legislation provides for the need to establish a patient’s informed consent for hospitalisation and treatment, which must be confirmed in a medical documentation.410 According to the CPT, consent to treatment can only be qualified as free and informed if it is based on full, accurate and comprehensible information about the patient's condition and the treatment proposed.411 The free expression of the patient's will is still problematic in Georgia, both in terms of hospitalization and treatment. Signed informed consent forms were available in all examined medical documentation as it avoids the administrations of the procedure of involuntarily412 placing a person in a hospital.413 Actually most patients sign the informed consent form upon entering a psychiatric establishment unknowingly or forcibly. Most of the patients are brought in by the ambulance, accompanied by police officers and a family member, against the will of the patient. Patients say they do not know what they signed, some of them cannot even remember the fact of signing. While visiting the Senaki Mental Health Center, the members of the Special Prevention Group had a reasonable suspicion that the signature on one of the informed consent forms belonged to the doctor and not to the patient.414 The example of the Tbilisi Mental Health Center also questioned the existence of informed consent, for instance, when the restriction method was used against 19 patients within 15-30 minutes after signing the informed consent. Challenges related to the expression of the patient's will during hospitalization are followed by a chain reaction of the treatment process. Patients are not informed about the methods of their treatment or alteration of the course of the treatment, in order to express informed consent to each modification of treatment strategy and to be fully involved in the process. This is primarily conditioned by the fact that the obligation to obtain informed consents for hospitalization and treatment separately is not determined at the normative level. According to the CPT Standards, even in case of involuntary psychiatric treatment, the admission of a person to a psychiatric establishment on an involuntary basis should not be construed as authorising treatment.415 It is important to provide patients with information about their rights, the essence, methods and duration of treatment, both at the initial stage of hospitalization and later.416 The patient’s informed consent on treatment is crucial, as it concerns the use of powerful psychotropic Law of Georgia on Psyhciatric Care, Article 17.2. CPT Standards, para 41. Available at: <https://rm.coe.int/16806cd43e >, [last visited: 30.12.2020]. 412 During the monitoring conducted in the psychiatric institutions in 2020, involuntary psychiatric care was provided only to a small number of patients. 413 Article 18 of the Law of Georgia on Psychiatric Care regulates involuntary placement of a person in a hospital, according to which, if the doctor on duty decides on the necessity of involuntary placement of a person in a hospital, a commission of psychiatrists must be established within 48 hours which by a majority of votes adopts a reasoned decision and applies to the court. Within 24 hours of application, the court shall review and decide on the issue of involuntary inpatient psychiatric care, which should not exceed 6 months. In addition, the Commission of Psychiatrists shall consider the expediency of continuing involuntary hospitalization every month. Each adopted decision shall be duly substantiated. 414 The signature on the consent form (outline of the letters) was practically identical to the doctor's handwriting. 415 Extract from the 8th General Report of the CPT on Involuntary placement in psychiatric establishments, para. 41. Available at: < https://rm.coe.int/16806cd43e > [last visited: 30.12.2020]. 416 “Every competent patient, whether voluntary or involuntary, should be given the opportunity to refuse treatment or any other medical intervention. Any derogation from this fundamental principle should be based upon law and only relate to clearly and strictly defined exceptional circumstances.” Extract from the 8th General Report of the CPT on Involuntary placement in psychiatric establishments, para. 41, available at: < https://rm.coe.int/16806cd43e > [last visited: 30.12.2020]. 410 411 124