Health Centre and Batumi Medical Centre made it clear that forced injections, as well the use of physical restraint against formally voluntary patients, still occur in the institutions.309 It is important for the institutions, when using the restraint method, to provide the patient with information on complaints mechanisms. The patient should be able to appeal against the use of physical and chemical restraint personally or through his/her representative, in order to ensure the realization of his/her right to a fair trial enshrined in Article 6 of the European Convention on Human Rights.310 4.4. Psychiatric care Treatment with antipsychotic drugs Psychiatric care at National Mental Health Centre and Batumi Medical Centre is not biopsychosocial in nature and is mainly limited to pharmacotherapy. The Special Preventive Group believes that it is impossible to ensure proper psychiatric care without biopsychosocial approach, which, in addition to pharmacotherapy, implies psycho-social rehabilitation of the patient, taking into account his/her individual needs. One of the problems at the National Mental Health Centre and Batumi Medical Centre is the prescription of several antipsychotic drugs to be taken together. Examination of medical records reveals that in several cases, patients were prescribed two, three, or more antipsychotic drugs,311 including, in some cases, in combination with Zopin (Clozapine).312 According to national clinical practice guidelines, for the majority of patients, except for extraordinary cases, it is recommended to prescribe one antipsychotic drug. It is important to avoid polypharmacy313 in order to prolong the QT interval314 and reduce the risk of sudden cardiac death. 309 The examination of documents made it clear that physical and chemical restraints were applied towards a total of 4 patients at Batumi Medical Centre in 2019, and all 4 of them were under formally voluntary treatment. As for the Mental Health Centre, from April 2018 to April 24, 2019, in the vast majority of cases, physical and chemical restraints were applied towards formally voluntary patients in the civic part of the facility. 310 Judgment of the European Court of Human Rights in the case of M.S. V. Croatia (no. 75450/12) para. 152. 311 The following drugs were prescribed for some patients: Patient 1 - Soliani 400 mg (antipsychotic); Tryptazine 10 mg (antipsychotic); Tisercin 1 amp. (antipsychotic); Cyclodol 2 p. (corrective); Patient 2: Psyzin 10 mg (antipsychotic), Zopin 50 mg (antipsychotic), Tisercin 25 mg (antipsychotic), Cyclodol 4 mg ( corrective); Patient 3 – combination of Sedarex (antipsychotic), Chlorosene (antipsychotic), Tisercin (antipsychotic), Tryptazine (antipsychotic), Cyclodol (corrective); 312 For example, one patient was prescribed Cedarex 4 mg (antipsychotic), Cyclodol 4 mg (corrective), Clopixol 40 mg (antipsychotic) and Zopin 100 mg (antipsychotic). 313 National clinical practice recommendation (guideline) - Treatment and Management of Schizophrenia in Adults, p. 46. Heart rhythm disorder that potentially causes a rapid, chaotic heartbeat. 314 Heart rhythm disorder that potentially causes a rapid, chaotic heartbeat. 106