isolation and mechanical restraint - were separated by a third method - manual restraint, which is different from mechanical restraint as at that time the patient is restrained manually without special means.397 Notwithstanding this amendment, there is no updated instruction (hereinafter, the Instruction on Restraint Methods) which will regulate the process of using the restraint methods in detail.398 Before and after the amendment, the psychiatric institutions document only the mechanical restraint for which they use the so-called "Fixation journals". However, as mentioned above, the facts of rapid tranquilization are not properly documented, which in its essence can amount to a chemical restriction and during which the staff applies the method of manual restraint against the patient for forced injection. According to the Law of Georgia on Psychiatric Care, the restraint method is an exceptional measure of last resort used for safety reasons and its use is permissible only when the patient poses a threat to his or her own health or another person’s health and prevention of danger is not otherwise inevitable.399 Examination of "fixation journals", "nursing diaries" and medical cards produced in the institutions reveals that mechanical restraint is still actively used to manage crisis cases in the psychiatric institutions. The growth trend of using mechanical restraint in the LTD Centre for Mental Health and Prevention of Addiction is observed.400 It is noteworthy that physical restraint is usually used in combination with chemical restraint as revealed through the dosage of medications listed in the "fixation journals". Isolation as another method of restraint is also used, however it is not documented. Interviews with the patients of LTD Tbilisi Mental Health Centre revealed a possible incident of resorting to long-term isolation of the patient in the ward. The established practice of restraint methods is explained by the fact that the psychiatric institutions do not have a policy on crisis prevention and use of non-violent (de-escalation)401 management methods that in the end should eradicate the practice of using restraint methods. The institutional management policy is not designed to minimize the risks of escalation and therefore no longer require use of restraint methods. In addition, enhancing the qualifications of the medical staff is particularly important for them to be able to calm a patient verbally or by resorting to other modern methods recognised in psychiatry, also convince and persuade a patient for ensuring the treatment. It is also noteworthy that due to insufficient numbers and inadequate qualifications of medical staff, staff without special qualifications, non-medical staff or patients participate in the process of physical and chemical restraints of psychiatric patients. Against this background, staff do not attempt to find out with the service users the possible causes of the crisis and their priority needs in times of crisis. The shortest and easiest way for unqualified 397 Law of Georgia On Psychiatric Care, Article 16.2. Order №92/N of the Minister of Labor, Health and Social Affairs of March 20, 2007 "On Approval of the Instruction on the Rules and Procedures for the Use of Physical Restraint Methods against the Patients with Mental Disorders. 399 Law of Georgia on Psychiatric Care, Article 16(1). 400 According to the data of the first 5 months of 2019, 64 cases of physical restraint were registered in the institution, while, according to the data of the first 5 months of 2020, 79 cases were registered. 401 Elements of de-escalation techniques are: immediate assessment of potential crisis and prompt intervention; problemsolving orientation; empathy and persuasion; stress management or relaxation techniques such as breathing exercises; allocating space for a person; offering choice; giving time to think. 398 122