ANNUAL REPORT OF THE PUBLIC DEFENDER OF GEORGIA 2013 and maintained. In none of the institutions monitored did the administration provide the Special Preventive Group members with a full list of disabled individuals at their respective institutions. In fact, none of the monitored institutions has established criteria to identify people with disabilities. For this reason, it was difficult or, virtually impossible, to check whether the number of the staff members of these institutions was sufficient to support the existing number of disabled individuals – a requirement that must be complied with by any institution having persons with disabilities, according to the United Nations Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. In particular, pursuant to Principle 14, a mental health facility shall have qualified medical and other appropriate professional staff in sufficient numbers (this requirement equally applies to penitentiary institutions having persons with mental health problems (Principle 20, par. 2). During the monitoring, disabled prisoners (convicted and remand prisoners) have not reported about any ill-treatment by the personnel after the election in October 2012. However, the monitoring group received numerous reports about alleged torture and ill-treatment before 2012. According to the prisoners, the acts of torture and ill-treatment often resulted in severe deterioration of health or even disability. Prisoners with disabilities may have special health care needs related to their status. If these needs are not satisfied, their condition may sharply deteriorate in short time period perhaps leading to more limitation of their ability to look after themselves, move and perform other important day-to-day functions. To satisfy these needs, in addition to standard medical assistance, they will need physiotherapy, regular eyesight and hearing examinations, occupational therapy, etc. They also need access to tools and services such as wheelchairs, hearing aids, canes, orthotics, prosthesis, etc. Often times disabled individuals also need assistance with their mental health. Increased mental health care needs have been noted among prisoners who have sensory disabilities (such as visual or auditory impairment) or problems with communicating with other prisoners as these are conditions which are isolating in themselves and such individuals may become victims of psychological abuse and bullying. Medical assistance becomes even more necessary when prisoners with disabilities lack access to a psychologist’s consultation. Ensuring easy access to healthcare services to disabled prisoners is one of the recommendations of the United Nations.104 Although recently the Georgian Ministry of Corrections and Legal Assistance has implemented a series of measures to provide prisoners with timely and effective medical services, the problem of medical assistance remains a major unresolved issue for convicted and accused prisoners with disabilities. The main source of the problem is that the Ministry has not yet identified the special needs of disabled prisoners, which are different from those of other prisoners. In none of the penitentiary institutions did the monitoring group find a single medical professional with updated and contemporary knowledge of how to handle medical problems of disabled individuals. There are no clear standards or guidelines to help these professionals correctly identify and satisfy the medical needs of such prisoners. Lack of these standards and approaches places disabled prisoners in a discriminated position. Save few exceptions, no personal assistance services are available to disabled prisoners (both convicted and untried). In most institutions, bedfast patients (prisoners) are assisted only by and are fully dependent upon the good will of other inmates. Such policy places them in undesirable subordination making them vulnerable to improper manipulation, which may easily grow into oppression and violence. Mental problems of prisoners are either identified by the prison staff belatedly or are not identified at all. Therefore, often times prisoners with mental disorders are punished for disobedience to the regime requirements. Prisoners’ manipulative behavior or protest reactions (such as injuring or poisoning themselves, swallowing different things, etc.) are regarded by the personnel as urgent psychiatric incidents. Because of the lack of professional training, they are unable to prevent auto- and hetero-aggressive behavior or locally assess/manage risks. For this reason, they simply call the ambulance to transfer such prisoners immediately to a psychiatric hospital were the prisoners refuse to receive treatment voluntarily, for various reasons. Because there is no established list of circumstances, in which case a patient must be provided with involuntary treatment, prisoners are then returned back to the institution – something that is heavily frowned at by the administration. Because of protracted diagnostic and legal procedures, convicted and remand prisoners with serious mental disorders are transferred to the National Center of Mental Health with a delay of 2-4 months on average, for involuntary inpatient psychiatric treatment. 104 United Nations Office of Drugs and Crime (2009). Criminal Justice Handbook Series, Handbook on Prisoners with disabilities. ISBN 978-92-1-130272-1. NPM Report 56