Foundations of Legal Regulation of Mental Health
The sphere of mental health in Georgia is governed by a special law that sets the rules for the application of restraint to a patient, involuntary inpatient psychiatric care, forced psychiatric treatment within criminal justice, forensic psychiatric examination, and the protection of medical secrecy. The essence of these rules is uniform: psychiatric care must be as least restrictive as possible, every harsh measure must be duly justified, and the patient must enjoy a real possibility of judicial control and appeal. Below we explain each institution on the basis of the provisions that govern this field.
The Application of Restraint to a Patient
For the purpose of controlling the violent behaviour of an inpatient, restraint may be applied. According to the law, restraint is an extreme, exceptional measure: it is used only when the danger of the patient harming himself, herself or others is inevitable and cannot be avoided by verbal calming or medication. Restraint is a security measure and has no therapeutic purpose; its use for punishment or intimidation by any method is prohibited. During restraint the patient must be provided with appropriate supervision and support, and the head of the institution must be regularly informed of its application. For a patient in voluntary treatment, the application of restraint requires a review of the treatment status.
The law distinguishes three methods of restraint: manual restraint, meaning control of the patient by manual means; mechanical restraint, meaning the use of restraint instruments for immobilization; and isolation, meaning the forcible solitary confinement of the patient in a specialized room. In selecting a method, preference must be given to the less restrictive mechanism, and the patient's previously expressed opinion on the preference of a particular method, together with accumulated experience, must be taken into account. The method applied must be proportionate to the danger emanating from the patient. The combined use of several methods is permissible only in order to reduce the duration of restraint or to prevent serious harm to the patient or others. Restraint must be applied for the shortest possible period, and all methods must cease as soon as the danger is eliminated. The patient, the legal representative, or, in the absence of one, a relative, has the right to appeal to court the propriety of the applied restraint method. The rules and procedures of restraint are established by an instruction approved by the appropriate order of the minister of health.
Involuntary Inpatient Psychiatric Care
A person receives involuntary inpatient psychiatric care only where, due to a mental disorder, the person lacks the capacity to make an informed decision; the provision of psychiatric care is impossible without placement in an inpatient facility; and a delay in care would endanger the life or health of the patient or others, or the patient may through his or her own actions suffer or cause to another significant material damage. In such a case the consent of the patient, the legal representative or a relative is not required. The need for involuntary care is determined by an emergency care physician or a physician holding an appropriate certificate, and law enforcement bodies are obliged, upon request, to ensure the placement of the patient in the inpatient facility.
The procedure is strictly defined. Preliminary involuntary placement is decided by the duty physician, and that moment counts as the beginning of involuntary treatment. Within 48 hours of placement, a commission of psychiatrist physicians must examine the patient's condition and decide on the propriety of the care; the decision is taken by majority vote, a tie is resolved by the clinical head of the institution, and a dissenting opinion is attached in writing. If the commission finds the care unjustified, the patient must be discharged immediately. If the commission concludes that the criteria exist, the administration applies to the court within 48 hours of placement for an order; the decision is immediately communicated to the patient, the representative or the relative, and in the case of a foreign citizen, to the diplomatic mission. The court is obliged to examine the application within 24 hours of its receipt under the Administrative Procedure Code; the participation of the patient is mandatory, the patient's interests are represented by the legal representative or a relative together with an attorney, and if the patient has no attorney, one is appointed ex officio at state expense. By court decision, involuntary care is provided until the criteria are exhausted, but the term must not exceed 6 months. The commission is obliged to review the propriety of continuation monthly. If continuation beyond 6 months is considered necessary, the administration applies to the court no later than 72 hours before the expiry of the 6 month term, and the court decides within 72 hours of the application; such extensions are permissible without limitation until the criteria are exhausted. Upon exhaustion of the criteria, the patient is discharged by decision of the commission, the court is immediately notified, and further treatment continues on a voluntary basis with the patient's consent, which is recorded in the medical documentation and confirmed by the patient's signature. The patient, the representative, the relative and the administration may appeal the judge's order or ruling on placement, refusal or extension under the Administrative Procedure Code.
Forced Psychiatric Treatment in Criminal Proceedings
A court examining a criminal case is empowered to apply forced psychiatric treatment to a person where two grounds exist: due to a mental disorder the person lacks the capacity to make an informed decision and care cannot be provided without inpatient placement, and at the same time there exists a risk of harm, threat or violent behaviour by the person to himself, herself or another person. The person is placed in an inpatient facility on the basis of a court ruling and only in a facility where special protection is ensured and a system of measures directed at risk reduction, resocialization and improvement of mental health is in place, as determined by the minister's order. Placement is for the term defined by the ruling, counted from the moment of placement. A special commission of the psychiatric facility is obliged to assess, once a year after placement, the existence of the grounds, and the treating physician may request an early assessment. If the grounds are eliminated, the patient must be discharged immediately; at the expiry of the term defined by the ruling, the patient must be discharged if no involuntary care criteria exist, and if such criteria exist, the administration applies to the court for care under the involuntary procedure. After discharge the person is obliged to register with the nearest outpatient psychiatric facility at the place of residence.
Forensic Psychiatric Examination and Medical Secrecy
Only an institution licensed by the relevant ministry and the state forensic expert institution may conduct forensic psychiatric examinations. It is prohibited for investigative bodies or institutions subordinate to them to conduct such examinations, a guarantee that insulates the expert from the investigation. The examination is secured and financed by the commissioning body or from state programme funding.
Information about a person's mental condition stands under medical secrecy. A person who, in the performance of official duties, learns of another person's mental disorder and deliberately or negligently uses that information to the detriment of that person or a third party bears liability under the legislation. Confidential information is accessible only to persons directly involved in treatment and scientific research. Data on mental health are entered into a unified information database administered by the ministry, and obtaining data from that database is permissible only in cases defined by law. Disclosure to third parties is possible with the consent of the patient or the legal representative, or by a court decision. A breach of confidentiality is also permissible where the life or health of the patient or a third party is endangered: in that case the decision is taken by the administration of the facility, and the information is provided only to the legal representative or, in their absence, a relative.
Frequently Asked Questions
For how long may involuntary treatment continue by court decision?
By court decision, involuntary inpatient psychiatric care is provided until the criteria are exhausted, but the term must not exceed 6 months. For extension, the administration applies to the court no later than 72 hours before expiry; the court decides within 72 hours, and extensions are possible until the criteria are exhausted.
Who may appeal the application of restraint in a facility?
The patient, the legal representative and, in the absence of one, a relative. Restraint is admissible only as an extreme, exceptional measure; its use for punishment or intimidation is prohibited.
How quickly does a court examine involuntary placement?
The court must examine the application within 24 hours of receipt. Before that, within 48 hours of placement, a commission of psychiatrist physicians decides on the propriety of the care.
Who may conduct a forensic psychiatric examination?
Only an institution licensed by the relevant ministry and the state forensic expert institution. Conducting the examination by investigative bodies or their subordinate institutions is prohibited.
How We Help on Legal.ge
The advocates of Legal.ge provide protection in every procedure of the mental health sphere: assessing the legality of restraint, participating in court examinations of involuntary placement, appealing orders, and protecting medical secrecy. Contact us — we will assess your case and plan an effective legal defence.