PROTECTION OF PERSONS WITH MENTAL ILLNESS • The system for providing medical and hospital care at state-run psychiatric hospitals (SPH) remains outdated and unreformed. • Most NPM recommendations directed at the Ministry of Health for much needed changes to the funding structure for state-run mental health services, medical standards implementation, and restructuring mental health institutions remained outstanding in 2015. • The competent institutions have been failing to find solutions to the serious problems related to the poor condition of the physical environment and equipment and inadequate staffing. These problems directly affect and violate the rights of both psychiatric inpatients and healthcare workers in mental health institutions. • Some psychiatric inpatients are persons of low socioeconomic status and the SPHs are required to perform social care functions as well. The recommendation directed at the MLSP to open additional social service facilities remains outstanding. • There remains the need for a comprehensive reform with a view to ensuring the healthrelated human rights of persons with mental illness and provide them with adequate social support. In 2015, the NPM conducted six inspections in healthcare establishments for residential mental health treatment services: the State-Run Psychiatric Hospital (SPH) in the village of Karvuna, municipality of Balchik, the SPH in the city of Pazardzhik, the SPH in the town of Radnevo, the SPH in the city of Lovech, the SPH in the village of Karlukovo, municipality of Lovech, and the Mental Health Centre (MHC) in the city of Plovdiv. This year's inspections identified, once again, the unsatisfactory condition of the state-run inpatient mental health treatment services and the need for comprehensive system reform. The physical environment and equipment of most healthcare establishments (HE) inspected was found to be in a poor state of repair and worn out. The two exceptions were the SPH in the city of Pazardzhik and the Mental Health Centre (MHC) in the city of Plovdiv. Partial repairs had been carried out to the inpatient wards at the SPH in Karvuna and the SPH in Karlukovo. Even though the NPM considers those to be a positive development, they were insufficient against the background of the hospitals’ actual needs, which have remained unmet. Some structural changes had been effected at the SPH in Karlukovo. The number of wards had been cut from seven to five, forty hospital beds had been lost, the hospital pharmacy had been closed, and the management team had been replaced. Overcrowding and lack of enough personal space for the inpatients were identified in some of the wards at the SPH in Karlukovo and at the SPH Radnevo. The technical equipment required for the medical treatment process was found to be inadequate in all mental healthcare establishments. With the exception of the SPH in Pazardzhik, all other hospitals did not have central oxygen supply systems, which are required for the provision of mental health services according to the Mental Health Standards. The MoH finds it difficult, if not impossible, to have such installations fitted in the hospitals’ worn out buildings, so oxygen canisters are supplied for the purposes of the medical treatment process. Medical diagnostic laboratories that meet the requirements of the Clinical Laboratory and Diagnostic Imaging Standards had opened at the SPH in Pazardzhik and at the MHC in Plovdiv. The remaining SPHs either did not have medical diagnostic laboratories or the existing ones 69