National Preventive Mechanism INVOLUNTARY TREATMENT Involuntary placement does not include involuntary treatment. The CPT standards provide that „Patients should, as a matter of principle, be placed in a position to give their free and informed consent to treatment. The admission of a person to a psychiatric establishment on an involuntary basis should not be construed as authorizing treatment without his consent. It follows that 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.“82 Special Preventive Group observed that in every psychiatric establishment of Georgia treatment of patient generally depends entirely upon the doctor who makes unilateral decision. Accordingly forced treatment is often used for both voluntary and involuntary patients. Patients of all establishments declared that it would have been better to receive medicines voluntarily. Some of them even stated that they were threatened by injection if refused to receive medicine. As mentioned above, the refusal to take medicine might also serve as a basis for fixation of patient. All aforementioned violations are tolerated by state control mechanisms. Though the Georgian legislation provides sanctions for violations of involuntary treatment procedures, there are no provisions sanctioning coercive hospitalization of patients on voluntary treatment; therefore, this fact promotes existence of such violations. As indicated in the letter of Asatiani Centre, during 2011 4 employees (a nurse and 3 nurse assistants) were punished for escape of patient. However the letter did not specify the status of patient’s (voluntary or involuntary) placement. Recommendations: To review the status of every voluntary patient in every establishment in order to ensure that the status was attributed in line with his/her will and relevant law; To establish strict control by relevant units of the Ministry of Labour, Health and Social Affairs over protection of rights of voluntary patients and to ensure relevant legal safeguards for involuntary patients. RIGHT TO INFORMATION OF PATIENTS Recommendation of the Committee of Ministers of the Council of Europe dated 2004 provides that persons subject to involuntary placement or involuntary treatment should be promptly informed verbally and in writing of their rights and of the remedies open to them. They should be also informed of the reasons of the decision and the criteria of its possible extension and termination.83 Patients should be informed in the form and language understandable to him/her of any information mentioned in the previous paragraph, as well as of the rules in the establishment and any issue of his/her interest. CPT standard provides: “Regular reviews of a patient’s state of health and of any medication prescribed is another basic requirement. This will inter alia enable informed decisions to be taken as regards a possible de-hospitalization or transfer to a less restrictive environment. A personal and confidential medical file should be opened for each patient. The file should contain diagnostic information (including the results of any special examinations undergone by the patient) as well as an ongoing 82 83 CPT 8th General Report, para. 4. Rec(2004)10, art. 22; www.ombudsman.ge NPM Report