The main reasons for the lack of human resources are poor working conditions and low pay. It is clear from the working schedules of the hospitals that the evening shift are performed only by one doctor on duty, nurses and paramedics. Insufficient number of doctors, nurses and orderlies create conditions for poor and untimely treatment of patients and risk in respect of the monitoring and care of patients with symptoms of aggression, self-harm and the danger of leaving the hospital. Another important issue in these hospitals is the lack of an approved practice of a Concilium and the clinical supervision of each member of the staff at the hospital in accordance with the requirements of the Medical Standard „Psychiatry”. Diagnostic and therapeutic medical activities, documenting the therapeutic and diagnostic processes In the state psychiatric hospitals the following activities are performed: medical recovery activities of patients with psychiatric problems, diagnostic activities specific psychiatric care, rehabilitation and recreation activities, forensic and labour expert activities, advising on social problems and preparation for integration in appropriate services. Upon admittance in such hospitals, patients are signing „Informed consent for hospitalization and treatment.” In addition to the informed consent form, in some psychiatric hospitals there is a form of „Declaration of withdrawal of consent to treatment” which the patient can voluntarily sign and to terminate his treatment in the hospital. A large number of patients are hospitalized in the SPH involuntarily, by a judgment. A person is appointed as a guardian or custodian of these persons, who to sign the informed consent on behalf of the patient. However, such action is not performed. During the inspections the NPM has found that the informed consents of the patients who are under full interdiction were signed by the patients themselves, rather than by the specified custodians. During the inspection it was also found out the perfunctory regard to the informed consent of patients admitted for emergency treatment by medical professionals. These informed consents are incomplete, uniform (do not reflect the disease and specific therapy) and perfunctory. Experts, however, have a different attitude towards the informed consent of patients enrolled in clinical programmes for drug trials. These programmes are associated with a substantial financial interest and are strictly controlled by companies doing tests. Therefore, informed consents for these programmes are detailed and documented with strict clauses. Since both informed consents are signed by one and the same medical specialists, what is still puzzling is the double standard in the preparation of these documents. In examining the medical records the NPM noted that they are conducted in accordance with the requirements shown in section IV, paragraph 2.3.3.2. and section 2.3.4.2. of Ordinance No 24 of 7.07.2004 on the approval of the Medical Standard „Psychiatry”. Monitoring of patients is recorded on a daily basis. The condition of admitted patients with suicidal attitudes and high levels of aggression, the assessment of suicide risk and aggressiveness is not documented in the history of the disease, nursing reports and the temperature charts. 24 Annual Report of the National Preventive Mechanism | OMBUDSMAN OF THE REPUBLIC OF BULGARIA