conditions, especially given the fact that patients are not allowed to be in the open air or engage in meaningful activities, create a particularly depressing and harsh environment. Methods of controlling the behavior of an agitated patient and involuntary medical interventions for fulfilling the prescription, create a high risk of arbitrariness in the psychiatric institutions. The cases of forced injenctions as well as rapid tranquilization used against the patient to control his/her behavior are not documented which increases the risk of arbitrariness.391 The only way for obtaining information on these issues are interviewing the patient or directly witnessing the fact.392 Patients at the LTD Tbilisi Mental Health Center noted that forced injections as well as participation of other patients in this process were frequent. Cases of male patients’ involvement in the process of forced injections used against female patients have also been reported. Patients also spoke out to take medication in powdered form by using force against their will.393 In the Public Defender’s opinion, the established practice of rapidly acting tranquilisation against a patient’s will without an adequate justification or legal safeguards, which leads to complete or partial suppression of the patient's consciousness and reflexes as well as excessive sedation, violates the patient's physical integrity394 and amounts to inhuman and degrading treatment of a patient. According to the CPT, use of rapidly acting sedative injections is a form of chemical restraint that causes significant harm to a patient’s health. The application of rapid tranquilisation is permitted only in accordance with a strictly determined protocol under appropriate legal safeguards.395 According to the National clinical practice recommendation (guideline) on Treatment and Management of Schizophrenia in Adults, the use of rapid tranquilization is allowed as a last resort, when other sedation methods are exhausted and the patient refuses to take the medicine.396 However, the procedure on application of chemical restraint or rapid tranquilization is not regulated at the legislative and normative levels, which allows medical staff to disregard the standards set out in the guideline and without any legal safeguards use rapid tranquilization against the patient's will. 4.4. Practice of Using Restraint Methods Restraint methods are still actively used in psychiatric institutions to manage the behaviour of agitated and/or aggressive patients. However, not all cases are documented. After the adoption of the new version of the Law of Georgia on Psychiatric Care on June 23, 2020, the two methods of physical restraint In case of forced injections, only the fact that the patient was injected beyond the prescription is recorded in the medical documentation. 392 The Special Prevention Group itself witnessed the fact of using forced injection against the patient in LTD Sekani Mental Health Center. 393 The medical staff of the institution also confirmed the fact that medicines are frequently given in powdered form. 394 Article 17 of the 2006 UN Convention on the Rights of Persons with Disabilities reinforces the physical integrity of persons with disabilities. 395 Report on the visit to Portugal carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 3 to 12 December 2019, (CPT/Inf (2020) 33), para.101, available in English: <https://rm.coe.int/1680a05953> [last visited: 30.12.2020]. 396 The National clinical practice recommendation (guideline) on Treatment and management of schizophrenia in adults, para. 7.3.3. available at: <https://bit.ly/3bgMtAi> [last visited: 30.12.2020]. 391 121