CAT/OP/MNG/1 Involuntary placement, legal safeguards and restraint measures 118. Involuntary placement in psychiatric facilities is regulated by chapter five of the Law of Mongolia of 3 January 2013. The purpose of the involuntary placement procedure is to protect patients who are not in a position to provide consent at the time of the hospitalization. However, the Subcommittee notes that the law does not distinguish between involuntary hospitalization and voluntary treatment. Furthermore, there are no specific regulations on the need for patients to give informed consent for their treatment. In addition, there are no external oversight mechanisms, and judicial authorities have no involvement in decisions concerning involuntary hospitalization. 119. The Subcommittee recommends that medical staff systematically seek to obtain the free and informed consent of the patient for both their placement and their treatment. 120. The Subcommittee recommends that steps be taken to ensure that judges regularly review the situation of persons who have been involuntarily placed in such institutions, in order to safeguard the right to liberty of those patients who no longer need to be involuntarily hospitalized. 121. The Subcommittee recommends that the State party adopt legislation clearly setting out and protecting the rights of patients and specifying clear criteria for identifying those exceptional situations in which patients may be placed in psychiatric institutions and treated without their informed consent. 122. The Subcommittee underlines that restraints should be used only as a measure of last resort, never applied as a punishment and used only if no lesser way of controlling an actual risk is available, and they should be removed as soon as possible.21 123. The Subcommittee recommends that voluntary patients should not regularly be restrained against their will. Restraint measures, if absolutely necessary, should only be taken in places specially designated for that purpose, and the restrained patient should be adequately clothed and not be visible to other patients. Staff involved should be properly trained and not be assisted by other patients when applying means of restraint; such means should be applied with required skill and care in order not to endanger the health of the patient or cause unnecessary pain. 124. The Subcommittee also recommends that Mongolia should adopt a comprehensive, carefully developed policy on the application of restraint measures that stipulates the means of restraint that can be used, the circumstances under which they can be used, the practical means by which they might be applied, the permissions and systems of supervision which need to be in place before and during their application, including the duration of their use, and the procedure to be followed following the termination of their use. In addition, all incidents of the use of restraints should be recorded in a special register, and complaint mechanisms, as well as internal and external reporting mechanisms, should be provided for. VIII. Next steps 125. The Subcommittee requests that the State party transmit its reply to the present report within six months from the date of its transmission to the Permanent Mission of Mongolia to the United Nations Office and other international organizations in Geneva. The reply should respond directly to all recommendations and requests for further information made herein, giving a full account of action already taken or planned to be taken, including time frames, to implement them. It should include details concerning the implementation of institution-specific recommendations and concerning more general policy and practice. 22 21 22 The Nelson Mandela Rules, rules 43 and 47–49. The reply should also conform to the guidelines concerning documentation to be submitted to the United Nations Human Rights treaty bodies established by the United Nations General Assembly. 19