personnel to manage the crisis and ensure their own peace is to restrict the patient physically and chemically, which is unacceptable402 and constitutes a gross violation of the patient's rights. Incomplete and unsubstantiated documentation of the incident increases the risk of arbitrariness from the staff.403 Institutions produce "fixation journals" in various formats. For example, LTD Center for Drug Prevention and Mental Health did not provide any justification as to why the restriction was used. Some records at LTD Tbilisi Mental Health Center do not adequately describe how dangerous the patient's behavior was towards himself / herself and / or those around him / her. None of the fixation journals examined during the 2020 monitoring contained information on whether de-escalation methods were used prior to the restriction.404 Staff without special qualifications, non-medical staff or patients are involved in the process of physical and chemical restraints of patients in the institutions which is contrary to the Instruction on Restriction Methods,405 according to which physical restraint must be carried out by the relevant personnel determined with the internal regulation of the institution, who have the necessary qualification and experience in using physical restraint methods. The documentation406 produced by the medical and support staff of the institutions does not indicate who exercised the restriction, by what means and in what place. In exceptional cases, it is stated that the patrol inspectors and other department employees assisted the staff in the restraining process.407 The practice of involving non-medical, personnel without special qualifications in the restraint process is not only a threat to the patient's health but also a strongly stigmatising experience, especially if another patient is involved or attends the restraint process. The general exception is only when the patient him/herself requests the presence of another patient.408 4.5. Legal safeguards Inpatient psychiatric care is voluntary except in cases determined by law.409 Voluntariness implies a patient expressing a genuine will that he/she wishes to receive psychiatric care at a psychiatric institution. The 402 CPT standards on Means of restraint in psychiatric establishments for adults. Standard 1.6. notes that means of restraint should never be used as punishment, for the mere convenience of staff, because of staff shortages or to replace proper care or treatment. Available at:: < https://rm.coe.int/16807001c3 > [last visited: 30.12.2020]. 403 According to Article 16.1 of the Law of Georgia on Psychiatric Care, the restraint method is an exceptional measure of last resort used for safety reasons and its use is permissible only when the patient poses a threat to him/herself or those around him/her. 404 Judgment of the European Court of Human Rights, M.S. v. Croatia (No. 2)) (no. 75450/12), para. 106, available at: < https://bit.ly/3q2HSWv >, [last visited: 30.12.2020]. The Court found a violation of Article 3 after examining the documentation produced on restraint methods which did not indicate the reasons why the use of mechanical restraint became necessary and whether alternative, non-coercive methods were used against the patient, which proved ineffective. 405 Order №92/N of the Minister of Labor, Health and Social Affairs of March 20, 2007 "On Approval of the Instruction on the Rules and Procedures for the Use of Physical Restraint Methods against the Patients with Mental Disorders, para 8. See also CPT standards on Means of restraint in psychiatric establishments for adults, Standards 3.2. and 3.6. available at: <https://rm.coe.int/16807001c3 > [last visited: 30.12.2020]. 406 "Fixation journals", "nursing diaries" and medical cards. 407 Records of LTD Tbilisi Mental Health Center’s fixation journals. 408 CPT standards on Means of restraint in psychiatric establishments for adults, Standard 3.5, available at: <https://rm.coe.int/16807001c3 > [last visited: 30.12.2020]. 409 Law of Georgia on Psyhciatric Care, Article 15.1 123