National Preventive Mechanism as inhuman and degrading treatment. Good living conditions are important not only for patients, but for personnel too.64 Aforementioned is the very reason why living conditions of patients fall within particular interest of the Monitoring Group. It should be mentioned that the tendency of replacing large-capacity psychiatric establishments with the small capacity ones is indeed a positive trend, as provided by the CPT standards. The Committee considers that large psychiatric establishments pose a significant risk of institutionalization for both patients and staff, the more so if they are geographically isolated. This can have a detrimental effect on patient treatment.65 Living environment The 8th General Report of CPT provides detailed provisions on living conditions of persons with mental disorders. As the Committee considers, „creating a positive therapeutic environment involves, first of all, providing sufficient living space per patient as well as adequate lighting, heating and ventilation, maintaining the establishment in a satisfactory state of repair and meeting hospital hygiene requirements.“66 The recommendation of the Council of Europe provides that facilities designed for the placement of persons with mental disorder should be as close as possible to normal, family conditions.67 The infrastructure of old establishments does not comply with the aforementioned requirements (Surami, Bediani, Qutiri, and Khelvachauri). These establishments have quite good natural light and ventilation; nevertheless due to conditions of infrastructure, age of the facilities themselves, poor state of repair, it is impossible to ensure adequate sanitary-hygienic conditions. Due to the large size, these establishments are not heated properly and the hot water is provided with limitations. Furthermore, in case of large-capacity dormitories, it is impossible to create comfortable environment for patients, neither can they have their personal space (bed-side table, wardrobe, etc). The CPT states: „The importance of providing patients with lockable space in which they can keep their belongings should also be underlined; the failure to provide such a facility can impinge upon a patient’s sense of security and autonomy.“68 The Committee also notes: “The CPT also wishes to make clear its support for the trend observed in several countries towards the closure of large-capacity dormitories in psychiatric establishments; such facilities are scarcely compatible with the norms of modern psychiatry. Provision of accommodation structures based on small groups is a crucial factor in preserving/restoring patients’ dignity, and also a key element of any policy for the psychological and social rehabilitation of patients.”69 Based on the same reason it is impossible to create “visual stimulation”70 recommended by the Committee - adequate decoration of dormitory, living space and recreational areas. The newly created small-capacity establishments with only double-occupancy wards promote creation of positive environment for patients. On the other hand, the doors of wards in these establishments are partially glassed that prevents creation of comfortable environment in the room as everybody can look inside from the halls. According to female patients, this circumstance is of particular discomfort for them, as newly opened establishments are for both, women and men patients. Sanitary-hygienic conditions of the new establishments are generally satisfactory. Except for natural ventilation problems, these establishments have comfortable environment for patients (Gudushauri, Asatiani, Hospital N5, Rustavi, Kutaisi, mixed unit of Khelvachauri establishment, Referral Hospital). Lack of fresh air causes serious discomfort for the patients, especially in the absence of ventilation. 64 Ibid. 65 Ibid, para. 58. 66 Ibid, para. 34. 67 Rec(2004)10(2004)10, art. 9; 68 8th General Report on the CPT’s activities covering the period 1 January to 31 December 1997, para. 34.. 69 Ibid, . para. 36. 70 Ibid, .para. 34. www.ombudsman.ge NPM Report