CAT/C/LVA/CO/6 subjected to reprisals as a result their complaints, including the complaints submitted to the Office of the Ombudsman. Treatment of persons in social care and psychiatric institutions 22. The Committee is gravely concerned about: (a) The absence of legal safeguards concerning involuntary hospitalization, involuntary medical treatment and the application of restraints to persons with intellectual or psychosocial disabilities in psychiatric institutions; and that psychiatric hospitals continue to fail to request the informed consent of patients regarding both their hospitalization and their intended treatment; (b) The placement of children from orphanages, boarding schools and social care institutions in psychiatric institutions for bad behaviour, and their medication with dangerous and obsolete medicines and severe polypharmacy, without consideration of the possible side effects; and possible criminal offences in the children’s psychiatric hospital in Ainazi; (c) The absence of adequate care in social care institutions for the elderly, including the use of medical restraints in lieu of outdoor exercise (arts. 2, 11 and 16). 23. The State party should: (a) Ensure that national legislation provides a proper regulatory framework for social care and psychiatric institutions, including guarantees for effective legal safeguards for all persons with intellectual or psychosocial disabilities concerning involuntary treatment in psychiatric institutions; that such treatment is a measure of last resort, including with regard to decisions to use chemical and physical restraints or coercive force; that such treatment is duly registered and monitored by specialized medical personnel at regular intervals; that any restraints are legal, necessary and proportionate to the individual circumstances; that guarantees of an effective remedy are provided for; and that the persons concerned or their legal representatives are allowed to avail themselves of the right to appeal against decisions; (b) Ensure the right of the patient or his or her legal representative to be heard in person by the judge ordering the hospitalization, and that the court always seeks the opinion of a psychiatrist who is not attached to the psychiatric institution admitting the patient and on the basis of objective medical criteria stipulated in law; (c) Take the necessary measures to ensure that the Ombudsman and other independent monitoring bodies are able to conduct regular and unannounced visits to psychiatric and other social care institutions without any restrictions; establish an independent complaints mechanism; and ensure that recommendations made by the Ombudsman are effectively implemented; (d) Promote psychiatric care aimed at preserving the dignity of patients; investigate effectively, promptly and impartially all allegations of ill-treatment or abuse of persons with intellectual or psychosocial disabilities, children placed in psychiatric institutions, in particular possible criminal offences in the children’s psychiatric hospital in Ainazi, and older persons in social care institutions; bring those responsible to justice, in particular persons using medication on children and medical restraints in lieu of outdoor exercise; and provide redress to victims; (e) Inform the Committee about the outcome of the criminal proceedings relating to the children’s psychiatric hospital in Ainazi; (f) Envisage reforming psychiatric care, including by seeking to increase the use of less restrictive alternatives to the forcible confinement of persons with intellectual and psychosocial disabilities; promote community-based or alternative social care services; and provide the Committee with updated information regarding the process of deinstitutionalizing children and older persons. 8