National Preventive Mechanism is the non-existence of the accommodation or income for living in the outside world. In Georgia there are no services to assist the persons with mental disorders to adjust with the outside world. The director of Bediani Facility noted that the majority of patients of this institution may freely live in society, however they have no place to go. The institutionalization of some of the patients is initiated by their own family members. One patient of the Bediani institution stated that he had been undergoing the treatment at psychiatric institution on Asatiani street since 90s. When the territory of Asatiani psychiatric institution was sold, those patients who had no accommodation were taken to other institutions. The majority of patients of Qutiri and Surami institutions have been living there for many years mainly because they do not have other places to live. Senaki Dispensary administration noted that the number of patients at the institution increases during winter season because of the social hardship of patients. During the monitoring it was also observed that another reason for institutionalization of patients is the fact that during dispensary treatment the cost of drugs is not reimbursed and patients cannot afford buying them; thus, they are forced to remain at the hospital as in that case the cost of medicine is financed by the government program. SOMATIC AND DENTAL DISEASES MANAGEMENT Article 5.1.i of the Law of Georgia on Psychiatric Assistance provides that a patient has the right to “receive relevant medical care in a non-psychiatric medical institution”. This provision is of a declaratory character, as it does not specify the relevant methods of implementation. In practice, the issue of managing the non-psychiatric diseases of mental disorder patients is still not decided up to today. During the Monitoring serious shortcoming in psychiatric treatment was observed – regular blood analysis to check existence of leucocytes in blood is not conducted for those patients who undergo Leponex treatment; the international guidelines provide that such patients should be checked on a regular basis as the Leponex treatment might cause decrease of leucocytes in blood that poses danger to life. Presumably this gap is also related to the lack of financing. The directors of institution clarified that one-time allocated finances do not suffice for diagnostics and treatment of somatic and dental diseases; this issue is especially important for the patients who regularly take strong psychotropic medicaments. As directors and doctors noted, they may provide such treatment only based on their personal contacts. The patients are treated in the same establishments if the psychiatric institution operates on the basis of multi-profile hospital. However none of the directors could identify the source and program for financing such treatment and diagnostics. Presumably, in such hospitals the availability of doctors with different specialization is improved while financing is still problematic. As the director of Rustavi Mental Health Centre noted they have to clarify the details of placement of patient with the Ministry of Labour, Health and Social Affairs in every specific instance. They have to contact Tbilisi Catastrophe Service that would send car to take a patient to Tbilisi.74 As recorded, in 2011 only one emergency displacement of patient took place; as for diagnostics and different manipulations, the same letter states that the institution concluded the contract with Rustavi Central Hospital. During 2011 32 patients received consultation services (therapeutic, surgeon, proctologist, ophthalmologist and laryngologist), while 11 patients used laboratory examinations. (including ex-rays, echoscope, electrocardiogram). In M. Asatiani Psychiatry Institute therapist and neurologist provide services to patients. The administration noted that they do not have finances for additional diagnostics and examination. Accordingly they cannot manage 74 It is not clear why Tbilisi medical services provide services to this facility as it is located on the territory of Rustavi Clinical Hospital. www.ombudsman.ge NPM Report