Voluntary and compulsory psychiatric treatment in Bulgaria

Private Clients, Medical law, Family and Children

Since the start of the COVID-19 pandemic, the global prevalence of mental health illness has increased, according to World Health Organization (WHO) studies. The family members of persons with serious mental health illness are often in a difficult position as carers, and because of the impact of their loved ones’ illness on them and on the relationship with them. We try below to shed some light on what happens in Bulgaria from a legal perspective when a family member is suffering from a mental disorder. Our comments may be generally applicable to any other carer or indeed any person concerned about the mental health of another, as well as of course for the person experiencing difficulties. Generally, such difficulties are not of a transient nature but need psychiatric treatment, which can be voluntary or involuntary. 

Voluntary treatment

The person requiring specialist mental health help may start treatment of their own will. They or their family members (with the consent of the future patient) need to contact a qualified psychiatrist – this can be either through their existing family physician / general practitioner or privately. The specialist doctor would discuss the treatment options and decide (together with the patient) on treatment. They may prescribe drugs to be taken in the community, offer talking therapy (eg Cognitive Behavioural Therapy), or suggest that the person needing help be hospitalised, among other things. 

This can be a prelude to compulsory treatment if the psychiatrist finds the patient’s condition serious enough or the patient gets worse, but the psychiatrist does not have the power to compel themselves. This is in contrast to other countries. Eg, in the UK,  medical practitioners can “section” an individual for assessment and treatment of a mental health condition (eg, under s 2 of the Mental Health Act, for 28 days, and under s 3 – for periods of (up to) 6 months at a time).

Where the public prosecutor (in Bulgarian: прокурор) is involved, this is not because of any assumed criminality, but because they have a wider function to maintain order and intervene on behalf of various vulnerable people. 

Compulsory psychiatric treatment

In case the person requiring treatment does not recognise that need or wish to undergo such treatment, their relatives (or indeed any other person) can request compulsory treatment from a prosecutor, who will in turn exercise their discretion whether to apply to court for a compulsory treatment order or not. 

In Bulgaria,  to be treated compulsorily, a person must:

• have a mental illness with a serious impairment of mental functioning (specifically, a psychosis or a severe personality disorder) or a pronounced permanent mental damage as a result of mental illness; OR
• have moderate, severe or profound mental retardation or vascular and senile dementia; AND
• due to their illness, be at risk of committing a crime that poses a danger to their relatives, other persons, society at large, or their illness seriously endangers their own health.

If an application is filed, generally both the person requiring psychiatric treatment and the person(s) filing will need to attend court. The former will have to be represented by a lawyer who can be appointed by them privately or be  publicly appointed by the court and the latter would generally be expected to appear as a witness.

The court will order a psychiatric assessment of the subject, which will be carried out by medical doctors as experts reporting to the court. Subject to such assessment, the court may or may not order for them to be compulsorily treated in a psychiatric facility for a period determined by the court – it would in practice follow the medical experts’ views. The period can be extended and extensions require further applications to court by the prosecutor. 

Appointing a deputy over the patient’s affairs

When a person is placed in a mental health institution for treatment, their relatives can request the court to appoint a deputy over the patient’s personal affairs. Generally, anyone with a legal standing or interest can apply for the appointment of the deputy.

Once appointed, the deputy will take legal actions in the patient’s stead. For example, any transaction to which the latter is a party or any request to authorities will need to be approved and executed by the deputy. For more information on the legal aspects of psychiatric treatment and appointment of deputies including on the rights of patients to be discharged from compulsory treatment, access to medical records, the consequences of being treated on the property, disposals and affairs by an in-patient, please contact us at [email protected].