NATIONAL LEGAL AND POLICY FRAMEWORKS CONCERNING DEFENDANTS AND PERSONS DEPRIVED OF LIBERTY WITH INTELLECTUAL AND/OR PSYCHOSOCIAL DISABILITIES IN LAW AND IN PRACTICE ing purposes and in June 2022 (only for high-level meetings). On 4 November 2021 the Council of Europe’s Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) has issued a public statement on Bulgaria which addresses the persistent lack of implementation of long-standing recommendations of the CPT concerning the situation of persons placed in social care institutions and psychiatric hospitals in Bulgaria.180 The CPT emphasized the complaints of persons having been slapped, punched, kicked, and/or hit with sticks by the staff in social care homes and psychiatric hospitals (it almost seemed that sticks had become “standard items of equipment” for staff in many institutions); the deplorable shortage of staff; the use of seclusion and mechanical restraint which continues illegally in social care institutions and, in psychiatric hospitals, does not conform with international guidelines and is often recorded fraudulently or not at all; the non-provision of a range of modern psychiatric treatments, which is in itself neglectful and harmful to patients’ wellbeing; the persisting scarcity of effective community based mental health support services, resulting in many persons being inappropriately held in large psychiatric institutions without hope of return into the community.181 The CPT states that: “urgent action is needed in all areas – legislation, infrastructure, human resources and training, and the development of bio-psychosocial treatments in line with modern practices across Europe. The whole systemic approach to mental health care and institutional social care in Bulgaria must radically change. And this change must include fundamentals – fighting the stigma around mental health, changing the paternalistic, controlling attitude towards patients with psychiatric disorders and social care residents, involving them in their treatment and care, and making genuine efforts to integrate persons with psychiatric disorders and learning disabilities into communities”. During its 2020 visit to Bulgaria the CPT stated that: most dormitories were bare and lacked personalisation and privacy, with few personal belongings and no personal lockable space, inadequate, and often grossly insufficient numbers of ward-based staff; the atmosphere on many of the wards visited often appeared less than therapeutic, sometimes neglectful and even controlling, oppressive and punitive; treatment, was predominantly pharmacotherapeutic; many patients had no, or only very limited, access to daily outdoor exercise; a number of legally competent patients who had signed consent to hospitalisation forms and were still deemed voluntary, were nevertheless not truly consenting to their hospitalisation, stating that they wanted to leave but were not allowed to do so, and were thus de facto detained. European Committee for Prevention of Torture, Council of Europe anti-torture Committee issues public statement on Bulgaria, 4.11.2021, available at: https://www.coe.int/en/web/cpt/-/council-of-europe-anti-torture-committee-issues-public-statement-on-bulgaria 181 The CPT also notes that although restraint with metal chains, as found in 2020, was not found during the most recent visit, patients continued to give consistent and credible accounts of being placed in 4 or 5-point belt fixation to beds in seclusion rooms for days, in incontinence pads throughout, into which they had to urinate and defecate. Some also reported that their hands had been fixed above their head, causing pain, swelling and loss of sensation in their upper limbs, which could be described as ill-treatment. 182 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.3-4, available in English at: https://rm.coe.int/1680a090b7. 180 50 SLAVKA KUKOVA