Report on Conditions in Psychiatric Establishments in Georgia statements by the personnel whether it became necessary in particular cases, based on patients injures or his/ her comments, to apply to the law enforcement bodies for further investigation. THE REFORM OF MENTAL HEALTH SYSTEM One of the important documents on which the ongoing reform in mental health system is based is Healthcare Strategy of 2011-2015. Para. 4.6 of the Strategy deals with “Mental Health Support” highlighting the necessity of introduction of principles of balanced, integrated and continuous care. To reach this strategic goal, the “state will support” and take active part in improving the quality of rendered services by upgrading the infrastructure, opening new types of mental health centers and increasing skills of medical teams.” The Strategy also deals with introduction of new forms of social services as well as measures aimed at reduction of discrimination. The strategy specifies the modern vision of mental health system – the need of shifting from institutional approach to balanced care model, continuity of service, introduction of new services, the need for qualified personnel who are aware of modern approach in mental health treatment and able to use this knowledge, etc. This document is indeed a step forward, though it cannot replace mental health policy paper that should thoroughly define and identify the reforms and changes necessary in different sectors. At this stage it is necessary that the government takes further logical steps and adopts mental health reform action plan identifying priority measures, time-frames, reform success indicators, responsible agencies, etc. Unless the action plan is adopted, the implemented measures shall not develop logically and be fragmental, also, due to their unplanned character they might cause ambiguity and discontent among the main stakeholders, etc. Creation of children unit at N5 Psychiatric Department Clinic Hospital should be underlined. It is indeed a serious step forward as for decades children have been treated in adults departments. It is also worth mentioning that the unit is the integral part of a multi-profile hospital, which is a positive feature. However, non-existence of a specially arranged courtyard should be assessed negatively as children are basically “locked” in the unit. Unfortunately this 10-bed unit is designed only for children under 15 years; therefore 16-18 years juveniles remain in rather vulnerable position as this age is at high risk in terms of development of different mental health problems. Needs of children and juvenile mental healthcare are rather high, at the same time, are not adequately addressed, so there is a necessity to develop hospital-based, ambulatory-based and community-based services. REFORM WORKING GROUP One of the main prerequisites of success of the reform is full transparency of the process to ensure exchange and correlation of opinions and experience. In December 2010 the Ministry of Labour, Health and Social Affairs created a working group that was responsible for supervising the reform implementation. Unfortunately so-called ex-users were not involved in the process as required by international practice; furthermore, the working group did not define decision-making mechanism and correspondingly long debates did not often result in joint decisions. In addition, the adopted decisions were often changed without consultations with working group. NPM Report 2012 The major shortcoming is that new methods are either introduced in a very limited format or not introduced at all in the newly reformed establishments. Such methods imply to inter alia: introduction of multi-disciplinary groups and case management, promotion of treatment quality safeguards guidelines or integration of psychological treatment methods into the treatment schemes. Unfortunately only medication-therapy approach is employed in almost every acute (short-term) division, which applies to majority long-term divisions as well (f.e. division located on Kavtaradze str.). In addition introduction of internal regulations and schemes such as, for instance, suicide prevention algorithms were only a formality.