Report on Conditions in Psychiatric Establishments in Georgia Bediani Psychiatric Hospital. The Monitoring Group was informed in this hospital that fixation was not applied as the personnel is able to calm the patient down in any circumstances by just talking to him/her. Kutaisi Mental Health Centre. The administration noted that they do not use physical restraint procedures, although they do have a special room if needed. They also mentioned that they plan to receive acute patients and presumably might need fixation. In some establishments the fixation record book is run with defects or there are no entries on restraint duration or other important components. Tbilisi Mental Health Centre. The interviewers mentioned one patient who was systematically subjected to fixation; however there were no relevant entries in the record book. Surami Facility. Only few entries concerning restraints of patients were found in the record book. In addition, such important elements as duration of fixation or signature of doctors were missing. Gudushauri Psychiatric Department . There is no information concerning duration of fixation in the record book for the first half of 2011. The information concerning a decision-making doctor was also missing. In several establishments there are no special instruments of restraint and the patients are fixed with bed-sheets or other handmade materials (Referral Hospital, Tbilisi Mentl Health Centre, Surami, Senaki). In the majority of establishments fixed patient is under supervision of a nurse or nurse assistant, who claim to report to either medical doctor or doctor on duty on every case. There are no indications concerning injections in any record book. As the Monitoring Group was informed, this data is being registered in patient’s personal medical file, which, after double-checking by the Group, proved to be true. Nevertheless, it is recommended to register all medicaments used during the fixation period both in record book and medical file. Maximum duration of fixation differs. According to the record book of Referral Hospital (total 11 cases during 2011), duration of fixation is 15-40 minutes, while average duration, according to personnel, is 20 minutes. Afterwards the patient gets injection. LIVING CONDITIONS AND PHYSICAL ENVIRONMENT At the same time several old hospitals still exist and living conditions of patients are not satisfactory there. Furthermore, these establishments are designed for several hundred patients; dormitories are large and uncomfortable. Such conditions are not recommended for therapy of patients. Living conditions of patients are essential not only for safeguarding respect to and protection of rights of patients, but also for the efficiency of treatment; the CPT stated that adequate living conditions constitute “positive therapeutic environment”.63 Moreover, placement of a patient in inadequate living conditions might be considered 63 8th General Report on the CPT’s activities covering the period 1 January to 31 December 1997, para. 32. NPM Report 2012 The physical environment, and accordingly, the living conditions of patients are not similar in different psychiatric establishments. As already mentioned above, the National Preventive Mechanism welcomes opening of new establishments with refurnished infrastructure and improved conditions for patients. Such facilities are: Rustavi Mental Health Centre, M. Asatiani Psychiatry Institute, Psychiatric Department of Referral Hospital, Psychiatric Department of Gudushauri National Medical Centre, Psychiatric Department of Hospital N5, one division of Republican Clinical Psycho-Neurologic Hospital, Kutaisi Mental Health Centre. In these establishment the living conditions are much comfortable than in the old ones; bed-rooms are usually designed for two patients and equipped with adequate furniture, bedside tables and wardrobes, thus patients are able to keep personal belongings and to have so called personal space.