3.1.2 NATIONAL FRAMEWORK CONCERNING DEPRIVATION OF LIBERTY supervision of the local mental health centre, the court may replace or terminate the compulsory treatment at the proposal of the prosecutor.140 The court rules ex officio on the continuation, replacement or termination of compulsory treatment in a court hearing, after mandatory consideration of the opinion of the relevant psychiatric facility and the conclusion of an expert psychiatrist.141 The concerned person or his/her lawyer are not heard. The 1981 (last amended in 2004) Instruction/guidelines No. 1 of the Ministry of Healthcare on the activities of health authorities in the case of involuntary placement of persons in psychiatric hospitals governs the activity of health authorities in case of placement of persons in psychiatric hospitals for compulsory and involuntary treatment and for forensic psychiatric assessment.142 According to it compulsory treatment is to take place in psychiatric facilities designated by an order of the minister of healthcare upon a court decision.143 When it is imposed together with deprivation of liberty it is performed in psychiatric hospitals at the prisons. If there are not such hospitals it takes place in the psychiatric hospitals outside penitentiary system. Outpatient forensic psychiatric assessment is performed in a medical facility, at the investigative body, in the court, in pre-trial detention facility/prison or at the home of the assessed person. Inpatient forensic psychiatric assessment is performed in general psychiatric facility or a profiled facility for detainees and prisoners.144 The assessment of the person is carried out by the medical authorities only with the person’s consent. When the person does not give consent, the medical authorities immediately request from the prosecutor or the court a written order and assistance for an outpatient assessment or accommodation of the person temporarily in a psychiatric hospital for an inpatient forensic psychiatric assessment.145 The conclusion of the forensic psychiatric assessment, appointed with a view to applying compulsory treatment must contain: 1. a recommendation to the court about the nature of the psychiatric hospital where the treatment should be carried out; 2. opinion to what extent the patient’s condition requires his/her temporary accommodation in a psychiatric hospital until the case is heard in court. In this case, the expert notifies the head of the psychiatric facility about the need to apply this measure.146 Admission to an inpatient psychiatric facility takes place after assessment of the Bulgaria, Criminal Procedure Code (29.04.2006), Art. 432, para. 2. Bulgaria, Criminal Procedure Code (29.04.2006), Art. 432, para. 3. 142 Bulgaria, Ministry of Healthcare, Instruction/guidelines No. 1 of the Ministry of Healthcare on the activities of health authorities in the case of involuntary placement of persons in psychiatric hospitals (Инструкция № 1 за дейността на здравните органи при настаняване на лица в психиатрични стационари по принудителен ред), (shortly, Instruction/guidelines No.1) (24.07.1981), last amended on 4.06.2004, available in Bulgarian at: https://econ.bg/Нормативни-актове/Инструкция-1-за-дейността-наздравните-органи-при-настаняване-на-лица-в-психиатрични-стационари-_l.l_i.128593_at.5.html. 143 Bulgaria, Ministry of Healthcare, Instruction/guidelines No. 1, Art. 2, para. 2. 144 Bulgaria, Ministry of Healthcare, Instruction/guidelines No. 1, Art. 4. 145 Bulgaria, Ministry of Healthcare, Instruction/guidelines No. 1, Art. 4, para. 2. The temporary accommodation of persons for forensic psychiatric assessment in a profiled psychiatric hospital for detainees is carried out only after court’s decision on remand measure, detention in pre-trial facility or detention for serving a sentence of deprivation of liberty (Art. 4, para. 3). After the 30-days period for inpatient assessment (or its extension) if the prosecutor or the court did not instruct otherwise, the patient is discharged from the psychiatric hospital immediately, unless he/she declares in writing that he/she wishes to remain in treatment and there are medical indications for this. In both cases, the head of the psychiatric facility, notifies of the patient’s discharge the authority that appointed the forensic psychiatric assessment and ordered the temporary accommodation of the person in the institution for the assessment, as well as the person’s relatives. (Art. 5, para. 3) If the person is detained or imprisoned he should be brought back to the detention facility/prison (Art. 5, para. 4). 146 Bulgaria, Ministry of Healthcare, Instruction/guidelines No. 1, Art. 6. 140 141 Bulgarian Helsinki Committee 41