NATIONAL LEGAL AND POLICY FRAMEWORKS CONCERNING DEFENDANTS AND PERSONS DEPRIVED OF LIBERTY WITH INTELLECTUAL AND/OR PSYCHOSOCIAL DISABILITIES IN LAW AND IN PRACTICE Criminal Procedure Code does not allow such a person to stay in the hospital. In the particular case the judge gives as an example where there was data that the person concerned caused several abuse incidents in the prison. Then a possible option is placement in a high level security psychiatric hospital under civil involuntary treatment (under the Health Act) upon request by the head of the hospital. But some authorities need to be obliged to bring the person from the detention facility to the hospital and the head of the hospital needs to be obliged to examine the person. This procedure is not regulated in legislation.172 The interviewed judges stated that outpatient compulsory treatment with the supervision of the relatives/close persons (Art. 89, “a”, Criminal Code) ended up being imposed in the majority of compulsory treatment cases for petty crimes.173 According to another interviewed judge the biggest challenge in compulsory treatment cases is the lack of active state policy for provision of high quality treatment of persons with psychosocial disabilities. According to him, the overall conditions in which they are placed must be improved as Bulgaria is a potential subject of judgements before the ECtHR for the conditions in which they are medicated, treated and detained.174 One of the psychiatrists interviewed in the framework of the project175 enlisted several challenges related to compulsory treatment. Both laws - Health Act and Criminal Procedure Code – provide for no clear regulation for the discharge of patients on involuntary/compulsory treatment. It is not clear whether the presence of relatives outside the hospital is a criterion for this decision as observed also by the CPT.176 The properties of many patients have been taken/stolen by relatives and close ones, and they themselves have been discarded and forgotten. Long stays (for more than 1 year) in a psychiatric hospital due to social circumstances is often because of lack of property/housing, lack of social services and lack of desire of the relatives to take care of the disabled persons, confirmed also by several monitoring visits of the CPT.177 Another chal- Bulgaria, Interview with Sofia Regional Court Judge M.T. on 13 May 2022. Bulgaria, Interview with Sofia Regional Court Judge M.T. on 13 May 2022. It is far more common to find relatives and friends of a person who had committed a crime in a state when he/she is not criminally responsible than under the Health Act for whom civil involuntary treatment was sought. People placed under compulsory treatment are a much smaller number than those placed under involuntary treatment under the Health Act. While compulsory treatment cases, in my practice, maybe in more than 80% of the cases has always been with the participation of relatives who eventually take the responsibility to treat the concerned person at home. This applies of course for petty crimes perpetrators, like hooliganism, destruction and damage to property, breaking of objects in the street and thefts. Whereas under the Health Act, since the number of persons to be placed under involuntary treatment is much higher and there the relative share of those who still have relatives who would care for them is smaller. 174 Bulgaria, Interview with District Court judge in Sofia V.K on 9 June 2022. 175 Bulgaria, Statement of a psychiatrist on 28 April 2022 at the National Advisory Board discussion. She gives an example with a patient under compulsory treatment who has been living in the psychiatric ward for 27 years, although he has relatives who even visit him occasionally. There are cases of people who have been in the hospital where she works for 5 to 10 years. 176 CPT, Report to the Bulgarian Government on the visit to Bulgaria carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 10 to 21 August 2020, p.26, available at: https://rm.coe.int/1680a090b7.“46. However, it also transpired that the courts were occasionally unable to accept the recommendation of the hospital to release a forensic patient from the hospital on the condition of his or her subsequent outpatient treatment. As envisaged by Article 89(a) of the Criminal Code, such release depends on the next-of-kin assuming personal responsibility for ensuring that the released person would continue his or her treatment. In cases when there was no such family member available or willing to assume such a responsibility, the courts had no choice but to continue in-patient compulsory treatment under Article 89(b) of the Criminal Code.” 177 CPT, Report to the Bulgarian Government on the visit to Bulgaria carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 10 to 21 August 2020, p.10.“14. It is noteworthy that, as during the visit in 2017, the delegation was informed that in all three hospitals there were a number of patients who no longer 172 173 48 SLAVKA KUKOVA