Report on Conditions in Psychiatric Establishments in Georgia During monitoring the majority of voluntary patients in all institutions stated their will to be discharged, however they claimed that the decision on discharge is made solely by their doctors and they are not entitled to decide when to leave the establishment. Some patients mentioned that they cannot leave the hospital without permission as they already signed the consent on placement. In Kutaisi Mental Health Centre consent documents in the patient’s medical files were not signed. Nevertheless administration claimed that patients were on voluntary treatment. The interviews with patients at Senaki Psycho-Neurologic Dispensary revealed that some patients were forced to sign the document of consent. Some of them did not understand the meaning and essence of such consent. Khelvachauri Hospital mixed units. In one instance the consent document was not signed while other documents were signed by family members notwithstanding the legal incapability of patient to do it himself. During the interview, the patients claimed that they were forced to sign the consent form or did not understand the meaning of the document. Some patient even said that signature was not his/hers. M. Asatiani Psychiatry Institute. The nurse assistant noted that the doctor provides her the list of patients who could go for walk independently notwithstanding to their status of voluntary or involuntary treatment. The same is true for other establishments, for instance Gudushauri psychiatric establishment. The majority of interviewed patients claimed that they were forced to sign the consent document while they were under the influence of medicine and could not contemplate their behavior. In some instances the policemen who accompanied the patient also attended the procedure. In many establishments it is a practice to tell a patient that if he/she does not sign the consent document he/she will have to stay at the hospital for approximately 6 months, but if they sign the consent document they will remain in establishment for several weeks. (for instance, Qutiri, Referral Hospital). In Hospital N5 the consent of patient was expressed by marking crosses instead o f t h e signature of patient; the consent document was filled in by the doctor (G. P. diagnosis senile dementia). This demonstrates a formal and inadequate approach towards the conscious consent. In medical file of another patient (T.T. diagnosis: grave mental deficiency with pathology of behavior) the consent was also expressed by crosses. In the same facility, in the consent document the words “I am informed” were written by the doctor and patients had only signed the document. *** During the interviews it was revealed thatdoctors on a contrary, consider the aforementioned as progress. They consider that doctor has better knowledge and understanding of patient’s needs and a judge, who usually has no medical background, should not take decisions against doctors position. They also claimed that recently there were very rare instances when the court disregarded the decision of commission on placement. A patient of N5 Hospital also noted that he hardly understood the meaning of the court proceedings as he was intoxicated by drugs. In the same hospital the patient’s medical record included the court decision that prolonged in-patient placement until certain criteria were met and no legal reasoning or justification was provided thereto. Evidently the mentioned decision further confirms the patients’ claim concerning the formality of court decisions. NPM Report 2012 The Special Preventive Group members interviewed the involuntary patients concerning court proceedings. A patient of Hospital # 5 said that he was not allowed to invite his lawyer. The lawyer appointed by State Legal Aid intervened during the proceedings only with one sentence. Other patients also agreed that participation of legal aid advocate was just a formality. They also claimed that the judges usually agree with the opinion of doctor and disregard the patients.