ANNUAL REPORT OF THE PUBLIC DEFENDER OF GEORGIA 2013 Lack of medical and psycho-social rehabilitation mechanisms for prisoners is the penitentiary’s one of the major problems which entails severe implications for prisoners with disabilities, since their health and functioning ability directly depend on the availability of rehabilitation services. The same is true for disabled prisoners who have an after-stroke condition and need rehabilitation to retain mobility of their limbs and to avoid complete loss of independent movement ability. Disabled prisoners with amputated limbs or injured backbones are facing the same difficulties. Disabled prisoners’ limited functioning (for example, the fact that they stay in beds for long periods of time and are unable to look after themselves) is a direct result of unavailability of rehabilitation programmes. Had rehabilitation services been provided even to a minimum extent, their illnesses would no longer have such destroying impact. As the UN Convention on the Rights of Persons with Disabilities mentions, disability results from not only illness or condition but also the difficulty of having to interact with an unadapted environment (where no rehabilitation services are provided) which gradually develops into more limitations. The monitoring revealed that disabled prisoners’ access to a complaints mechanism (that is, a box for complaints) is limited: in some cases, prisoners are not aware of the complaints procedure or, those who are aware of it, cannot physically write a complaint and place it in the box. The toilets and washstands in the cells are inappropriate for persons with disabilities (wheelchair users) to satisfy their physiological needs and maintain personal hygiene with due respect for human honor and dignity. Disabled individuals are not involved in any handicrafts and other specific occupation learning courses offered in the penitentiary institutions. The existing educational/handicraft programmes do not take into account the needs of disabled people. Within the monitoring, special attention was paid to the situation at the National Center of Mental Health. The Center provides involuntary inpatient psychiatric assistance within a State Programme for Mental Health. The inpatient services imply the following: “Treatment and provision with additional services (such as protection and security) of patients who have been committed to placement in a hospital for involuntary psychiatric assistance by a court under Article 191 of the Code of Criminal Procedure; additionally, patients undergoing an inpatient treatment course will be provided with meals and items of hygiene as well as with urgent surgical services and therapeutic dental services.”107 The monitoring revealed a series of problems at the National Center of Mental Health. The first group of problems relate to placement of individuals in the hospital for involuntary psychiatric assistance. In particular, based on a report of a panel of psychiatrists, the administration of a psychiatric institution will apply to the court with a template application the form of which is approved by the Order of the Minister of Labor, Health and Social Protection No. 89/N dated 20 March 2007. The only reasoning of the request contained in the application is the text of Article 18(1) of the Law on Psychiatric Assistance108 cut and pasted from the Law verbatim; the author of the application is required to simply underline one of the criteria for committing an individual to involuntary psychiatric assistance. However, these criteria are too general allowing broad interpretation. Patients who have been subjected to this procedure are complaining of the fact that, when deciding whether to extend their stay at the hospital for involuntary psychiatric assistance, courts are not taking their views expressed at the court hearings into account. The above-described law and practice open up the possibility of both unlawfully placing individuals in mental hospitals for involuntary assistance and unlawfully extending their stay at the hospitals even when this is no longer necessary. Establishing a person’s identity is another problem issue. When patients are admitted to a mental hospital, no individual short- or long-term treatment plans are devised; the patient’s strengths and weaknesses are not evaluated and, accordingly, no preventative measures are contemplated. Patients’ aggressive behavior directed against themselves or others are usually prevented by subjecting them to physical restraints and injections of hypnotic anti-psychosis drugs. The way psychiatric incidents are managed contravenes the requirements of contemporary psychiatry and the national standards of disease management. Treatment with psycho-drugs is carried out using high doses of old-generation psychotropic substances for long periods of time and in combination with not-recommended medications – a practice that contradicts modern standards accepted in psychiatry. 107 2013 State Healthcare Programmes, Annex 11: “Mental health” (Article 2, paragraph 2). 108 A person will be committed to involuntary inpatient psychiatric assistance if, because of his/her mental disorder, he/she is unable to make conscious decisions and it is impossible to provide him/her with psychiatric assistance unless he/she is placed in a hospital. In addition, one of the following requirements should be met: a) delayed assistance will endanger the life and/or health of either the patient or others; b) there is a risk of the patient inflicting serious pecuniary damage to himself/herself or others. NPM Report 58