National Preventive Mechanism USE OF PHYSICAL RESTRAINT According to the European Committee for the Prevention of Torture (CPT ), every patient has the right to be free from all kinds of physical restraint unless it (physical restraint) is caused by urgent need. However, even in the latter case, means of restrains may only be used as the last measure and with accurate observance of all terms and procedures. The use of restraint may only be aimed at preventing and controlling violence in emergencies. Physical restraint cannot be considered as a part of a patient’s treatment, since it constitutes a safety measure. Physical restraint must never be used with the aim of punishing a patient or changing/modifying his/her behavior115. According to one of the beneficiaries of the Dzevri Boarding House for Persons with Disabilities, an orderly of the institution “R.B. hits everybody and makes them get up from bed at night; They are sleepy and don’t want to get up.” He also provided the group with information about a beneficiary living in his room, who gets undressed in the morning. For this reason, R.B. ties him to his bed and hits him in the face with an open palm. The presumable victim of abuse confirmed the aforementioned information – “R.B. ties me.” During the interview, he reacted with strong fear and started crying. He bore skin injuries on the lateral surface of his right forearm, near the wrist; Also, on the left edge of his bed sheet, where his hand had been presumably fixated, small dark red spots of (presumably) blood were detected. The first beneficiary demonstrated how R.B. tied the second beneficiary’s hand116. The special log of the institution did not contain any information about the physical restraint of the aforementioned beneficiary. There was no entry saying whether the physical restraint, that took place, had been caused by medical necessity, whether the norms envisaged by the Georgian legislation were complied with,117 when the beneficiary was restrained physically, and whether the restraint had a punitive character. The monitoring experts also received information about physical restraint of an underage disabled person during their visit to the Senaki children’s home. During the monitoring, the experts noticed that in one of the classes a teacher (or a nurse) had fixated 14-year-old B.S.’s hands with her own hands. According to staff members, the child’s hands had been held (by his/her wrists) uninterruptedly for 8-10 hours, because otherwise the child would carry out a self-damaging action. When the experts asked the staff members whether they had any other method of managing children’s self-damaging behavior, the monitoring group received a negative answer; The staff members said that uninterrupted manual restraint of a child’s both hands by a teacher or a nurse was the only method used for this purpose. However, a few hours later, when the experts returned to the same class, they saw that B.S.’s hands were already being restrained by another beneficiary who was the same age. A few more hours later, the monitoring group obtained photos that show that the child’s hands had been restrained (presumably) with a cloth or rope all day long. Other beneficiaries of the institution, independently from one another, confirmed that 14-year-old B.S. had been restrained physically all day long in the period before the monitoring. The March 3, 2005 document of the European Committee for the Prevention of Torture (CPT ) – Standards of the CPT on the Use of Restraints – indicates that the use of physical restraint of children remains a focus of the Committee in medical and social welfare institutions, since it is connected with a very high risk of abuse and ill-treatment, which is an area of particular concern to the Committee.118 A 2007 report of the same Committee says that restraint of patients in front of other patients (beneficiaries) is impermissible and must be prevented without delay.119 115 The European Committee for the Prevention of Torture, Means of Restraint in a Psychiatric Hospital (2006) 22 116 The injuries in the areas of wrists and forearms of both hands, as well as the spot on the bed sheet, have been photographed 117 The Law of Georgia on Psychiatric Assistance; Order 92/N of the Minister of Labor, Health and Social Affairs of Georgia of March 20, 2007, on Approval of the Instruction on the Rules and Procedures of Application of Methods of Physical Restraint of Patients with Mental Disturbance. 118 standards of the CPT on the use of restraints, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT ), march 3, 2005 http://www.cpt.coe.int/en/working-documents/cpt-2005-24eng.pdf 119 Report for 2007 of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT ) http://www.cpt.coe.int/documents/srb/2009-01-inf-eng.pdf www.ombudsman.ge NPM Report