Report on Conditions in Psychiatric Establishments in Georgia chronic patients, who are placed in these establishments, feel rather depressed due to the aforementioned conditions. As observed by the Monitoring Group, patients enjoy more or less respectful and normal living conditions in the newly opened establishments. Alongside the newly established facilities there are old establishments where heating, warm water and sanitary-hygienic conditions are still a problem. However in some newly established establishments with 24-hour warm water supply patients are not always allowed to use showers whenever they want, instead they have to observe the schedule established by the administration. One of the serious problems of the new establishments is either irrespectively arranged or small courtyards which make it difficult or often even impossible for the patients to spend enough time outside the buildings on fresh air. Notwithstanding the alarming conditions of the living space as well as of the utility rooms in the old facilities, the latter ones offer better conditions in this respect as they are usually located on a vast territory with greeneries, so patients may spend more time outdoors. Community-based services enabling persons with mental disorders to run a normal life in society are still unavailable. This is the very reason why certain number of psychiatric patients is not discharged from the establishments - they neither have a place to go, nor have income for living. Monitoring results showed that improvements were basically achieved in terms of infrastructure while there are no changes in systematic approaches – old treatment methods and practices are still used in the majority of the establishments. Moreover, in some cases the deterioration tendency is observed – the Minister of Labour, Health and Social Affairs introduced new regulations mainly on transparency of financial records aiming at fight against corruption, which do not comply with requirements on protection of confidentiality of information about a patient. During the monitoring process, an emphasis was also made on the system of financing psychiatric facilities which is based on differentiation of acute and chronic patients; this creates obstacles to normal functioning of the facilities. On the one hand, the establishments have to ensure that so called acute divisions always work at maximum capacity; at the same time establishments have to avoid re-hospitalization, otherwise, the quality of treatment might be challenged. On the other hand, financial support of each chronic patient is much less compared to the one of an acute patient; therefore the establishments are often forced to speed up the process of discharging chronic patients from the establishments earlier than needed, often against the interests of such patients. Taking into account the aforementioned the administrations of the establishments have to, in a sense, manipulate with statuses of patients (acute, chronic); this fact proves inflexibility of the financing system that does not comply with real needs of the establishments. The issue of voluntary patients is still acute – their voluntary status is only a formality. The vast majority of such patients are hospitalized involuntarily; often this status is usually granted to avoid the prescribed formalities for involuntary placement or, in some cases, due to social conditions of a patient or his/her family. Despite the ability of the majority of such patients to run independent life and take care of themselves, they are forced to stay at the establishments as they have no income or, in many cases, accommodation. This issue is directly linked to the non existence of community-based services as already highlighted in Public Defender’s Reports. The cases when the voluntary status of the patient is deceivingly preserved “in sake of his/her interests” should be especially mentioned (for instance, a patient is told that in case of involuntary treatment, he/she will not be able to leave the establishment soon). NPM Report 2012 Similar to previous years, system of treatment of somatic and dental diseases is not organized. As clarified on site this issue is not problematic for the establishments that are parts of multi-profile hospitals (Gudushauri Hospital, Referral Hospital); however the Monitoring Group observed that this issue is more relevant in terms of access to treatment. Such services (treatment of somatic and dental diseases) should be financed from the funding allocated for psychiatric treatment. The only exception is emergency services covered by the special state program.