deinstitutionalisation process, envisaging a plan to close large institutions in the foreseeable future, and allocating financial resources for community-based services. The Public Defender’s recommendations regarding the provision of psycho-social rehabilitation services tailored to individual needs and based on the respect for patients' rights in the psychiatric institutions remaine unfulfilled. During the reporting period, not all social workers employed in the psychiatric hospitals, who do not have a bachelor's degree, master's /equal to a master’s or a doctorate in the field of social work, were trained. Institutions still have restrictions on patients' access to telephone communications. The State Agency for Regulation of Medical and Pharmaceutical Activities has not studied the practice of using antipsychotic medications and managing the side effects in the psychiatric institutions. The Public Defender’s recommendation, which required all psychiatric institutions to justify the need for forcible rapid tranquilization, to document in writing the patient's consent to tranquilization, to implement physical monitoring in accordance with the national recommendations on clinical guidelines (guidelines), and reflect the results of this monitoring in medical records, was not implemented. Despite the Public Defender’s recommendations, the institutions still do not provide full treatment for the beneficiaries having physical health problems. No changes were made to the psychiatric care program to address the issue of treating somatic health problems of the patients admitted to a psychiatric hospital. In addition, no changes have been made to the psychiatric care program to manage the side effects of medications through appropriate examinations and consultations in accordance with guidelines existing in the country. In order to protect the right of service users to enjoyment of the highest attainable standard of physical and mental health care,385 it is important to undertake complex and systemic legislative and institutional changes, which primarily require the development of community-based services, the introduction of psycho-social model and other fundamental reforms. The Public Defender hopes that the Ministry will take active steps to implement the systemic recommendations. 4.3. Protecting patients from violence, inhuman or degrading treatment Patients in the psychiatric institutions are not protected from violence, inhuman and degrading treatment. Facts of ill-treatment are manifested in the psychiatric institutions in various forms, scales and severity. Iincidents involving physical violence and verbal abuse of patients by staff in overcrowded psychiatric institutions was evidenced also in 2020. For instance, during the monitoring visit made to LTD Tbilisi Mental Health Centre, patients spoke about beatings, rude and indifferent treatment. During the visit, the Special Prevention Group itself witnessed the incidents where personnel shouted at patients, addressed and replied to them in a rude manner. Patients of the LTD Senaki Mental Health Center did not talk about physical violence by staff, although addressing in an unethical and rude manner remains a problem here as well. Inadequate qualifications and number of personnel is a major cause of ill-treatment, which is even 385 Convention on the Rights of Persons with Disabilities, Article 25. 119