Report on Conditions in Psychiatric Establishments in Georgia Duration of outdoor activities also differ in the establishments. With this respect the old ones offer better conditions to patients as these establishments are usually located on a larger areas surrounded by parks; accordingly the outdoor conditions for patients are much better here (Bediani, Surami, Qutiri, Batumi). Nevertheless, patients of Qutiri Facility complained on the insufficiency of duration of outdoor activities. There is no walking area in Psychiatric Department of M. Asatiani Psychiatry Institute, Hospital N5 and Referral Hospital. In the latter establishment there is a practice of taking smokers (patients) to specially designated smoking areas (special room in the hall) in groups. One patient explained that though he is not a smoker he usually joins the group to leave the department even if he still stays in the building. Contact with the Outside World The CPT standards provide that “[t]he maintenance of contact with the outside world is essential, not only for the prevention of ill-treatment but also from a therapeutic standpoint. Patients should be able to send and receive correspondence, to have access to the telephone, and to receive visits from their family and friends. Confidential access to a lawyer should also be guaranteed.“73 Contact with the outside world for the patients of Georgian psychiatric establishments is quite limited. They are allowed to use telephone, however telephone is usually located in the administrative part of the building or procedures room and a patient can access the telephone only with special permission of personnel. Usually it is difficult to get such permission. Patients of Hospital N5 said that it is problematic to make a phone call. One of them told us that once when he requested the use of a phone he was threatened to be placed in an establishment with stricter regime. The patients of Bediani Hospital may use Magtifix telephone that is installed in procedures room (as confirmed by patients). In Surami Hospital it is problematic to have access to telephone and a patient may use it only with assistance of staff member. As patients of Qutiri Mental Health National Centre note, they are allowed to use telephone very rarely. In a forensic psychiatry unit access to telephone is better guaranteed – the telephones are installed in the halls and patients have better opportunities to freely exercise their right to use them. During the monitoring, there were no complaints regarding impediment of telephone communication. Visits of friends and family members are allowed everywhere. However in the majority of establishments there is no special room for visits. Patients often have to meet with their relatives and family members in the courtyard or wards. THE CONDITIONS AGAINST DE-INSTITUTIONALIZATION OF PATIENTS – NON-EXISTENCE OF EXTERNAL SERVICES As observed by the Monitoring Group and confirmed by the doctors and patients, the majority of patients – so called chronic, long-term patients do not necessitate hospitalization. For them, the psychiatric institution performs the function of social habitation rather than of medical treatment institution and the majority of patients stopped receiving medical treatment years ago. The only reason why the patients continue to live in the psychiatric institutions 73 CPT 8th General Report, para. 54. NPM Report 2012 We have been informed in Khelvachauri Psycho-Neurologic Hospital that the telephone call is sometimes made by social worker and not the patient. Patients may access telephone on a regular basis however with the permission and supervision of a social worker.