their safety and govern the following issues: Introduction of an adequate system of preliminary assessment of the risks derived from specific patients by the staff; multidisciplinary work; preventive measures to be taken to protect patients from violence and ensure their safety; conducting appropriate supervision/observation of patients by personnel, proper training of staff, development of strategy for standard operating procedures and de-escalation; prompt and adequate intervention immediately the threat; documenting incidents involving violence and response made; accountability and responsibility of the staff. Unfortunately, the indicated recommendation has not been fulfilled. 5.4. SOMATIC (PHYSICAL) HEALTH In 2018, problems were identified in terms of accessibility of somatic healthcare services for the patients of psychiatric facilities214 as well as providing them with respective medicines. The Mental Healthcare Programme215 does envisage monitoring of somatic (physical) health and treatment of patients with mental health problems in psychiatric facilities. This leads to the aggravation of the patients’ state of health and, sometimes, even death. Reimbursement is only provided for emergency cases within the Universal Health Care Programme and planned medical services are co-funded.216 Patients cannot afford this in certain cases. Transporting patients to a different medical establishment is also problematic. This causes additional expenses for patients. Furthermore, the services of consultants are not free of charge in the Academician B. Naneishvili National Centre for Mental Health. Moreover, patients have to buy therapeutic medicines to manage their somatic (physical) health problems. The problems of somatic healthcare are addressed also by the CPT in its report on the visit to Georgia carried out on 10-21 September 2018. It is completely unacceptable for the committee that psychiatric inpatients that lack financial means are requested to pay for somatic medical services. The CPT recommends that urgent action should be taken to remedy this.217 When monitoring218 the Academician B. Naneishvili National Centre for Mental Health, the Special Preventive Group studied the medical cards of deceased patients.219 Medical cards of patients deceased 214 See in detail, 2018 Report of the Public Defender of Georgia on the Situation of Protection of Human Rights and Freedoms in Georgia, pp. 273-274, available at: http://www.ombudsman.ge/res/docs/2019042620571319466.pdf, (accessed 11.06.2019). 215 Resolution no. 693 of the Government of Georgia of 31 December 2018 on Approving 2019 State Healthcare Programmes, Annex no. 11 Mental Health (programme code 27 03 03 01). 216 A patient pays for a part of medical services. 217 Visit carried out on 10-21 September, para. 128, available at: https://rm.coe.int/1680945eca, (accessed 11.06.2019). 218 The Academician B. Naneishvili National Centre for Mental Health was visited on 22-24 2019. 219 The medical cards of patients deceased in the respective establishment or other medical establishments have been studied. It is noteworthy that there is no death statistics maintained in the establishment. This hindered the work of the Special Preventive Group. Despite the difficulties, the group managed to locate and examine 25 medical cards of the patients deceased from 1 January 2018 until 24 April 2019. 7 patients died in the 79