News

22 July 2025

At the request of the Parliamentary Committees on Labour and Social Policy and on Health, Ombudsman Velislava Delcheva sent an opinion on the draft law amending the Health Act.

The opinion highlights that over the years the Ombudsman has identified a number of systemic problems related to the rights of psychiatric patients, one of the most significant being the application of extreme coercive measures to patients without a system of control.

Attention is drawn to the fact that the most serious case qualified as torture since the beginning of the Ombudsman's mandate as NPM is the fire that occurred on 2 October 2023 in the State Psychiatric Hospital in Lovech, during which a patient died.

The Ombudsman then found that on the day of the fire this patient had been isolated for 9 hours and had been immobilised, i.e. tied to all four limbs, for almost 6 hours. This is the reason why he died during the fire.

"The immobilisation happened nearly a month after he was admitted for treatment. This, in turn, suggests that after the treatment he received, the acute phase of his disease was brought under control. Moreover, he was accommodated in a so-called 'soft room', which allows patients to do everything and move freely without risks and without difficulties for the caring staff. It is evident in this case that instead of the soft room being used as a gentle and safe place for isolation, it was used as a 'punishment room' and the patient was immobilised in it," the public defender writes in her opinion.

Another significant problem identified by the Ombudsman is the violation of Ordinance No. 1 of 28 June 2005 on the procedure for the application of temporary physical restraint measures for patients with established mental disorders.

"According to Article 11(2) of the Ordinance, a patient who is subject to a temporary physical restraint measure shall be continuously monitored by nurses designated by the doctor, who shall change every hour. It is evident from the case that there was no continuous monitoring of the patient during the immobilisation," the NPM team states firmly.

In addition, the Book of Measures Taken for Temporary Physical Restraint identified a number of cases where patients were assigned several consecutive isolations and several immobilisations on the same day or on consecutive days. Particularly drastic was the case of a patient diagnosed with vascular dementia who, from 30 September to 2 October, had been isolated a total of 5 times for 6 hours each and immobilised 2 times for 2 hours each.

“It should be stressed that Ordinance No. 1 of 28 June 2005 on the procedure for the application of temporary physical restraint measures to patients with established mental disorders contravenes the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and the Council of Europe Convention for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. The Ombudsman considers that it is inhuman and degrading treatment or humiliation for a patient to be tied up for hours on the same day and isolated, as was found during the inspection at the State Hospital in Lovech. The Ordinance does not stipulate if once a measure of immobilisation (tying) has been imposed for 2 hours whether this means that 5 minutes after the measure has expired the patient may be tied up again an unlimited number of times. Similarly, when a person has been isolated for 6 hours, it is not stipulated how many times this measure may be extended for another 6 hours. In practice, a person can be isolated every day for 15 days almost without interruption of the measure," the opinion says.

In it, the Ombudsman Institution once again urges the Ministry of Health to revise the ordinance in question, including to draw up a protocol for the application of the coercive measures of "immobilisation" and "isolation", in which it is clearly noted for what duration and how often patients can be isolated and immobilised for a period of 24 hours, as well as to specify the grounds on which these measures are applied.

Another significant problem mentioned in the Ombudsman's opinion is the lack of a legal redress mechanism and other systemic deficits. Emphasis is placed on the Public Statement on Bulgaria of 4 November 2021 of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT). In its concluding observations, the Committee then noted that in its previous reports it had taken due account of the repeated assurances given by the Bulgarian authorities that action would be taken to improve the treatment of persons detained in psychiatric hospitals and social institutions.

"At the same time, the findings of the 2021 visit have once again highlighted the serious and long-standing problems that have not been systematically acted upon. This state of affairs demonstrates a continued lack of action by the Bulgarian authorities on most of the major shortcomings and on the implementation of the Committee's specific and repeated recommendations over many years. The CPT is of the opinion that action along these lines is long overdue and a fundamental change in the approach to the overall issue of mental health care and social care in institutions in Bulgaria is needed," the opinion stresses.

It also draws attention to the fact that in March 2023, the CPT again inspected two psychiatric hospitals in Bulgaria, where it found that violence against patients by staff continued. The Committee considers it a serious failure that the Ministry of Health has failed to stop these unacceptable practices.

"On 23 November 2023, the National Assembly adopted a decision to set up an Ad Hoc Committee to examine the violations of the rights of mentally ill patients found in Bulgaria by the European Committee against Torture and the Ombudsman of the Republic of Bulgaria and to propose legislative changes to guarantee the equal rights of Bulgarian citizens as provided for in the Constitution of the Republic of Bulgaria and the conventions to which the Republic of Bulgaria is a party. Among the tasks of the Committee are: to place at the forefront of the National Strategy for Mental Health; to guarantee respect for the rights of patients; to discuss and propose the abolition of the institution of mental institution; to take the necessary steps, in cooperation with NGOs and medical experts, to ensure the deinstitutionalization of mentally ill patients and respect for their personal choice. The Ombudsman, as the NPM, has proposed to this Ad Hoc Committee legislative changes that address the rights of mentally ill patients," the statement adds.

It further specifies that tragic incidents continue to recur, and one of the Ombudsman's most important recommendations for legislative change, which is not included in the current draft law, is the creation of a single information system in which it is mandatory to record in real time every "immobilisation" and "isolation" from all psychiatric hospitals in the country. This system should link all psychiatric hospitals to the Ministry of Health, and the Ministry of Health should make publicly available, on a monthly basis, data on coercive measures applied in psychiatric hospitals in the country.