master's/equivalent or doctor’s academic degree in the field of social work or the relevant certificate as required by law. It should be particularly noted that the scarce psycho-social rehabilitation measures available at Batumi Medical Centre are intended only for the so-called "quiet" patients.327 Space for occupational therapy is allocated only for women under long-term treatment. Interviews with patients show that "acute" female patients or male patients have never been offered to participate in similar activities. At the same time, the registers produced by occupational therapy instructors show that basically one and the same patients, up to 15 persons, participate in the activities. 4.5. Somatic (physical) health Management of somatic (physical) health problems and access to medical services are still problematic in psychiatric institutions. The Mental Health Programme328 in 2019 did not provide for the monitoring and treatment of somatic (physical) health problems of persons with mental health problems, which may deteriorate their health or may even cause death in some cases.329 Unfortunately, the mental health programme 2020 does not provide for somatic health either.330 The medical cards of the National Mental Health Centre and Batumi Medical Centre do not include the list of clinical-laboratory examinations or consultations provided by specialists for the management of comorbid331 somatic diseases or side effects of medicines. In order to timely identify, refer and treat somatic health problems, it is important to ensure access to a family doctor free of charge in all facilities.332 Patients enrolled in universal health care programme are mainly transferred in case of aggravation of their health condition, as urgent cases, which in most cases is caused by the lack of timely detection of the disease and regular treatment. Regular medical services, including dentistry, require co-financing, but patients do not have enough financial resources for it. Other problems are transportation to another medical facility and purchase of therapeutic drugs for treatment, which are associated with additional 327 This is how the medical staff of Batumi Medical Centre refers to patients undergoing long-term inpatient treatment. 328 Decree No. 693 of the Government of Georgia (2018) on Approval of State Health Care Programmes 2019, Annex 11 - Mental Health (Programme Code 27 03 03 01) 329 See the report on the visit to Acad. B. Naneishvili National Mental Health Centre: <http://www.ombudsman.ge/res/docs/2019101014124916439.pdf> [last accessed: 20.01.2020]. 330 Decree No. 674 of the Government of Georgia on Approval of State Health Care Programmes 2020, 31 December 2019. 331 Concomitant diseases. 332 At Batumi Medical Centre patients are served by a doctor-therapist, whose services are not free. As for the National Mental Health Centre, they do not have a family doctor, although they have specialist doctors and their services are also associated with additional costs. I happens often that patients cannot afford to enjoy these services. 109