environment. The CPT recommends that the role of security staff at Kutiri Psychiatric Hospital is reviewed accordingly. Similar to the previous years, the situation in ten large facilities operating nowadays remains a serious challenge in the country. The conditions and therapeutic environment existing in ten large operational facilities do not ensure patients’ dignified life and protection of their rights. It is important that the policy making state agencies take effective steps in the shortest possible time to contribute to deinstitutionalising the process and developing community based, among others, family-type services in mental health care.200 5.1. PHYSICAL AND CHEMICAL RESTRAINT The Special Preventive Group shares the spirit of the United Nations Convention on the Rights of Persons with Disabilities (hereinafter the “CRPD”)201 and the approach of the World Health Organisation to mental health care which is rights-based and recovery oriented.202 The Special Preventive Group maintains that the state should facilitate the reduction of the use of means of physical203 and chemical204 restraint against patients in inpatient facilities and their complete eradication. It is noteworthy that the legislation does not determine the de-escalation technique205 as the alternative means to physical and chemical restraint. Therefore, the alternative method (de- escalation technique) to physical and chemical restraint is not applied in psychiatric facilities. The approach of the state and psychiatric facilities do not ensure the reduction and elimination of the resort to physical and chemical restraint. In the opinion of the Special Preventive Group, this is caused by the following factors: the absence of legislative regulation of alternative means to physical and chemical restraint; the absence of legislative regulation of chemical restraint;206 the problem related to 200 Report to the Georgian Government on the visit to Georgia carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 10 to 21 September 2018, (CPT/Inf (2019) 16), para. 123, available in English at: https://rm.coe.int/1680945eca, (accessed 17.06.19). 201Guidelines on article 14 of the Convention on the Rights of Persons with Disabilities, available in English at: https://www.ohchr.org/.../GC/GuidelinesArticle14.doc, (accessed 06.03.2019). 202Quality Rights is WHO’s global initiative to improve the quality of care provided by mental health services and promote the human rights of people with psychosocial, intellectual and cognitive disabilities, 2017, available at:http://www.who.int/mental_health/policy/quality_rights/en/(accessed 06.03.2019). 203 Under Article 16.2 of the Law of Georgia on Psychiatric Care, “Methods of physical restraint are isolation in a specialised ward and/or the physical immobilising of a patient.” 204 Chemical restraint implies forcible administration of medication for the purpose of controlling a patient’s behaviour; see the Means of restraint in psychiatric establishments for adults (Revised CPT standards), p. 2, available at: https://rm.coe.int/16807001c3, (accessed 11.03.2019). 205 De-escalation technique implies immediate assessment of potential crises and prompt intervention; orientation towards the solution of a problem, empathy and reassurance; possessing stress management or relaxation technique such as breathing exercises, allowing personal space; offering a choice and allowing to think. 206 Neither the legislation nor the regulations applying to facilities determine the alternative means to physical and chemical restraint. 76