National Preventive Mechanism provided easily. They also noted that the government programs do not finance routine health problems, but only emergency cases. The written submission of the hospital stated that emergency aid was provided to one patient; while 28 patients were transported for examination during two years (2010-2011). VOLUNTARY AND INVOLUNTARY PLACEMENT A patient may be placed in psychiatric hospital voluntarily or involuntarily. Recommendation of the Council of Europe dated 1983 defines involuntary medical treatment as the admission and placement for treatment of a person suffering from mental disorder in a hospital, other medical establishment or appropriate place without prior request of the patient.76 Such patients should be under special care as any improper approach/treatment or misdemeanor on behalf of medical staff may violate their rights and freedoms. Article 18 of the Law of Georgia on “Psychiatric Assistance” provides that a patient may only be placed in the psychiatric institution against his/her will if s/he has no ability to make conscious decisions and it is impossible to treat him without in-patient placement and he poses threat to himself/herself or third persons or may cause serious material damage. This procedure is laid down in details in article 4 of Order #87/n of the order of the Minister of Labour, Health and Social Affairs. Due to the fact that the procedures for placing involuntary patients are very labor-consuming, including receiving court order to that effect, also systematic review of the court decision, hospitals endeavor to decrease to minimum the number of involuntary patients which is possible through the means provided in chapter below (see chapter “Right to information of patients ”) During the reporting period involuntary patients were not placed in the following institutions: Rustavi Mental Health Centre, Surami Psychiatric Hospital, Kutaisi Mental Health Centre. In addition according to the CPT standards,77 while deciding upon involuntary placement a court shall also consider opinion of an independent external psychiatrist who does not represent the establishment where the patient is placed. The Georgian legislation has not incorporated this provision that shall be considered as the gap of the full protection of patient’s rights. As for the voluntary medical treatment - the law of Georgia on “Psychiatric Assistance” provides that treatment shall be considered as voluntary if a patient is hospitalized based on his/her request and/or gives his/her informed consent; juvenile or legally incapable person shall be hospitalized only after request or informed consent of his/her legal representative.78 The law also provides that such a patient shall be discharged from the hospital at any stage of treatment if the patient so requests.79 If a person does not want to continue treatment but he/she may pose a threat to himself/herself or third persons, the hospital shall resort to involuntary treatment procedures.80 All other cases of rejecting the request on discharge of the patient shall be considered as violation of law. At the present moment the vast majority of hospitalized patients of psychiatric institutions are under voluntary treatment. The voluntary treatment procedure requires that upon admission to the hospital patients sign special documents confirming the consent for treatment. The law requires that this document be kept in the medical file of the patient.81 76 77 78 79 80 81 Rec (83)2, art. 1; http://www.cpt.coe.int/documents/fin/2009-05-inf-eng.pdf, para 138, 139. Article 1, paragraph 1 of the Law of Georgia on Psychiatric Assistance. Ibid, para. 3; Ibid, para. 4; Ibid, para. 2; www.ombudsman.ge NPM Report