National Preventive Mechanism The practice in the establishments reveals the formal nature of the voluntary status – notwithstanding his/her status, a patient is not allowed to leave the building independently. There is indeed a list of exceptions defined by doctors, however, they do not take into account either voluntary or involuntary status of the patient, but rather his/ her personal abilities and features. The patients are not duly informed on the methods and duration of treatment in the majority of the establishments. As a rule, such information, if existent as such, is available for the family members or relatives. The patients, in most cases, are not informed on details and methods of their treatment. Similar to previous years, the treatment process basically includes drug treatment; rehabilitation and adaptation programs are rarely and insufficiently incorporated in to the treatment course. This problem is mainly directly linked to the lack in financing – funds allocated for a patient do not suffice to cover rehabilitation measures. It goes without saying that entertainment, cultural and other events are not available – libraries and entertainment or leisure rooms do not exist in the majority of the facilities. It is a positive development that in the majority of the establishments there are social workers and psychologists who are responsible for identifying non-medical needs of the patients as well as for solving different types of their problems. Nevertheless, it shall be noted that in most cases the work of such employees is more of a spontaneous nature and often based on their individual abilities. There are neither government regulations concerning standards of work of social workers and psychologist at the psychiatric establishments, nor any kind of support to their activities or directions of their work. During the monitoring process, the qualification of staff and their work conditions were also examined. Similar to previous years, due reimbursement of lower-level medical personnel (nurses and assistants to nurses) is still an issue. Due to very low wages it is difficult to hire and sustain qualified personnel. As stated by all directors of the establishments, assistants to nurse have undertaken the special trainings on treating patients, including methods of behavior with and fixation of aggressive patients. We consider that these trainings positively influenced the reduction of ill-treatment; however it is necessary to ensure relevant conditions of work and leisure for those lower level medical personnel directly and intensively dealing with patients on a daily basis, as social problems of such employees might influence their relations with patients. Besides, due to the lack of relevant number of lower-level personnel at the establishments, the process of the supervision of patients is not implemented properly. As observed by the Monitoring Group, this very issue creates the necessity of introduction of stricter living conditions (locked windows and doors, rare outdoor walks, etc.). On the other hand, the allocated finances do not suffice to hire medical personnel in line with the needs of the establishments/ patients. Contact with the outside world is vital for patient’s rehabilitation process. As found out during the monitoring, patients are enjoined the right to use a telephone in some facilities. The visits are not limited (the special time-frame is determined for visits) however in the majority of establishments there are no special rooms for visits, so a patient meets the visitor in the ward, courtyard or any other place. None of the establishments employs the specific limitations regarding acceptance of parcels, apart from the prohibition of subjects that are sharp and prickly. ILL-TREATMENT The main priority of National Preventive Mechanism is monitoring of treatment quality at all places of the deprivation of liberty including psychiatric establishments aiming at revelation and prevention of facts of ill treatment. The Monitoring Group notes with satisfaction that no cases of ill-treatment were identified during interviews with the patients at the majority of establishments. Even though some patients mentioned few such cases (described below) these are rather isolated, rare cases of a non-systematic nature. Nevertheless, it is indeed necessary to immediately reveal every such case and to react accordingly. This issue is still pending for every establishment as the www.ombudsman.ge NPM Report