4.3. Physical and chemical restraints The Public Defender shares the spirit of the UN Convention on the Rights of Persons with Disabilities295 and the approach of the World Health Organization in relation to mental health, which are based on a model promoting rights and recovery,296 and believes that the State should promote the reduction and ultimate elimination of the use of physical297 and chemical298 restraints. The Special Preventive Group considers that the approaches of the State and the institutions are not directed towards the abovementioned goal. The Law of Georgia on Psychiatric Care does not clearly indicate the institution's obligation to prevent crises, identify or manage potential triggers and warning signs.299 It is important for the Ministry of IDPs from the Occupied Territories, Labour, Health and Social Affairs, as required by law, to develop a general standard to oblige all psychiatric institutions to develop a mandatory internal document for crisis prevention and management in order to minimize the risks of escalation of the situation and consequently, to avoid the use of extreme measures. The Public Defender and the Special Preventive Group welcome the approval of verbal de-escalation methods300 at the National Mental Health Centre and Batumi Medical Centre. However, the institutions do not use verbal (non-violent) de-escalation methods in practice, because the staff interviewed by the Special Preventive Group did not have information about the above methods. They try to handle crises with wrong methods.301 The use of restraint methods requires special knowledge and special caution, which makes it necessary to train staff and equip them with necessary skills in order to ensure the 295 Guidelines for the definition of Article 14 of the Convention on the Rights of Persons with Disabilities. WHO QualityRights initiative – Improving quality, promoting human rights of people with psuchosocial disabilities, 2017, available at: <http://www.who.int/mental_health/policy/quality_rights/en/>[last accessed: 19.02.2020]. 297 According to Article 16 (2) of the Law of Georgia on Psychiatric Care, "Methods of physical restraint are the isolation of a person in a specialized ward and/or physical binding of a patient." 298 According to the European Committee for the Prevention of Torture, chemical restraint is forcible administration of medication for the purpose of controlling a patient’s behaviour. See the CPT Standards, Introduction, p. 2, available at: <https://rm.coe.int/16807001c3>, [last accessed: 03.01.2020]. 299 Triggers – Situations or stimuli which can lead to a range of emotions, including distress, frustration, anger or agitation, which may escalate into a potentially tense and challenging situation. Warning signs – Changes in the mood, thoughts or behavior that indicate that something is not in order. Identification of such signs is important as far as timely measures may prevent a crisis. For details, see WHO Course Guide - Creating mental health and related services free from coercion, violence and abuse. 300 Order No. 058/2 of the Director General of Ltd. Academician B. Naneishvili National Mental Health Centre on the approval of methods of verbal de-escalation, March 3, 2019. 301 For example, there are so-called surveillance/isolation wards at Batumi Medical Centre for the patients that need strict supervision. The wards are overcrowded, discomfortable and patients are at higher risk of self-harm. 296 104