National Preventive Mechanism LTD Kutaisi Mental Health Centre, Qutiri Mental Health National Centre, Senaki Psycho-Neurologic Dispensary), thus they definitely contravene national and international legislation. At other establishments existence of such journal is only a formality, as there are no entries on fixation in the record book whatsoever. (Gldani establishment, Referral Hospital). Kutaisi Mental Health Centre. There is no fixation record book in this establishment. The administration members claimed that they do not run the record book as such procedures are not applied therein. Nevertheless there is an isolation room at the establishment. Qutiri. There is no fixation record book in this establishment; therefore cases of fixation are not being registered here. Qutiri hospital represents that exceptional case where even isolation procedures are being used rather intensively, although neither in this case there is a record book for registration of such practices. Senaki Psycho-Neurologic Dispensary. The fixation journal is neither run in Senaki establishment. The personnel clarified that the relevant entry is made in the nurse’s journal and oral notification is given to the substitute nurse. Isolation measures are also periodically applied in this establishment, however without running a special record book. Khelvachauri Psycho-Neurologic Hospital The administration stated that fixation is not used therein, therefore there is no special record book with registered cases. Sometimes isolation procedure is applied – there are two isolation rooms in male as well as in female units. In these rooms the Monitoring Group found special soft belts for fixation and straitjackets. No record book on isolation cases is run in this establishment. In certain establishments – Gudushauri, Psychiatric Department of Hospital N5, Referral Hospital, Surami Psychiatric Hospital - there is no special room for physical restraints and therefore the fixation of patients is practiced in wards in front of other patients. This indeed is unacceptable practice. As the personnel of the Asatiani Institute clarified fixation takes place upon need, sometimes even in the ward. Similarly, in the Senaki Dispensary, despite the existence of a special room fixation is usually applied in the wards, in front of other patients and sometimes with their help too. The reasons of fixation differ upon establishments. For instance, the Director General of Asatiani Psychiatry Institute stated that main reason for fixation can be refusal to take medication, however medical doctors clarified that fixation is normally not applied in such cases. In the majority of establishments fixation is applied only in cases when the patient poses threats to himself or other persons (Asatiani, Referral). Nevertheless, several rather unusual entries were found in the record book of Referral Hospital. Those are as follows: “Falls down from the bed” (20min); “felt sleepy, but refused to go to bed, was reeling and falling down” (15 min); “felt sleepy, refused to go to bed, made noise, woke up others”(30 min). Hospital N5.One of the patients claimed that he was fixed after he had released another fixed inmate. Tbilisi Mental Health Centre. Female patient of Social Department said that fixation is prohibited therein though she mentioned one patient, L.G., who was sometimes tied for 5 minutes as she liked to enter rooms and take others’ belongings. A male patient of the same department mentioned that fixation was not applied therein; however the practice was used downstairs” (in long-term department). Based on the aforementioned it might be concluded that physical restraints of patients are used as punishment in these establishments that is strictly prohibited. During the interview one patient of the Referral Hospital stated that when a patient is aggressive, personnel twist his arms and fix him. This patient interviewed stated that he was tied himself upon admission to the hospital as he acted aggressively. He was fixed for 10-15 minutes. Another patient mentioned that two days before an interview, new, aggressive inmate was brought and “was tied for half of a day and later released”. www.ombudsman.ge NPM Report