3.1.2 NATIONAL FRAMEWORK CONCERNING DEPRIVATION OF LIBERTY The Bulgarian Ombudsman institution functions as a National Preventive Mechanism and monitors psychiatric hospitals also. In its 2020 Annual report it sent a statement to the Ministry of Health in which two major problems related to psychiatric care provided in state psychiatric hospitals were underlined – funding and shortage of staff.183 According to the statement the insufficient number of doctors, nurses and paramedics creates conditions for untimely and low-quality treatment of patients, as well as risk in terms of monitoring and care for patients with aggression and auto-aggression. Social rehabilitation and psychological care, long hospital stays and repeated hospitalisations of persons with severe social status are also a problem according to the Ombudsman.184 State psychiatric hospitals have patients (eg homeless persons) who live permanently in them due to a lack of sufficient residential social services for people with IPD.185 The interviewed psychologist from the NPM underlined several serious problems – the extremely low budget of the hospitals186, the lack of coordination and functioning between state and municipal institutions in cases of persons under or needing compulsory treatment187 and the lack of residential services appropriate for them.188 In its report on Bulgaria (2018) the European Psychiatric Association underlined that the Bulgarian psychiatric care system is “fragmented”, which leads to a lack of continuity and ultimately to a violation of human rights in the sense of the UN Convention on the Rights of Persons with Disabilities. Bulgaria, Ombudsman, 2020 Annual report of the National Preventive Mechanism, p.12, https://www.ombudsman.bg/pictures/ Annual%20Report%20NPM%202020(1).pdf. On p.36 details about the funding are presented: historical budgeting is a system that was in place before the time of health insurance system and is outdated. With this budget, there is no direct relationship between the volume and quality of the performed medical activities and the received funding. The financial resources allocated to state psychiatric hospitals are extremely insufficient. The so-called historical budget is the reason both for the poor conditions in the medical facilities where the patients are treated, and for the marked shortage of medical personnel, due to the low remuneration for their work and poor working conditions. 184 Bulgaria, Ombudsman, 2020 Annual report of the National Preventive Mechanism, p.12. 185 Bulgaria, Ombudsman, 2020 Annual report of the National Preventive Mechanism, p.12. 186 She states that she is “very angry about the state psychiatric hospital budgets in recent years. It is incredible misery, incredible! There could be no quality of health service. In the psychiatric hospital in Byala, where one of the largest number of patients on compulsory and involuntary treatment were accommodated in 2019, the food daily allowance is BGN 1.96 (EUR 1), the medicines daily allowance is BGN 0.89 (EUR 0.45), and the funds allocated for bedding and clothing is BGN 0.47 (EUR 0.23) per patient for the entire stay. In 2021, there is an increase in the food daily allowance –BGN 2.50 (EUR 1.25), and in the medicine daily allowance - BGN 2.00 (EUR 1). In this hospital for the total of 6 wards there are three psychiatrists employed and the head works every day for 12 hours a day. The acute male ward does not have any doctor employed. “ She also adds that the substinence funding of another psychiatric hospital - in Carev brod (visited by the CPT) was even reduced in 2020 compared to 2019. 187 She describes a case in which she got a phone call from the only women’s prison in Bulgaria from which a woman with psychosocial disabilities was to be discharged but in a psychotic state. The woman was sentenced for several thefts and one of them done during probation period. She has a daughter with a baby and the daughter could not take care of her at that time. It took 9 months and many phone calls for the whole NPM unit to find a place where the woman can live permanently. In the meantime, she was placed in the same psychiatric hospital where she used to be treated before the prison due to the good will of the head. Another recent case is of a woman who was placed in a hospital for a forensic assessment but after that was not released as the judge went on a sick leave and the case was blocked. So the lawyer of the woman notified the NPM about this illegal detention and asked for intervention for her release. 188 Bulgaria, Interview with a psychologist at the National Preventive Mechanism I.V. on 3 June 2022. 183 Bulgarian Helsinki Committee 51