On Psychiatric Care

LAW OF GEORGIA

ON MENTAL HEALTH

Law of Georgia No 6360 of 23 June 2020 – website, 1.7.2020

Georgia, as a democratic state, recognises that mental health is a fundamental aspect of human health and is an indispensable condition for the well-being of society, and that the protection of the rights of people with mental disorders is an obligation of the State, and by this Law determines the legal and organisational basis for psychiatric support.

Chapter 1 – General Provisions

Article 1 - Objectives of the Law

The objectives of this Law are the following:

a) to ensure access to and the continuity of psychiatric care for people with mental disorders, and the protection of their rights, freedoms and dignity;

b) to determine the rights and obligations of persons working in the field of psychiatry.

Article 2 - Scope of the Law

1. This law determines the forms for providing psychiatric care for people with mental disorders, and the rights of such people, as well as the rules and conditions relating to the activities of persons working in the field of psychiatry.

2. This Law shall apply to citizens of Georgia, stateless persons and citizens of foreign countries who are in the territory of Georgia, who need psychiatric care.

Article 3 - Legal basis for psychiatric care

The legal bases for psychiatric care shall be the Constitution of Georgia, the treaties and international agreements of Georgia, this Law, and other legislative and subordinate statutory acts.

Article 4 – Terms used in the Law

For the purposes of this Law, the terms used herein shall have the following meanings:

a) mental disorder – a group of symptoms manifesting a disorder of the basic mental functions or behaviour, which cause personal dysfunction and disturb the process of adaptation of a person to the environment. A mental disorder shall be diagnosed on the basis of international medical standards;

b) patient – a person with a mental disorder who is provided with psychiatric care;

b¹) beneficiary of care – a person recognised by a court as a beneficiary of care in accordance with the rules provided for by the civil legislation of Georgia;

c) psychiatric care – a set of measures aiming at the examination and treatment of a person with a mental disorder and the prevention of exacebration, and the facilitation of social adaptation and community reintegration of a person with mental disorder;

d) psychiatric institution – a medical institution with the relevant right or its division, activities of which aim at providing psychiatric care and/or psychosocial assistance to a person;

e) persons working in the field of psychiatry – physicians, psychologists, nurses, caretakers, social workers or other persons who are entitled to provide psychiatric care to people with mental disorders, on the basis of qualifications granted in accordance with the rules established by the legislation of Georgia;

f) capacity to make a conscious decision – ability of a person to evaluate his/her own mental health, the goal of medical intervention and the expected result of medical treatment;

g) legal representative of a patient – a parent if the patient is under 16, or a patient's guardian or caretaker;

h) relative of a patient – a parent, child, spouse, sibling, grandparent, grandchild and/or other lineal ascendant and descendant, or a person permanently living with the patient;

i) person under examination – a person who is examined for the purposes of evaluating his/her mental condition;

j) informed consent – the consent of a person or his/her legal representative on receiving psychiatric care after the delivery of complete, objective, timely and comprehensible information about his/her disorder and medical intervention;

k) committee of psychiatrists – a committee composed of at least two specialists, which is making a decision in accordance with the rules provided for by this Law;

l) clinical head of a psychiatric institution – a member of the administration of a psychiatric institution who is leading the process of psychiatric support;

m) risk assessment – a preliminary assessment of the behaviour of a person with a mental disorder in relation to the risks of injury, threat and/or violence against to himself/herself and/or other persons;

n) compulsory psychiatric treatment – a special type of inpatient psychiatric support consisting of a system of measures ensuring the resocialisation and improvement of the psychiatric health of a person with a mental disorder and the mitigation of behaviour of a person with a mental disorder who risks injury, threat and/or violence to himself/herself and/or other persons;

o) system of measures ensuring risk mitigation, resocialisation and improvement of psychiatric health – a system comprising medical and psychosocial interventions;

p) special committee of a psychiatric institution – a committee operating in a psychiatric institution for the purposes of the evaluation of the psychiatric health of a patient subject to compulsory psychiatric treatment, whose composition and rules of operation are determined by an ordinance approved by the Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia;

q) mental health – well-being of a person, including the social, mental, cognitive and emotional aspects, namely, the state when he/she manifests and exercises own abilities, copes with regular, everyday stresses and can work efficiently and fruitfully, and contribute to civil life;

r) psychosocial assistance – a combination of measures aimed at providing psychosocial support to a person with mental disorder, maintaining/developing his/her social contacts and ability to work, and facilitating the integration of this person into society;

s) community mental health services – the delivery to a person with mental disorder of such a service close to his/her place of residence, which will provide the service recipient with appropriate care and which is aimed at supporting his/her mental health and facilitating his/her social adaptation, integration into society and the maintenance/development of his/her ability to live independently;

t) assessment instrument – in psychiatric institutions and community mental health services, a standardised questionnaire for assessing the protection of patients’/service recipients’ rights and the quality and conditions of services (the ‘standardised assessment questionnaire’), which is approved by an appropriate order of the Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia.

Law of Georgia No 2530 of 26 July 2014 - website, 6.8.2014

Law of Georgia No 3341 of 20 March 2015 - website, 31.3.2015

Law of Georgia No 3123 of 5 July 2018 – website, 11.7.2018

Law of Georgia No 6360 of 23 June 2020 – website, 1.7.2020

Chapter II – Patient’s Rights and Protection Guarantees

Article 5 - Patient's basic rights

1. Patients shall be entitled to:

a) receive humane treatment which shall exclude any degrading measures;

b) receive appropriate treatment deemed necessary by medical indication with minimal restriction of conditions, as near to his/her place of residence as possible, and using methods approved by the Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia;

c) receive complete, objective, timely and comprehensible information about his/her disease and any proposed medical intervention; if a patient is incapable or is unable to make a conscious decision, the information shall be delivered to a legal representative of the patient, and in the absence of such, to a relative of the patient;

d) become familiar with his/her medical records; a physician shall determine the amount and form of the information included in medical records to be delivered to a third party;

e) reject medical treatment; this right is limited in the cases provided for in Articles 16, 18 and 22¹ of this Law. If a patient is under 16, a legal representative of the patient, or in the absence of such, a relative of the patient (the participation of the patient in the decision-making process shall be necessary taking into account the age and mental health condition of the patient) shall be entitled to make a decision about the provision of treatment;

f) enjoy the services of lawyer. A psychiatric institution shall arrange a meeting of a patient with a defence lawyer without the presence of a third party, except when this is not permitted because of the mental condition of the patient;

g) complain and appeal to a court and submit an application to other government agencies;

h) participate in elections;

h¹) participate in private legal relations, except those private legal relations, in relation to which a beneficiary is receiving care that has been granted by the court;

i) receive appropriate medical assistance in a non-psychiatric medical institution;

j) enjoy social protection in accordance with the legislation of Georgia;

k) enjoy recreational and leisure services;

l) receive education, vocational training and retraining;

m) enjoy other rights and freedoms provided for by the legislation of Georgia.

2. A lawyer and/or a legal representative of a patient shall be entitled to examine any kind of medical records about the patient and ask for copies. Requests for the examination of medical records and for the receipt of copies shall be submitted in writing to the administration of the psychiatric institution.

Law of Georgia No 2530 of 26 July 2014 - website, 6.8.2014

Decision No 2/4/532,533 of the Constitutional Court of Georgia of 8 October 2014 - website, 28.10.2014.

Law of Georgia No 3341 of 20 March 2015 - website, 31.3.2015

Article 6 - Partial restriction of patients' rights

1. The restriction of a patient's professional activities shall be determined in accordance with rules established by the legislation of Georgia. The list of these professions shall be approved by an order of the Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia.

2. A patient's rights shall not be restricted only on the basis of a mental disorder. Any kind of restriction determined by the legislation of Georgia shall be based not only on the diagnosis of a mental disorder of a person but also on his/her mental condition and degree of social adaptation.

3. Restriction of a patients' rights as determined in Article 5(1)(k) and (l) of this Law shall be permitted in the cases provided for in Articles 18 and 22¹ of this Law if the implementation of the said rights is impossible either due to the nature of the involuntary inpatient psychiatric care or the compulsory psychiatric treatment.

Law of Georgia No 2530 of 26 July 2014 - website, 6.8.2014

Article 7 - Recognition of patients as beneficiaries of psychiatric care

1. Only a court is entitled to recognise patients as beneficiaries of psychiatric care.

2. The administration of a psychiatric institution shall apply to the court with a request to recognise a patient as a beneficiary of psychiatric care and to impose psychiatric care for the patient if a committee of psychiatrists considers that the patient has well founded psychiatric, mental/intellectual impairments which, in interaction with various barriers, may impede his/her full and efficient participation in social life on an equal basis with others.

3. A court shall make a decision on the recognition of a patient as beneficiary of psychiatric care in accordance with the rules provided for by the legislation of Georgia.

4. In the case provided for by paragraph 2 of this article, a legal representative of the patient, or in the absence of such, a relative of the patient shall immediately be informed by the administration of a psychiatric institution of the fact that the institution had applied to the court.

Law of Georgia No 3341 of 20 March 2015 - website, 31.3.2015

Chapter III – Psychiatric Care

Article 8 - Psychiatric care

1. A person with a mental disorder shall be provided with psychiatric care on the basis of a necessary medical indication, based on their own request and/or their informed consent, except in the cases provided for in Articles 16, 18 and 22¹ of this Law.

2. Patients under the age of 16 shall receive psychiatric care on the basis of the request and/or informed consent of their legal representatives (the participation of the patient in the decision-making process shall be necessary taking into account the age and mental health condition of the patient).

3. Within the scope of their competence, psychiatrists shall make decisions independently and shall be guided only by necessary medical indications and professional ethics when providing psychiatric care, and shall act in accordance with the legislation of Georgia.

4. Only methods determined by an order of the Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia shall be used during the examination, treatment and psychosocial rehabilitation of patients.

Law of Georgia No 2530 of 26 July 2014 - website, 6.8.2014

Law of Georgia No 3341 of 20 March 2015 - website, 31.3.2015

Article 9 - Examination and diagnosis

1. A mental disorder shall be diagnosed in accordance with standards approved by the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia. A person may be diagnosed with a mental disorder by a physician holding an appropriate certificate.

2. Merely professional or family conflicts, or discrepancies with moral, religious, cultural or political values prevalent in society, shall not form the basis of a diagnosis of mental disorder.

3. The fact of having treatment in a psychiatric institution in the past shall not be considered as a decisive factor when evaluating the current mental condition of a person.

4. When examining a patient, a psychiatrist shall introduce himself/herself to the patient and explain the purpose of the examination, except where such action might exacerbate the condition of the patient. A decision on the restriction and/or non-delivery of information, as well as the basis of such a decision, shall be indicated in the medical records.

Article 10 - Treatment

1. Treatment shall be provided on the basis of the consent of a patient, or if the patient is under 16, on the basis of the informed consent of the patient's legal representative, which shall be confirmed in the medical records by the signature of the patient or the patient's legal representative.

2. If a patient waives treatment, it shall be indicated in the medical records.

3. Treatment by active biological methods (shock therapy, convulsive therapy, etc.) shall be permitted only in the case of an appropriate medical indication, with the informed consent of the patient or his/her legal representative, and only on the basis of a decision of a commission of psychiatrists.

Decision No 2/4/532,533 of the Constitutional Court of Georgia of 8 October 2014 - website, 28.10.2014.

Law of Georgia No 3341 of 20 March 2015 - website, 31.3.2015

Article 11 - Financing psychiatric care

1. The sources of funding psychiatric care are the following:

a) state financing;

b) fees paid by the patient;

c) grants and other donations;

d) other income permitted by the legislation of Georgia.

2. The State shall provide psychiatric care of persons with mental disorders through financing programmes and financing targeted programmes.

Chapter IV – Primary Psychiatric Examination

Article 12 - Objectives and grounds of primary psychiatric examination

1. Primary psychiatric examination is the examination of a person by a physician when the physician has no information on the mental condition of the person. Primary psychiatric examination shall be performed by a physician holding an appropriate certificate.

2. The purpose of primary psychiatric examination is to determine whether a person:

a) has a mental disorder;

b) needs psychiatric care.

3. The basis of primary psychiatric examination is:

a) the request of the person to be examined;

b) the request of a legal representative of a person under 16 (the participation of the person to be examined shall be necessary taking into account his/her age and mental condition);

c) the written request of a legal representative, a relative or a physician of a psychiatric institution with or without the consent of the person to be examined if the behaviour of the said person gives rise to a reasonable belief that his/her mental disorder threatens his/her life and health and/or those of other persons.

Article 13 - Conditions of primary psychiatric examination

Primary psychiatric examination shall be performed in a psychiatric institution or, in exceptional cases, at home; the examination shall be performed in such an environment as to protect the life and health of the physician.

Chapter V – Organisational Forms of Psychiatric Care

Article 14 - Outpatient psychiatric care

1. Appropriately licensed inpatient psychiatric institutions shall perform the primary psychiatric examination, and provide treatment for, and if necessary observation of, a patient.

2. Except for cases provided for by Article 22¹(8) of this Law, when applying to an outpatient psychiatric institution, a patient, or if the patient is unable to make a conscious decision or is under 16, his/her legal representative, shall be entitled to:

a) choose a psychiatric institution and a physician;

b) terminate the examination and/or treatment at any stage.

3. If involuntary inpatient psychiatric support is needed, an inpatient psychiatric facility shall take appropriate measures to place the patient in the psychiatric facility in order to provide inpatient treatment. The physician in charge shall inform the patient, his/her legal representative or, in the absence of such, the patient's relative, about the decision; the administration of the outpatient psychiatric institution, if necessary, shall apply to appropriate law enforcement bodies for help.

4. The rules of registration and deregistration of patients in outpatient psychiatric institutions, as well as the rules of observation of patients, shall be determined by an order of the Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia.

Law of Georgia No 2530 of 26 July 2014 - website, 6.8.2014

Law of Georgia No 3341 of 20 March 2015 - website, 31.3.2015

Article 15 - Inpatient psychiatric support

1. Inpatient psychiatric support shall be voluntary except in the cases provided for in Articles 16, 18 and 22¹ of this Law, and shall be provided to patients when necessary by medical indication in an inpatient psychiatric institution with an appropriate permit (hospital).

2. A patient placed in a hospital shall have the right to:

a) receive and send letters and parcels without checking;

b) use telephone and other means of communication in accordance with the internal regulations of the hospital;

c) receive visitors at a specified time and place without the presence of a third party;

d) leave hospital for a short period of time without deregistering from the hospital, taking into account his/her mental condition;

e) buy and keep articles of daily necessity;

f) perform religious rituals unless it violates the rights of others;

g) receive audio-visual information;

h) participate in sports and cultural events organised in the hospital;

i) enjoy other rights determined by Article 5 of this Law.

3. When extremely necessary, physicians shall be authorised to restrict the said rights of patients for security purposes, except the rights provided for by Article 5(1)(a), (f), (g), (i) and (j) of this Law. A decision made by a physician shall be indicated in the medical records.

3¹. The administration of a psychiatric institution shall, on the basis of an affected person’s application, ensure that a person, who had been criminally prosecuted for committing domestic violence provided for by Article 126¹ of the Criminal Code of Georgia, or a domestic crime provided for by Article 11¹ of the same Code, and who, under Article 191(2¹) of the Criminal Procedure Code of Georgia, has been placed in a hospital for compulsory treatment, does not have the possibility of communicating with the affected person using the means defined in paragraph 2(a) and (b) of this article.

3². The procedure established by paragraph 3¹ of this article shall also apply to a case when a person had been criminally prosecuted for committing domestic violence provided for by Article 126¹ of the Criminal Code of Georgia, or a domestic crime provided for by Article 11¹ of the same Code and he/she was placed in a psychiatric institution for receiving non-voluntary inpatient psychiatric support in accordance with Article 191(3) of the Criminal Procedure Code of Georgia, or the Penitentiary Code.

4. The labour activity of a hospitalised patient shall be voluntary and shall have only therapeutic and rehabilitative purposes and shall be carried out on the recommendation and with the observation of a physician.

4¹. A hospitalised beneficiary of support shall be restricted from exercising the right provided for in Article 5(1)(h) of this Law.

5. Keeping patients in hospital longer than necessary for examination and treatment shall be prohibited.

6. Upon discharging a patient from hospital, an extract of the medical records shall be sent to an outpatient psychiatric institution according to the place of residence of the patient, and the patient and his/her legal representative shall be informed about it.

7. A psychiatric institution shall send information on hospitalised beneficiaries of support to the legal entity under public law subject to the state control of the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia – the Agency for State Guardianship and Support of Victims and Affected Persons of Trafficking, as to a custodianship and guardianship body.

Law of Georgia No 2530 of 26 July 2014 - website, 6.8.2014

Decision No 2/4/532,533 of the Constitutional Court of Georgia of 8 October 2014 - website, 28.10.2014.

Law of Georgia No 3341 of 20 March 2015 - website, 31.3.2015

Law of Georgia No 5028 of 20 September 2019 – website, 1.10.2019

Law of Georgia No 5465 of 11 December 2019 – website, 19.12.2019

Law of Georgia No 4007 of 15 December 2023 – website, 26.12.2023

Article 16 – Application of restriction against patients

1. In order to control violent behaviour of a patient placed in an inpatient facility, restriction may possibly be applied against him/her. Restriction shall be the ultimate, exceptional measure applied when the danger that a patient can harm himself/herself or others (people around him/her) is inevitable and it cannot be avoided by verbal comforting or medication treatment of the patient. Restriction shall be a safety measure and it shall not have a therapeutic purpose.

2. Methods of restriction shall be as follows:

a) manual restriction – restriction of a patient by controlling him/her manually;

b) mechanical restriction – use of restriction instruments for immobilising a patient;

c) isolation – coercive placement of a patient in a specialised solitary ward.

3. When selecting a method of restriction, preference must be given to a less restrictive method. Furthermore, in this process, consideration must be given to a preliminarily expressed opinion of a patient about the advantage of any method of restriction and existing experience must be shared. A method of restriction used must be proportional to a possible danger coming from a patient.

4. Several methods of restriction may be jointly used against a patient to reduce the length of restriction or to avoid causing a serious harm by a patient to himself/herself and/or to others (people around him/her).

5. A method of restriction must be used against a patient for a possibly short period. All methods of restriction must be stopped as soon as the danger defined in paragraph 1 of this article is eliminated. Information about the use of a restriction must be regularly communicated to the head of a facility concerned. Concurrently with the restriction used, a patient must be provided with appropriate surveillance and support.

6. No method of restriction may be used against a patient with the intention of punishing or intimidating him/her.

7. A patient, his/her legal representative, or a relative of a patient, if there is no legal representative of the patient, shall have the right to appeal to court the appropriateness of using a method of restriction against a patient.

8. When a method of restriction is used against a patient voluntarily receiving treatment, revision of the status of treatment shall be needed.

9. The rule and procedures for using methods of restriction against a patient shall be established by the directions approved by an appropriate order of the Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia.

Law of Georgia No 6360 of 23 June 2020 – website, 1.7.2020

Article 17 - Voluntary inpatient psychiatric care

1. A patient shall be hospitalised for voluntary treatment on the basis of:

a) a request and/or the informed consent of the patient;

b) a request and the informed consent of a legal representative of a patient under 16 (the participation of the patient in the decision-making shall be necessary taking into account his/her age and mental condition);

c) (deleted – 20.3.2015, No 3341).

2. Informed consent to hospitalisation and treatment shall be confirmed by the signature of a patient or his/her legal representative, evidence of which shall be included in the medical records.

3. A patient hospitalised for voluntary treatment shall be discharged:

a) by the decision of a commission of psychiatrists if the treatment is no longer needed;

b) upon the request of the patient at any stage of treatment;

c) upon the request of a legal representative of a patient under 16 (the participation of the patient in the decision-making shall be necessary taking into account his/her age and mental state);

4. If a hospitalised patient receiving voluntary treatment refuses to continue the treatment but his/her mental condition has changed and meets the criteria for involuntary inpatient psychiatric care, the treatment of the patient may be continued without the consent of the patient or his/her representative, in accordance with Article 18 of this Law.

Decision No 2/4/532,533 of the Constitutional Court of Georgia of 8 October 2014 - website, 28.10.2014.

Law of Georgia No 3341 of 20 March 2015 – website, 31.3.2015

Article 18 – Involuntary inpatient psychiatric care

1. Involuntary inpatient psychiatric care shall be provided to a person when he/she is unable to make a conscious decision due to mental disorder, psychiatric care cannot be provided to this person without placing him/her in an inpatient facility and when a delay in providing care will pose a danger to the life and/or health of the patient or other persons or the patient can, by his/her actions, cause significant material damage to himself/herself or to others.

2. When involuntary inpatient psychiatric care is indicated, the consent of a patient or his/her legal representative, or in the absence of such, the patient's relative, shall not be necessary.

3. The need for involuntary inpatient psychiatric care shall be defined by a physician of urgent medical aid or a physician holding an appropriate certificate. Appropriate law enforcement bodies are obliged to carry out the hospitalisation of a patient upon request.

4. The involuntary preliminary hospitalisation of a patient shall be carried out on the basis of a decision of the physician on duty. The hospitalisation of a patient shall be deemed the commencement of involuntary treatment.

5. Within 48 hours from hospitalisation, a commission of psychiatrists shall study the mental condition of the patient and make a decision on the advisability of involuntary inpatient psychiatric care. The commission of psychiatrists shall make the decision by a majority of votes. Where votes are equally divided, the decision shall be made by a clinical head of a psychiatric facility, or in his/her absence, by a duly authorised person who has been granted such powers in writing. The dissenting opinion of any psychiatrist shall be attached to the decision of the committee in written form.

6. If a committee of psychiatrists concludes that involuntary inpatient psychiatric care is unreasonable, the patient shall immediately be discharged from the hospital.

7. If a commission of psychiatrists concludes that the criteria defined in paragraph 1 of this article are present and involuntary inpatient psychiatric care is necessary, within 48 hours from the hospitalisation of a person, the administration of a psychiatric institution shall apply to court with a request to issue an appropriate order on the hospitalisation of the person for the purposes of involuntary inpatient psychiatric care. Information on the decision of the commission shall be immediately delivered to the person, his/her representative or, in the absence of such, the person’s relative; in the case of a foreign citizen, the information shall be delivered to an appropriate diplomatic mission.

8. A court is obliged to consider an appropriate request of the administration of a psychiatric institution within 24 hours from its receipt and to make a decision on involuntary inpatient psychiatric care, in accordance with the rules established by the Administrative Procedure Code of Georgia. The participation of a patient in the consideration of the case shall be necessary. The interests of the person in court shall be represented by his/her legal representative or, in the absence of such, by the person’s relative and a lawyer. If the person does not have a lawyer, the court shall appoint a lawyer for him/her.

9. According to the court decision, a patient shall receive involuntary inpatient psychiatric care as long as the criteria for involuntary inpatient psychiatric care exist, but this term shall not exceed six months.

10. A committee of psychiatrists shall review the continuation of involuntary inpatient psychiatric care of a patient on a monthly basis.

11. If the court does not make a decision on the hospitalisation of a person for the purposes of providing involuntary inpatient psychiatric care (or on extending the period of involuntary inpatient psychiatric care of an already hospitalised patient), the patient shall be immediately discharged from hospital.

12. If a committee of psychiatrists considers it necessary to extend the period of involuntary inpatient psychiatric care of a patient for more than six months, the administration of a psychiatric institution shall apply to court, 72 hours prior to the expiry of the 6-month period of involuntary inpatient psychiatric care, with a request to extend this period. The court shall make a decision, in accordance with the rules provided for by the Administrative Procedure Code of Georgia, within 72 hours of receipt of the request. The administration of the psychiatric institution shall be entitled to apply to court without limits with a request to extend the period of involuntary inpatient psychiatric care, on the basis of an opinion of a committee of psychiatrists, until the criteria for involuntary inpatient psychiatric care are no longer presented.

13. When the criteria for involuntary inpatient psychiatric care are no longer presented, a patient shall be discharged from hospital on the basis of a decision of a committee of psychiatrists and the court shall be immediately notified; thereafter, treatment shall be continued voluntarily and with the consent of the patient, which shall be indicated in the medical records and confirmed by the signature of the patient.

14. A patient, his/her legal representative or, in the absence of such, his/her relative, as well as the administration of a psychiatric institution, shall be entitled to appeal an order of a judge on the hospitalisation of a person for the purposes of involuntary inpatient psychiatric care or an ordinance on the refusal to hospitalise a person for the purposes of involuntary inpatient psychiatric care, or an order on the extension of the period of hospitalisation for the purposes of involuntary inpatient psychiatric care, or an ordinance on the refusal to extend the period of hospitalisation of a patient for the purposes of involuntary inpatient psychiatric care, in accordance with the rules established by the Administrative Procedure Code of Georgia.

Law of Georgia No 2269 of 21 July 2010 - LGH I, No 45, 21.12.2009, Art. 330

Law of Georgia No 6360 of 23 June 2020 – website, 1.7.2020

Article 19 - Provision of involuntary inpatient psychiatric care to unidentified persons

1. In the cases provided for in Article 18 of this Law, when a person whose identity (name, surname, age, citizenship, address of place of residence) is unknown (an unidentified patient) and needs involuntary inpatient psychiatric care, a psychiatric institution may provide him/her with appropriate care.

2. An unidentified patient shall be involuntarily hospitalised on the basis of a decision of a physician on duty. The hospitalisation of the person shall be deemed the commencement of involuntary treatment.

3. The administration of a psychiatric institution shall immediately notify a city (district) police department in the area of the discovery of the patient after his/her hospitalisation, and the police shall take appropriate measures to identify the patient after the receipt of this notification. Forthwith, a police officer shall draw up a protocol describing the physical appearance of the patient (estimated age, gender, height, colour of hair and eyes, and other details of appearance and expression), which might enable identification (a photo shall be attached to the protocol).

4. If, based on the grounds provided for in Article 18 of this Law, a court issues an order in accordance with the rules established by the Administrative Procedure Code of Georgia on the hospitalisation of an unidentified person for the purposes of providing involuntary psychiatric care, the person shall be assigned an identification number according to the number of the discussed administrative case and shall be referred to as 'unidentified patient No' which shall be indicated in the order of the judge, and thereafter, the patient shall be identified with this name in all documents. Moreover, the administration of a psychiatric institution shall be authorised to give the patient a conventional name which shall not be degrading to his/her honour and dignity, in order to simplify contact during the process of treatment; the conventional name shall be used for personal contact and shall not be kept in medical records.

5. If, after hospitalisation, at any stage of court hearings and/or treatment, the police identifies the patient, the name 'unidentified patient No' given in accordance with paragraph 4 of this article shall be replaced by the identified name of the patient in all documents relating to him/her.

Article 20 - Specialised psychiatric care

1. Specialised psychiatric care shall be provided in a licensed psychiatric institution.

2. Specialised psychiatric care shall be provided to patients with chronic mental disorders who need care and who have to undergo maintenance therapy and a rehabilitation course.

3. A patient shall be placed in a specialised psychiatric institution on the basis of an opinion of a committee of psychiatrists upon the request of the patient or his/her legal representative.

4. A patient may be discharged from a specialised psychiatric institution:

a) upon the request of the patient if he/she is capable to live independently;

b) upon the request of his/her legal representative.

Article 20¹ – Community mental health services

1. The state shall ensure provision of community mental health services to a person with mental disorder.

2. Community mental health services shall be as follows:

a) the outpatient psychiatric service;

b) the mental health mobile group;

c) the mental health crisis intervention service;

d) the community psychiatric rehabilitation day centre;

e) a long-term care facility for persons with mental disorder.

3) The community mental health services shall also be other services supporting the persons with mental disorder, which do not contradict with the principles established by this Law.

Law of Georgia No 6360 of 23 June 2020 – website, 1.7.2020

Article 21 - Psychosocial rehabilitation

1. The purpose of rehabilitation measures is to maintain the social and labour contacts of patients and to enable them to develop skills which facilitate his/her ability to live independently in society.

2. Only diagnostic, treatment and rehabilitation methods permitted by the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia shall be used for the purposes of psychosocial rehabilitation.

3. Psychosocial rehabilitation shall be voluntary and shall be provided by a licensed institution.

4. Patients shall be entitled to voluntarily terminate participation in psychosocial rehabilitation at any time.

5. In the psychosocial rehabilitation process, a psychiatrist shall act in accordance with Article 18 of this Law if a patient needs involuntary inpatient psychiatric care.

Law of Georgia No 3123 of 5 July 2018 – website, 11.7.2018

Article 22 – Providing psychiatric support to accused and convicted persons

1. In the case provided for in Article 191(2) of the Criminal Procedure Code of Georgia, the involuntary psychiatric treatment of a person shall be provided in accordance with the rules established by Article 22¹ of this Law.

2. If a convicted person placed in a penitentiary institution of the state sub-agency within the system of the Ministry of Justice of Georgia (‘the penitentiary institution’) – the Special Penitentiary Service (‘the penitentiary institution’), against whom the legal proceedings have already ended, shows signs of mental disorder, the Director of a psychiatric facility shall, on the basis of an opinion of the psychiatric commission of the Penitentiary Service, apply to an authorised expert institution for forensic psychiatric expertise. If the opinion of the authorised expert institution confirms that involuntary psychiatric care is necessary, the Director of the penitentiary facility shall apply to a court for the provision of involuntary psychiatric care on the basis of the opinion of the authorised expert institution. The court shall make a decision in accordance with the rules provided for by the legislation of Georgia on the provision of involuntary psychiatric care until the recovery of a convicted person, after which the convicted person shall continue serving the sentence in accordance with general penal rules.

3. If a patient is provided with involuntary inpatient psychiatric care in the cases provided for by Article 191(3) and (4) of the Criminal Procedure Code of Georgia and he/she recovers within the term of the sentence to be served, which fact is confirmed by an opinion of а committee of psychiatrists, the administration of the psychiatric institution shall notify the Penitentiary Service, which must ensure the immediate escort of the convicted person to an appropriate penitentiary institution to serve out his/her sentence. The period spent in a psychiatric institution shall be included in the total term of sentence.

4. If a patient is provided with involuntary inpatient psychiatric care in the cases provided for in Article 191(3) and (4) of the Criminal Procedure Code of Georgia and he/she does not recover within the term of the sentence to be served, such that the criteria for involuntary psychiatric care are still present, the issue of providing involuntary psychiatric care to the person after the completion of the term of the sentence shall be dealt with in accordance with the rules provided for by this Law.

Law of Georgia No 5208 of 4 July 2007 - LHG I, No 28, 18.7.2007, Art. 293

Law of Georgia No 2269 of 21 July 2010 - LGH I, No 45, 21.12.2009, Art. 330

Law of Georgia No 3551 of 21 July 2010 - LGH I, No 46, 4.8.2010, Art. 283

Law of Georgia No 3619 of 24 September 2010 - LGH I, No 51, 29.9.2010, Art. 332

Law of Georgia No 1783 of 13 December 2013 - website, 28.12.2013

Law of Georgia No 2530 of 26 July 2014 - website, 6.8.2014

Law of Georgia No 3543 of 1 May 2015 - website, 18.5.2015

Law of Georgia No 959 of 1 June 2017 – website, 20.6.2017

Law of Georgia No 3123 of 5 July 2018 – website, 11.7.2018

Article 22¹ - Compulsory psychiatric treatment

1. In the case provided for in Article 191(2) of the Criminal Procedure Code of Georgia, the court hearing criminal cases shall be authorised to use compulsory psychiatric treatment on the two following grounds:

a) a person is unable to make a conscious decision due to a mental disorder and the provision of psychiatric support is impossible unless he/she is hospitalised;

b) there is a risk that due to a mental disorder a person will behave in such a manner that may damage, threaten and/or harm himself/herself and/or other persons.

2. For the purposes of providing compulsory psychiatric treatment, a person shall be hospitalised by the court hearing criminal cases on the basis of a ruling made in accordance with Article 191(2) of the Criminal Procedure Code of Georgia. A person shall be placed only in a hospital where special security is provided and a system of measures ensuring risk mitigation, resocialisation and improvement of psychiatric health is implemented. A system of measures ensuring risk mitigation, resocialisation and improvement of psychiatric health shall be determined by an order of the Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia.

3. A person shall be hospitalised for the purposes of providing compulsory psychiatric treatment for the period specified in the ruling indicated in paragraph 2 of this article. This period shall start from the moment of the hospitalisation of the person. The patient may be discharged from an inpatient facility before the end of this period in accordance with paragraph 5 of this article if the grounds provided for in the first paragraph of the same article no longer exist.

4. Once a year, a special committee of a psychiatric institution shall evaluate whether the grounds provided for in paragraph 1 of this article still exist in the case of a patient subject to compulsory psychiatric treatment. The physician in charge of the patient shall be authorised to apply to a special committee of a psychiatric institution to provide a premature evaluation and opinion if it is reasonable according to the mental health condition of the patient.

5. If, as a result of a regular or premature evaluation, a special committee of a psychiatric institution concludes that the grounds provided for in paragraph 1 of this article no longer exist, the administration of the psychiatric institution shall immediately discharge the patient from hospital.

6. If the grounds provided for by paragraph 1 of this article no longer exist at the moment of the expiry of the term specified in the ruling provided for by paragraph 2 of this article and the criteria defined in Article 18(1) of this Law are not presented, the patient shall be discharged from hospital.

7. If the criteria indicated in Article 18 of this Law exist at the moment of the expiry of the term specified in the ruling indicated in paragraph 2 of this article, the administration of a psychiatric institution shall apply to a court to request the provision for a patient of involuntary inpatient psychiatric care as defined by Article 18 of this Law, after which the patient shall be provided with psychiatric care in accordance with the rules established by Article 18 of this Law.

8. After discharge from hospital in accordance with paragraphs 3 and 4 of this article, a person shall be registered in the nearest outpatient psychiatric institution to his/her place of residence.

Law of Georgia No 2530 of 26 July 2014 - website, 6.8.2014

Law of Georgia No 3123 of 5 July 2018 – website, 11.7.2018

Article 23 - Rights of patients convicted of crimes who receive treatment on the basis of a court decision

Patients convicted of crimes who receive treatment on the basis of a court decision shall enjoy the basic rights and guarantees of patients except the rights to choose the type of psychiatric support and to waive treatment.

Law of Georgia No 5208 of 4 July 2007 - LHG I, No 28, 18.7.2007, Art. 293

Chapter VI – Forensic Psychiatric Expertise

Article 24 - Forensic psychiatric expertise

1. The following shall be authorised to conduct activities which require forensic psychiatric expertise:

a) appropriate institutions licensed by the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia;

b) state expert forensic institutions.

2. Investigation bodies or their subordinate agencies shall be prohibited from conducting activities which require forensic psychiatric expertise.

3. Forensic psychiatric expertise shall be provided and financed by a body (person) appointing an expert or the State through state-financed programmes or other sources. Detained persons to be examined shall be taken out/escorted and guarded in an expert institution by an appropriate division of the Penitentiary Service.

Law of Georgia No 480 of 1 November 2008 - LGH I, No 30, 7.11.2008, Art. 196

Law of Georgia No 965 of 30 December 2008 - LHG I, No 41, 30.12.2008, Art. 337

Law of Georgia No 3619 of 24 September 2010 - LGH I, No 51, 29.9.2010, Art. 332

Law of Georgia No 1783 of 13 December 2013 - website, 28.12.2013

Law of Georgia No 3543 of 1 May 2015 - website, 18.5.2015

Law of Georgia No 3123 of 5 July 2018 – website, 11.7.2018

Article 25 - Right to guard a person to be examined during the provision forensic psychiatric expertise

A hospitalised person may enjoy the services of a lawyer during the provision of forensic psychiatric expertise in accordance with the rules provided for by the legislation of Georgia.

Chapter VII – Maintenance of Medical Confidentiality

Article 26 - Maintenance of medical confidentiality

1. A person who has learned about the mental disorder of another person during the performance of his/her official duties and who uses this information deliberately or by negligence against the said person or a third party, shall be liable in accordance with the legislation of Georgia.

2. Confidential information on the mental condition of a person shall be available for persons directly involved in the process of his/her treatment and scientific research.

3. The information may be disclosed to a third party with the consent of the patient or his/her legal representative, and/or by a court decision.

4. Except for the case provided for in paragraph 3 of this article, confidential information may also be disclosed if the life and/or health of a patient or a third party are threatened. In this case, a decision on the disclosure of information about the psychiatric health condition of a patient shall be made by the administration of a psychiatric institution; such information shall be delivered only to a legal representative of the patient, or, in the absence of such, to his/her relative.

Chapter VII¹ – Measures for Ensuring Assessment of Protection of Rights and of the Quality of Services of Patients/Receivers of Services in the Area of Psychiatric Care

Law of Georgia No 6360 of 23 June 2020 – website, 1.7.2020

Article 26¹ – Insurance of assessment of protection of rights and of the quality of services of patients in the area of psychiatric care

1. The assessment of protection of rights and of the quality of services of patients in psychiatric facilities and community mental health services shall be insured by the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia through an assessment instrument.

2. The assessment of protection of rights and of the quality of services of patients in psychiatric facilities and community mental health services shall be carried out in the form of monitoring.

3. Monitoring shall mean the on-site inspection by the monitoring group of the existing situation in psychiatric facilities and community mental health services, under the procedure established by the legislation of Georgia.

4. The monitoring group shall elaborate recommendations for the implementation of measures facilitating the development of an appropriate system, which are based on the systemic analysis of the monitoring data, existing practice and international experience.

5. To assess the protection of rights and the quality of services of patients in the area of psychiatric care, the composition of the monitoring group shall be defined and the monitoring/assessment procedure and conditions in psychiatric facilities and community mental health services shall be established by an appropriate order of the Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia.

Law of Georgia No 6360 of 23 June 2020 – website, 1.7.2020

Article 26² – implementation of measures facilitating the development of an appropriate system

1. The monitoring group shall submit to the Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia an annual report and recommendations for the implementation of measures facilitating the development of an appropriate system.

2. The monitoring group shall ensure that information meetings with psychiatric service providers, persons engaged in psychiatry, patients and their parent groups and non-governmental organisations are held at intervals set by the legislation of Georgia.

3. A report of the monitoring group shall be public.

Law of Georgia No 6360 of 23 June 2020 – website, 1.7.2020

Chapter VIII – Rights and Social Guarantees of Persons Engaged in Psychiatry

Article 27 - Rights and social guarantees of persons engage in psychiatry

1. Taking into account the specific conditions of their working environment, the personnel working in the field of psychiatry shall enjoy the following benefits:

a) reduced working week – 30 hours;

b) increased leave – 42 working days.

2. If the life and/or health of a physician are threatened by a patient, he/she shall have the right to refuse to examine and/or treat the patient.

Chapter IX – Transitional and Final Provisions

Article 28 - Transitional provisions

 The Minister of Labour, Health and Social Affairs of Georgia shall, before 1 January 2007, draw up and publish the following normative acts:

a) on the Approval of the Rule of Hospitalisation;

b) on the Instruction of Establishing and Operating the Commission of Psychiatrists;

c) on the Conduct of Primary Psychiatric Examination and the Issuance of Opinion;

d) on the Approval of the Application Form of the Administration of Psychiatric Institutions about the Placement of Persons in Inpatient Facilities for the Purposes of Providing Involuntary Psychiatric Care;

e) on the Approval of the Form for Applying to Court about the Placement of Persons in Inpatient Facilities for the Purposes of Providing Involuntary Psychiatric Care;

f) (Deleted – 12.10.2007, No 5390);

g) on the Rule for Registering and Deregistering Patients in Outpatient Psychiatric Institutions, and Observing Patients;

h) on the Special Form of Exchanging Information Among Psychiatric Institutions and the Establishment of a Unified Information Bank;

i) on the Instruction on the Rules and Procedures for Using Methods of Physical Restriction Against Patients with Mental Disorders;

l) on the Approval of Psychosocial Rehabilitation Standards.

Law of Georgia No 5390 of 12 October - LHG I, No 41, 24.10.2007, Art. 359

Article 28¹ - Measures to be implemented regarding compulsory psychiatric treatment

The Minister of Labour, Health and Social Affairs of Georgia shall, until 1 October 2014, ensure that:

a) the list of measures ensuring risk mitigation, resocialisation and improvement of psychiatric health of patients receiving compulsory psychiatric treatment necessary for providing compulsory psychiatric treatment in a psychiatric institution is compiled;

b) the composition and the rules for the operation of a special commission of a psychiatric institution for the purposes of evaluating the mental health condition of a patient subject to compulsory psychiatric treatment are approved;

c) risk assessment standards are defined.

Law of Georgia No 2530 of 26 July 2014 - website, 6.8.2014

Article 28² – Measures to be implemented for ensuring assessment of protection of rights and of the quality of services of patients/receivers of services in the area of psychiatric care

The Minister of Labour, Health and Social Affairs of Georgia shall, until 1 September 2020, ensure that the composition of the monitoring group for assessing the protection of rights and the quality of services of patients in the area of psychiatric care is defined and the monitoring/assessment procedure and conditions in psychiatric facilities and community mental health services are established, and the standardised assessment questionnaire is approved.

Law of Georgia No 6360 of 23 June 2020 – website, 1.7.2020

Article 29 - Invalid normative act

Upon the entry into force of this Law, the Law of Georgia on Psychiatric Support of 21 March 1995 (Parliamentary Gazette of Georgia, 1994-1995, No 23-26, Art. 559) shall be declared void.

Article 30 - Entry into force

1. This Law, except Article 28, shall enter into force from 1 January 2007.

2. Article 28 of this Law shall enter into force upon its promulgation.

President of Georgia                                            M. Saakashvili

Tbilisi

14 July 2006

No 3451_ რს