from preventable causes, and those of two more children who died in similar conditions in the Medven institution shortly before the Committee’s consideration of the State party’s previous report. The Committee is dismayed by the statement in which the State party indicated that 22 inspections of the institutions in question did not establish inhuman treatment of children by the personnel of the specialized institutions and merely stated that there were certain loopholes in legal regulations whereby some of the children had been buried without autopsies. 7