Report on Conditions in Psychiatric Establishments in Georgia The State should take into account the peculiarity of psychiatric establishments and introduce procurement system in compliance with their needs. PROCEDURES OF PHYSICAL RESTRAINTS Physical restraints of patients – isolation or fixation are subject to regulations by Georgian legislation, as well as international and European standards. These r e g u l a t i o n s a r e a i m e d a t avoiding improper or inadequate use of physical restraints t h a t might cause physical or any other injury to a patient. Article 16 of the Law of Georgia “On Psychiatric Assistance” deals with this issue. Application of physical restraints is also regulated by the Order #92/n of the Minister of Labour, Health and Social Affairs dated March 20, 2007 on Approval of Regulations on Rules and Procedures of Physical Restraints Methods of Patients with Mental Disorders. Article 27 of the Committee of Ministers of The Council of Europe Recommendation Rec (2004) 10 precisely defines this procedure. The same issue is regulated by paragraphs 47-50 of the 8th General Report of CPT. The aforementioned provisions provide that physical restraints shall be used only if the patient poses threat to himself/herself or other parties. Both the Georgian legislation and European standards requires that physical restraints shall be used only in strict compliance with prescribed, defined in advance detailed procedures. Physical restrain could be imposed: at the specially designated places, using special equipment57, in only exceptional cases and only in case it is impossible to control a patient’s behavior using other, less restrictive measures, for the least possible period of time and only in accordance with an express order and approval of a doctor. Physically restrained patient should be under the uninterrupted supervision of the doctor. Every case of fixation shall be registered in the relevant record book. The patient should have a right to appeal the doctors’ decision on physical restraint. These measures shall never be applied as punishment. CPT standards also provide that physical restraints of patients should be applied in accordance with detailed procedures, which clearly state the following: agitated and violent patients should be, to the maximum possible extent, controlled via non-physical methods (for instance, verbal instruction) while in cases, where physical restraints are absolutely necessary, it should be limited to manual control.58 The Committee considers that relevant training of personnel is necessary for managing situations the way that neither patients nor staff members are injured.59 It is recommended to specify the document where the records on restrain procedure is made. As provided in the CPT 8th General Report,62 every detail of the physical restraints should be recorded in a specific register created for this very purpose, as well as in the patient’s personal medical record. The record should indicate time of the beginning and the end of the procedure, name of the doctor who ordered or approved the measure, also any injury inflicted to a patient or staff. During the monitoring it was observed that the practice on physical restraints journal is not consistent in different establishments – some hospitals do not have such records at all (Khelvachauri Psycho-Neurologic Hospital 57 Order #92/N dated March 20, 2007 is the only legal document regulating this issue. It provides: “Special instruments for physical restraint shall be resorted for physical limitation.” 58 CPT 8th General Report, para. 47; 59 Ibid. 60 Order #92/N of the Minister of Labour, Health and Social Affairs dated March 20, 2007 on Approval of Regulations on Rules and Procedures of Physical Restraints Methods of Patients with Mental Disorders, para. 6. 61 Ibid, para. 14. 62 Para. 50. NPM Report 2012 As for the record of physical restraint cases, the Order of the Minister of Labor, Health and Social Affairs on procedures of physical restraints specifies that medical doctor or doctor on duty shall “register the reason, nature, specific times at which the measure began and ended in the medical file of the patient”.“60 As soon as the reasons for restraints are eradicated, psychiatrist makes the decision on termination of measures as well as makes an appropriate record on the case.61