more evident in overcrowded psychiatric insitutions. Further, under the State’s improper supervision, the risk of arbitrariness from the institution is high. The Public Defender reiterates that the state has an obligation to exercise proper oversight,386 to proactively detect and prevent facts of violence against patients by staff, as this falls under its positive obligation.387 The new legislative amendments set an obligation for the Ministry of Internally Displaced Persons from the Occupied Territories, Labor, Health and Social Affairs of Georgia to proactively monitor the quality of protection of the patients’ rights and services in the field of psychiatric care.388 Unfortunately, the order of the Minister of the same agency on monitoring / evaluation rules, conditions and the composition of the monitoring group has not been approved yet.389 There are also incidents involving conflict and inter-patient violence in the psychiatric institutions. This problem is even more serious in large psychiatric institutions where a chaotic, non-therapeutic environment, overcrowding and inadequate living conditions are evident. The insufficient number of staff further worsenes the situation, due to which the staff not only fails to prevent conflict, but also does not undertake rapid respond or fails to undertake at all to the cases of violence between patients. 390 For instance, patients at the LTD Tbilisi Mental Health Center reported that staff arrived late to help the patient beaten by another one, while in one case did not arrive at all. One of the causes of the problem is the lack of an inter-patient conflict prevention strategy in the establishments. Consequently, the staff is unable to identify the dangers posed from the patients. Responding to violence is one of the key components of a conflict prevention strategy. Psychiatric institutions practically leave the conflicts that have already occurred without responding. Institutions are not obliged to document an incident of violence in a special logbook and take appropriate measures to prevent a recurrence of such incident. Patients who are victims of violence do not receive adequate psychological assistance. Leaving incidents of conflict and violence between patients unattended increases the risk of recurrence of conflicts. To ensure a safe and therapeutic environment, it is important, in addition to the Conflict and Violence Prevention Tool, the institutions to have a strategy on measures that should be implemented in the event of conflict and violence. The living conditions in which patients have to live and receive treatment in the psychiatric institutions, amount to ill-treatment. During the visits in 2020, the situation was especially difficult at LTD Centre for Mental Health and Prevention of Addiction. Overcrowded wards, faulty and outdated WCs, unhygienic Judgment of the European Court of Human Rights of 1 February 2018 in the case of V.C. v. Italy, no. 54227/14, paras:8995, available at: <https://bit.ly/2Lq2skO>, [last visited: 29.12.2020]. See also Osman v. the United Kingdom. 387 UN Convention on the Rights of Persons with Disabilities, 2006, Article 14.2. 388 Law of Georgia on Psychiatric Care, Article 261. 389 Law of Georgia on Psychiatric Care, Article 282. 390 It is an obligation of the staff of the psychiatric institutions to take care of the patients, which also includes protecting patients from danger coming from other patients. Report on the visit to Georgia carried out by the European Committee for the Prevention of Torture from 10 to 21 September 2018, (CPT/Inf (2019) 16), para 108, available in English: <https://rm.coe.int/1680945eca > [last visited: 30.12.20] 386 120