initiative.431 An internal complaint box is located in the LTD Senaki Centre for Mental Health, albeit without any function, as patients have no information about complaint procedures. 4.6. Therapeutic and safe environment Psychiatric institutions shall ensure that patients are treated in a safe and therapeutic environment and in the conditions respecting their dignity.432 During the monitoring visits to the psychiatric institutions in 2020, it is still noticeable that the existing infrastructure, living conditions and sanitary-hygienic condition fail to ensure the treatment of patients in conditions respecting their dignity. Further, the principle of universal design and reasonable accommodation is not ensured in the hospitals.433 The living conditions of patients in the psychiatric institutions inspected during 2020 have not improved. It is noteworthy that the infrastructure of inpatient institutions is not fully or partially adapted for people with mobility and sensory impairments. For example: there is no elevator in the LTD Tbilisi Mental Health Center, and the stairs between the 3rd and 4th floors are depreciated, which creates a risk of falling down. The elevator is functioning at the LTD Center for Mental Health and Drug Prevention, while the LTD Senaki Center for Mental Health is equipped with ramps, although the sanitary-hygienic facilities in both institutions are not adapted to the needs of patients with mobility impairments. Both the buildings and the household inventory are outdated requiring renovation. 4, 5 and 6 patients live in some wards at LTD Centre for Mental Health and Prevention of Addiction and LTD Tbilisi Mental Health Centre making it impossible to ensure the minimum living space set by the standard.434 In addition, in the Center for Mental Health and Drug Prevention the standard of minimum distance435 between the beds are violated while in small wards the beds are practically put next to each other. Lack of personal space, especially against the background of impossibility to engage in meaningful activities outside the ward, negatively affects the health of patients. Not all patients in the wards have a storage room for personal items. Existing closets are still not locked with a key and loss of item often becomes a cause of conflict between the patients. In 2019, In the thematic monitoring report of Ltd., Acad. B.Naneishvili National Center for Mental Health, the Public Defender welcomed the introduction of a Patient Complaints Review Commission, which studies the suggestions and complaints made by patients orally or in writing. See the special report of the Public Defender on Monitoring Ltd., Acad. B. Naneishvili National Center for Mental Health. p. 10, available at: <https://bit.ly/3sIxe9H>, [last visited: 21.01.2021]. 432 Extract from the CPT general report, CPT/Inf(98)12-part. para 32. 433 UN 2006 Convention on the Rights of Persons with Disabilities, Article 4. 434 According to the rules and conditions on issuing a license for medical activities and the permit for an inpatient institution approved by the Resolution N385 of the Government of Georgia of December 17, 2010, the area per patient in the ward should not be less than 8 sq.m. 435 According to the rules and conditions on issuing a license for medical activities and the permit for an inpatient institution approved by the Resolution N385 of the Government of Georgia of December 17, 2010, distance between the beds should not be less than 1.5 meters. 431 128