Promoting Equal Environment for Persons

with Disabilities and Older Persons

Partnership for Human Rights (PHR)

Report

(October 2018 - October 2019)

Prepared by:
Ana Saldadze
Tamar Robaqidze

Cases described in the report have been handled by:

Ana Saldadze
Ana Tavkhelidze
Tamar Robaqidze
Sophiko Menabdishvili

Edited by:
Nino Beqishvili

Authorized by:
Ana Abashidze

This Report has been produced with the support of Open Society Georgia Foundation (OSGF). View-
points expressed by the authors of the Report may not reflect the views of OSGF.
OSGF takes no responsibility for the contents of the Report.

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Contents
Introduction ............................................................................................................................................................4

Key Findings...........................................................................................................................................................6

I. Exposed Practices during Discrimination Case Proceedings..............................................................................8

Positive examples................................................................................................................................................8

• Settlement of cases....................................................................................................................................8

• Moral damages due to unlawful placement in a psychiatric institution....................................................9

Delayed court hearings – “Justice Delayed” ........................................................................................................11

• S.Q. vs. Government of Georgia ...........................................................................................................12

• D.Kh. vs. Ministry of Internal Affairs of Georgia...................................................................................12

• M.M. vs. Liberty Bank............................................................................................................................13

II. Mental Health and Human Rights....................................................................................................................14

Lack of adequate services..............................................................................................................................14

Obstruction of meetings between lawyers and residents of psychiatric institutions .....................................16

Placement in psychiatric institutions for involuntary treatment ...................................................................18

Legislation addressing involuntary treatment................................................................................................19

III. Discriminatory State Policies towards Individuals under the State Care.......................................................20

The human rights situation of elderly populations............................................................................................20

• International standards............................................................................................................................20

• The situation in Georgia .........................................................................................................................22

• Private residential Homes .......................................................................................................................23

• Large state-run institutions for the elderly..............................................................................................24

• State funding system and the monitoring outcomes................................................................................24

• Discriminatory policies...........................................................................................................................26

Residential care institutions for persons with disabilities.....................................................................................26

• Large residential institutions as a systemic discrimination.....................................................................26

• Unfavorable environment of the residential institutions.........................................................................28

• Neglecting needs of persons with disabilities by responsible state agencies .........................................29

Conclusions...........................................................................................................................................................30

Recommendations ................................................................................................................................................31

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Introduction

PHR has been actively supporting enforcement and monitoring of Georgia’s anti-discrimination legis-
lation since the day of its enactment. The organization has already produced a number of special reports
on the issues of discrimination1. These reports have thoroughly described the significant precedents
generated through PHR efforts and the challenges that persons with disabilities (hereinafter referred
to as PWDs) have been facing in Georgia for multiple years without any substantial improvement.

The purpose of this report is to present the issues encountered by PHR in its activities during the
report period and the struggles of particular population groups in terms of both legislative as well as
institutional contexts. Specifically, the publication emphasizes issues such as: mental health and the
challenges at the residential institutions for PWDs and the elderly. The target audiences of the report
include decision-makers of responsible government agencies, the communities whose interests are put
forward in this report and other stakeholders.

Despite efforts to tackle discrimination and the ensuing important precedents throughout this period,
the State is still failing to substantially improve the adverse human rights conditions of vulnerable
groups in Georgia. Communities experience daily struggles to access the physical environment and
public or private services, including those necessary for their very existence. The human rights situa-
tion and the living conditions of individuals with psycho-social needs are alarming. They are contin-
ually subjected to societal pressure and stigmatization leading to their isolation from the public. This
detrimental situation is further sustained by national policies, which are not particularly committed to
enforcing human dignity and respect for human rights in general.

The report is distinctive in that its language is less charged with professional jargon and is more read-
er-oriented. It is PHR’s aspiration to make the report readable and easily applicable for audiences of
any profession or experiences as well as those whose rights are accentuated in the report.

The report methodology is largely based on the analysis of problems exposed during monitoring and
the actual cases filed by PHR during the report period (October 2018 – October 2019) applying the an-
ti-discrimination legislation. The first section of the report reviews both positive and negative trends in
the justice system, which emerged during the proceedings of discrimination cases. The second section
examines the challenges prevailing in the field of mental health while the third section assesses the
human rights situation of PWDs and older persons living under the State care (residential institutions
of PWDs, homes for the elderly) and describes problems found as a result of monitoring.

1 PHR, Enforcement of Anti-discrimination Legislation of Georgia to Ensure Equality of Persons with Disabilities, 2017.
Available at: https://bit.ly/2LpsMe5
PHR, Enforcement of Anti-discrimination Legislation of Georgia to Ensure Equality of Persons with Disabilities, 2018.
Available at: http://phr.ge/home/content?content_id=827

4
Notably, this report marks the first year that PHR has started working on the issues of older
persons, thus the corresponding section does not engage with all of the concerns in this field. It
describes conditions of older citizens living in the State-run institutions and subsequently offers
recommendations. However, it has to be emphasized that these are wide-ranging and complex
issues that must be addressed through committed efforts.

Publication of this report would not be possible without the valuable assistance of Open Society
Georgia Foundation who has been supporting civil society organizations in Georgia for many years,
ensuring that concerns of certain communities are not neglected. Strong civil society, in its turn, is
decisive in preventing human rights violations and occurrence of discrimination.

5
Key Findings

Analysis of the issues and challenges discussed in the report has yielded the following key findings:

 There was one case of admitting to practicing discrimination by a certain private kindergarten
and meeting the demands of the victim. We believe that such cases significantly increase the
responsibility of the society which is an important prerequisite for preventing discrimination;
 For the first time in the Georgian court practice, the court ordered the institution to compensate
the claimant for the moral damages incurred due to her unlawful placement in a psychiatric es-
tablishment for involuntary treatment (GEL 5000). The ruling has been appealed in the Court
of Appeals, however, such a decision of the first instance court is already a step forward in
improving the human rights standard for individuals with psycho-social needs;
 In its rulings regarding involuntary placements in psychiatric institutions for treatment purpos-
es the Court of Appeals has stressed that drawing only from the diagnosis of the patient cannot
provide sufficient grounds for their placement in a psychiatric institution – a practice which is
very common in the field;
 Delays in court hearings continue to persist which particularly affects the process of protecting
the rights of vulnerable groups and which can arguably be described as delayed justice;
 The declared goals of deinstitutionalization are not effectively pursued. A detailed plan for
deinstitutionalization is still lacking while related commitments described in a number of doc-
uments are basically ignored. Segregated and specialized residential institutions (psychiatric
establishments, residential institutions for PWDs) are still maintained which produces more
stigmatization and incites non-ethical and often cruel attitudes towards persons with disabil-
ities;
 In terms of availability of adequate services, the extreme lack of housing and community-based
services for people who do not have to continue treatment at a psychiatric establishment is one
of the most fundamental concerns. People are forced to spend years in isolation and segrega-
tion from the society, deprived of the opportunity to reintegrate within their communities. It
is particularly alarming that the children’s units of these institutions which are meant for short
stays in practice function as places for long-term residence which is a gross violation of chil-
dren’s fundamental rights;
 Institutionalization of individuals with psycho-social needs aged between 15 and 18 are also
problematic in their nature. The legislation provides for placing such patients in adult units,
which violates the best interests of the child and the rights enshrined in the international leg-
islation;

6
 There are instances when administrations of psychiatric establishments obstruct meetings of
rights defenders with their residents. This problem is of a systematic nature, however, the
Ministry of Healthcare does not take any action to solve it;
 The State fails to adequately meet the needs of the elderly. Management policies of residential
care establishments, including their financial provisions, need to be profoundly revised so that
they ensure dignified living of older persons. These communities are entitled to services that
are tailored to their individual needs;
 Residential institutions for PWDs continue to be charged with conflict and confrontations
occurring between the residents as well as the residents and the staff. The administrations fail
to neutralize and adequately manage these conflicts. Failure to timely and effectively respond
to the needs of the residents of these institutions on the part of responsible state agencies con-
tinues to be a major concern.

7
I. Exposed Practices during Discrimination Case Proceedings

Positive examples

• Settlement of cases

The instance of settling the discrimination case between the disputing parties that has occurred during
the report period has to be assessed as a positive development. A child represented by PHR in the
court was voluntarily compensated by a certain private kindergarten in Tbilisi for the moral damages
incurred. The last annual report produced by PHR also describes the case, however, the legal outcomes
of the case have been achieved this year2.

N.K. was enrolled in the class of 2-year old children at one of the private kindergartens of Tbilisi. In
January 2018 the child was expelled by the administration. According to them, the child was aggres-
sive, hyperactive and failed to perform in a group setting. The expulsion document also described
discontentment of other parents towards the behavior of N.K.

PHR filed a complaint with Tbilisi City Court demanding recognition of discrimination in the case
and compensation for moral damages. The Public Defender of Georgia also investigated the case and
issued recommendations where it posited that the defendant had failed to act in the best interests of the
child and argued that expulsion could have traumatized the child3.

The administration of the kindergarten acceded to the recommendation of the Public Defender and
agreed to compensate for the moral damages incurred by the victim of the discrimination after which
Tbilisi City Court closed the case with the settlement act between the disputing parties.

This case is an important precedent as it demonstrates that both the kindergarten as well as the individ-
ual who discriminated against the child admitted to the discrimination which, in its turn, resulted with
the kindergarten taking responsibility over its illegal action. Settling the case was also significant as
it spared the court expenses on the one hand and ensured speedy recovery of the violated right of the
victim. At the same time, understanding and acknowledging the responsibility is a crucial prerequisite
for preventing such unlawful actions in the future.

2 PHR, Enforcement of Anti-discrimination Legislation of Georgia to Ensure Equality of Persons with Disabilities, 2018, p. 22
3 Public Defender of Georgia. April 16, 2018 Recommendation regarding direct discrimination on the grounds of behaviour. Available
at: http://ombudsman.ge/uploads/other/5/5192.pdf

8
• Moral damages due to unlawful placement in a psychiatric insti-
tution

On May 31, 2019 Tbilisi City Court ruled that a psychiatric establishment had to pay the claimant
GEL 5000 to compensate for the moral damages incurred by her due to her unlawful and involuntary
placement at the psychiatric institution.

This ruling provides an important precedent, as it marks the first time when the court argued for the
compensation of moral damages by the State in relation to psychiatric establishments. It will also
significantly improve the quality of human rights at these institutions. The decision has not yet been
enforced as it has been appealed in the Court of Appeals.

On request of the mother, in October 2017, M.M. was unwillingly transferred by the police and the
ambulance to one of the psychiatric hospitals for involuntary in-patient psychiatric treatment. The
police and ambulance personnel did not hear what M.M. had to say about the conditions in her family
when they transferred her to the institution. M.M. insisted that the mother had been abusing her and
demanding her forced treatment as a punishment. Notably, it was not the first of such experiences in
M.M.’s life.

Based on the solicitation of Tbilisi Center for Mental Health LLC and October 18, 2017 decree of the
judge of Administrative Cases Panel of Tbilisi City Court, M.M. was placed in the in-patient unit for
involuntary psychiatric treatment where M.M. spent 11 days. From the day of her placement to the day
of discharge M.M. had not received any psychiatric treatment or medication whatsoever.

PHR challenged the above-mentioned decision of the City Court in Tbilisi Court of Appeals which
concurred with the arguments presented by PHR lawyers and canceled the decision made by the first
instance court. It established that the placement of M.M. in the psychiatric institution to receive in-pa-
tient psychiatric treatment without her consent was unlawful. Based on this ruling of Tbilisi Court of
Appeals and with support from PHR, M.M. filed a complaint in Tbilisi City Court and demanded com-
pensation from the psychiatric hospital for the moral damages incurred due to the unlawful deprivation
of her liberty. Nino Mamulashvili, the judge at the City Court agreed with the claims advanced by
PHR and demanded that the psychiatric hospital paid M.M. GEL 5000 for the moral damages caused
because of her involuntary placement in the hospital.

The court provided a number of important clarifications in its decision: in keeping with the practice of
the European Court of Human Rights, the court equated involuntary placements at psychiatric estab-
lishments to the deprivation of one’s liberty and emphasized that the unlawful restriction of M.M.’s
freedoms infringed on her honor and dignity and the right to privacy, which caused M.M. deep moral
and mental anguish4.

4 May 31, 2019 Ruling of Tbilisi City Court N2/37031-18, p. 16.

9
The ruling offers the following justifications: “The court believes that the placement of the claimant
in the psychiatric hospital on October 17, 2017 to receive psychiatric treatment without consent which
was carried out in violation of the national legislation and the Convention before the legal enforcement
of the October 27, 2017 ruling of the Administrative Cases Panel of Tbilisi Court of Appeals - dis-
charge of the claimant from the hospital - must be recognized as an unlawful restriction of M.M.’s
freedoms, which entitles M.M. to demand applicable compensation. Pursuant to paragraph 6, Article
13 of the Constitution of Georgia – an individual whose freedoms have been unlawfully restricted has
the right to receive compensation; also according to paragraph 5, Article 5 of the Convention – anyone
who has been detained or arrested for violation of the provision of this article are entitled to receive
compensation5“.

In its ruling the court was also highly critical of the attitudes of doctors/psychiatrics towards M.M.:
“Actions of M.M. (refusal to eat and take medication) as well as her desire to leave the hospital were
perceived by the personnel as symptoms of M.M.’s mental health condition and not as the expressions
of her personal freedoms and reasonable objections to the restriction of her rights6“. Based on this
reasoning the court argued that in the process of addressing the issue under their competency, the psy-
chiatrists failed to examine important circumstances in an adequate manner which led to the violation
of the constitutional rights of M.M.

PHR believes that the above-described ruling of the court enforces the standard embedded in Article
14 of the UN Convention on the Rights of Persons with Disabilities which is a valuable step forward
in the rights protection of individuals with psycho-social needs. According to this provision: States
Parties shall ensure that persons with disabilities, on an equal basis with others: (a) Enjoy the right to
liberty and security of person; (b) Are not deprived of their liberty unlawfully or arbitrarily, and that
any deprivation of liberty is in conformity with the law, and that the existence of a disability shall in
no case justify a deprivation of liberty.

5 Ibid. p. 13
6 Ibid. p. 17

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Delayed court hearings – “Justice Delayed”

Regardless of successful examples of access to justice, the important and neglected problem of de-
layed hearings continues to persist. It is mostly a matter of priority, which is a rather harmful practice
for particular communities. As demonstrated by the efforts of PHR, delays in court hearings have ad-
opted a systematic nature. Individuals who have been discriminated against have to wait for hearings
of their cases for years and these include children who expect the justice system to restore their vital
rights; women who are victims of different kinds of violence and harassment; persons with disabilities
who face discrimination and unequal treatment, violation of their dignity, and others groups.

Article 31 of the Constitution of Georgia and Article 6 of the European Convention on Human Rights
secures the right to a fair trial. This right incorporates in itself the right to hearing within a reasonable
time, which in its turn is reflected on access to and pace of justice. Failure of courts to hear cases with-
in reasonable timeframes leads to violation of the right to a fair trial7.

To illustrate the magnitude of the problem it is helpful to review a number of cases handled by PHR
where the claimants are still waiting for the hearings of their cases to be completed by the first instance
courts. Importantly, due to the nature of the complaints, these cases are precedential and they deal with
physical and mental security of the claimants.

7 European Court of Human Rights. July 13, 1983 ruling in the case “Zimmermman and Steiner vs Switzerland”

11
• S.Q. vs. Government of Georgia

This case is about the discrimination to be found in the lack of a state-provided service, which is of
vital importance for S.Q., a child with disability. The Ministry of Internally Displaced Persons from
the Occupied Territories, Health, Labor and Social Affairs is a third party to the case.

PHR filed the complaint with Tbilisi City Court on June 20, 2016 and has been waiting for the com-
pletion of hearings for 3 years. Notably, PHR appealed for speeding up the process 3 times, however,
with no success. In addition, the judge was replaced during the proceedings of the case as a result of
which the almost finished hearing was re-launched from the very beginning.

Timely resolution of the dispute and the development of the service, which will respond to the indi-
vidual needs of the child, is extremely important for many children who are facing the risks of being
abandoned by their families, who are separated from their parents and placed in residential institutions
due to the absence of services that are vitally essential for them. In addition to the risks of institution-
alization, it also increasingly jeopardizes their lives and health conditions on a daily basis; therefore
without a prompt hearing of the case and the provision of the service tailored to the individual needs
of S.Q., children with psycho-social needs and behavioral problems may suffer from unfortunate con-
sequences. Taking 3 years to hear such cases completely deprives the legal disputes of their purpose-
fulness which results in children not being able to enjoy their right to justice.

• D.Kh. vs. Ministry of Internal Affairs of Georgia

The case involves a person with disability using a wheelchair, who has been subjected to degrading
and discriminatory treatment on the part of the police.

PHR filed the lawsuit on September 14, 2016 and despite several attempts in the past 3 years to speed
up the hearings (including the appeal to the Chair of the Panel), even the preparatory session of the
case has not yet taken place.

Certain actions of the Prosecutor’s Office of Georgia regarding this case are also troublesome. The
Investigative Unit of Shida Qartli and Mtskheta-Mtianeti District Prosecutor is investigating the
claims of D.Kh. about their degrading and inhumane treatment by the police officers. According to
the Prosecutor, they are unable to decide on the criminal case until the end of the court hearings on
discrimination. It is unclear and legally unjustifiable on the part of the Investigative Unit to link its
investigation into a possible crime to the outcomes of the court hearings of the same case, which does

12
not involve examining facts that might be of importance for criminal justice purposes. Therefore, in
PHR’s observation the Prosecutor’s Office is unreasonably delaying the proceedings, which obstructs
criminal prosecution. In addition, the police officers involved in this case continue to perform in their
jobs to this day which, in the absence of adequate and timely actions, may lead to more individuals,
like D.Kh., falling victim to the inhuman and degrading treatment on their part.

• M.M. vs. Liberty Bank

This case involves a person with visual impairments who has been discriminated against due to a re-
stricted access to the bank services.

Even though PHR filed the complaint on April 27, 2017, the court has not scheduled a preparatory
session yet. Timely hearing and completion of the case is important as in the absence of inaccessible
bank services, the claimant as well as many other persons with disabilities continue to rely on the sup-
port from others which is humiliating on the one hand and limiting their independent living and full
integration into the society on the other.

Thus, considering the common practice of delayed court hearings, it can be argued that access to jus-
tice is not ensured in Georgia, particularly for those communities who may reasonably be in most need
but for whom, unfortunately, justice is not accessible in an adequate and timely manner.

13
II. Mental Health and Human Rights

Lack of adequate services

Persons with psycho-social needs historically have been one of the most stigmatized communities and
therefore the most vulnerable as they face regular violation of their rights. The WHO Mental Health
Action Plan 2013-2020 places particular emphasis on a number of major challenges in this direction
and reiterates that people with mental health disorders are victims of a wide range of human rights
violations8.

Continued existence of large residential psychiatric institutions calls for criticism as the places for
regular discrimination. These specialized and segregated institutions sustain the stigma towards these
communities and maintain and often encourage non-ethical and cruel attitudes towards people with
psycho-social needs. Moreover, the large residential institutions with their specialized character are in
breach of Article 19 of the UN Convention on the Rights of Persons with Disabilities, which requires
abolition of institutionalization of persons with disabilities9.

Government of Georgia developed the Mental Health Strategy and the 2015-2020 Action Plan in
201410, which were designed to begin the process of deinstitutionalization and take the first steps to
differentiate between the services, implement the human rights-based vision and minimalize the stig-
ma. However, no specific objectives have yet been accomplished in order to achieve the stated goals.

One of the main challenges in terms of service provision is the lack of housing and community-based
services for individuals who have no medical reasons to stay in psychiatric hospitals but are unable to
leave as they have no housing and/or their families refuse to take them in.11

Significant number of people are forced to spend years in isolation from the society and often in des-
titute and degrading conditions12 without opportunities to reintegrate into the community. Although
alternatives to residential institutions are available in the country in the form of community-based
small group homes financed through the State programs13, access to these services is in practice re-
stricted for such groups as there is no community organization who is completely and solely focused
on individuals currently residing in psychiatric institutions. In addition, the program supported by the
State offers community-based services and not individual housing only to those who are able to live
independently. Therefore, more investment is needed on the part of the State to increase effectiveness

8 The WHO Mental Health Action Plan 2013-2020. Available at: https://www.who.int/mental_health/action_plan_2013/mhap_
brochure.pdf?ua=1>
9 Public Defender of Georgia, National Prevention Mechanism, Monitoring Report of Psychiatric Institutions, 2015. Tbilisi, p. 94
10 December 31, 2014 Resolution of the Government of Georgia #762 on approving ‘Mental Health Strategy and the Action Plan for
2015-2020’ https://matsne.gov.ge/ka/document/view/2667876?publication=0.
11 Human Rights Education and Monitoring Center (EMC): The Right to Adequate Housing – the Analysis of Basic Challenges, 2018,
pp. 151-156
12 Public Defender of Georgia, National Prevention Mechanism, Monitoring Report of Psychiatric Institutions, 2015. Tbilisi, p. 90
13 December 31, 2018 Resolution of the Government of Georgia #684 ‘On Approving the 2019 State Program for Social Rehabilitation
and Childcare’. Appendix 1.12 – The sub-program of community-based service provision.

14
of the program and to enable community organizations to meet the needs of this particular group. It is
important that community and individual services are made available in the country.

This issue has been stressed in multiple reports of the Public Defender who has offered recommenda-
tions for the government to assess the needs of patients living in psychiatric hospitals for more than 6
months and to work towards their discharge from the hospitals and referral to community-based ser-
vices. These recommendations have also been included in the 2017 parliamentary report of the Public
Defender, however, their enforcement is yet to take place. Therefore, the problem persists, as stressed
in Public Defender’s 2018 report as well14.

Certain challenges remain regarding mental health of children as well. Due to the lack of adequate ser-
vices, often treatment is either delayed or unsuccessful in terms of achieving desired effects. There are
no specialized day care centers for children with mental health conditions and/or behavioral problems
where they would receive services that respond to their individual needs. Children with mental health
diagnosis and/or behavioral problems require socialization and opportunities to realize their abilities at
every stage of development which are often unavailable because of the stigma and the way the mental
health system works.

As for the placement in psychiatric establishments for treatment purposes, the purpose of the in-pa-
tient care is to minimize the in-patient treatment period; their programs should make sure that children
spend as less time in the hospital as possible and that they continue treatment and receive alternative
services outside the institution, which sadly is impossible today. Due to the absence of such services,
the children’s unit of #5 Tbilisi Clinic which is meant for short stays, sometimes serve as a home for
children which is very alarming and a gross violation of children’s rights.

The practice of placing young people with psycho-social needs aged from 15 to 18 in psychiatric
institutions is also problematic. Current legislation15 allows placement of patients aged 15-17 in adult
unites of psychiatric hospitals which is in contradiction with the best interests of the child and their
rights secured by international legal acts. It is also a problem that the performance standards of adult
and child units at psychiatric institutions differ, therefore, young people in adult units have to live in
the conditions offered for adults. Consequently, it increases the risk of neglect and violence towards
them16.

PHR appealed to the Public Defender with the request to examine the prevalence of discrimination in
the above-described approach to the matter. After studying the PHR application carefully, the Public
Defender issued a recommendation to the Ministry of Internally Displaced Persons from the Occupied
Territories, Labor, Healthcare and Social Affairs to modify the process of institutionalization of young
people aged 15-18 in order to ensure protection of their best interests. The recommendation has also

14 Ibid. pp. 101-102

15 March 20, 2007 Decree #87/n of the Ministry of Labor, Healthcare and Social Affairs on ‘Approving the rules for placements in
psychiatric institutions’, Article 3, paragraph 13.
16 Public Defender of Georgia, Report on the Situation of Human Rights and Fundamental Freedoms in Georgia, 2017, p. 300

15
been incorporated in the Report on the Situation of Human Rights and Fundamental Freedoms in
Georgia, produced by the Public Defender in 201717.

Two years have elapsed since this recommendation. Although Healthcare Ministry has been informed
about this discrimination on the grounds of disability, it has failed to enforce the recommendation to
this day. Consequently, the rights of minors at psychiatric institutions are being violated for almost
two years now.

Obstruction of meetings between lawyers and residents of psychi-

atric institutions

Multiple instances of psychiatric institution administrations obstructing meetings between lawyers of

civil society organizations and patients of the psychiatric institutions continued to occur in the given
report period, as in previous years.

In order to provide legal aid to the patients PHR lawyers visited different psychiatric institutions as
scheduled as well as when meetings were requested by the residents themselves. The need for PHR
visits is generated by the lack of opportunities for residents of psychiatric institutions to freely seek
help from human rights defenders if legal issues arise. Thus, lawyers visit the institutions instead.

PHR lawyers were twice prevented from communicating with the patients of B. Naneishvili Mental
Health Center LLC (Khoni, Qutiri) by their administration18 and from offering legal services, if re-
quested. Similar obstructions took place during visits at Surami psychiatric institution19 and the Center
for Mental Health and Drug Use Prevention20.

The gravity of this problem is underlined in Public Defender reports, which emphasize the unfavorable
conditions at these psychiatric institutions and the exposed cases of human rights violations. During
meetings with representatives of the Public Defender, residents of psychiatric institutions openly talk
about degrading, violent and inappropriate behavior on the part of the personnel21. The Public Defend-
er’s special report further stresses that communication of beneficiaries with human rights defenders

17 Ibid. p. 300
18 Please see the public statement issued by PHR at https://bit.ly/2T5mdNR
19 Please see the public statement issued by PHR at https://phrgeorgia.wordpress.com/2018/05/15/phrphrr-5/#_ftn1
20 Please see the public statement issued by PHR at https://bit.ly/2mnhGdL
21 Public Defender of Georgia, Monitoring Report of Psychiatric Institutions, 2015, p. 35;
Public Defender of Georgia, Report on the Situation of Human Rights and Fundamental Freedoms in Georgia, 2017, p. 72

16
may serve as a reason for their physical or chemical restriction22, which in its turn implies that admin-
istrations/personnel of psychiatric institutions are not favorably disposed towards the residents and
their communications with others. Thus, it is important that in case of the need for information about
their rights or the need for legal services, individuals residing in psychiatric institutions can access
lawyers and legal aid on the site, without delay. It must be noted that there are cases when personnel
of certain psychiatric hospitals contact PHR lawyers and/or assist the residents seeking legal aid to
connect with PHR. Here, we would like to express our gratitude towards these individuals and our
hope that such occasions will take on a permanent pattern, rather than that of an exception to the rule.

PHR contacted the Healthcare Ministry23 to address the problem of obstructed communication be-
tween lawyers and patients of psychiatric institutions, but with no avail. On the contrary, such instanc-
es have become more permanent. Such neglect on the part of the Ministry begs for the conclusion that
it is not in the priority list of issues for the Ministry to improve the human rights situation of individ-
uals living in psychiatric institutions.

Importantly, in response to the request of PHR, the Advocates Rights Committee of the Georgian Bar
Association is currently examining the case of obstructing professional activity since access to law-
yer’s services at a psychiatric institution is the right provided to every citizen by the regional24, as well
as international25 legislation, therefore, it is unallowable for administrations of psychiatric institutions
to arbitrarily restrict this right.

22 Public Defender of Georgia, Monitoring Report of Psychiatric Institutions, 2015, p. 52

23 Please see the public statement issued by PHR at https://phrgeorgia.wordpress.com/2018/04/18/phr-157/
24 Constitution of Georgia, Article 31
25 Convention on the Rights and Fundamental Freedoms, Article 6; UN Convention on the Rights of Persons with Disabilities, Article
13.

17
Placement in psychiatric institutions for involuntary treatment

The lawfulness of placing individuals in psychiatric establishments for involuntary treatment who
have a mental health diagnosis and/or a history of institutionalization is questionable. Often the expe-
riences of previous institutionalization negatively influence decision-making regarding the placement
of the individual at a psychiatric institution for involuntary treatment. Namely, they play into a certain
‘presumption of sickness”26.

PHR’s experiences have demonstrated that during such occasions the police, the expert-psychiatrists
commission and the court act based on their predisposition that the behavior of the individual is a
sign of worsening mental health and they must therefore be placed in a psychiatric hospital without
adequately assessing the circumstances and without their consent. Such an attitude on the part of au-
thorized agencies result in the discrimination on the grounds of mental health diagnosis27.

PHR has examined 3 cases where individuals were institutionalized for involuntary treatment purpos-
es. As a result of PHR involvement in these cases, the three individuals, all female, were discharged
from the psychiatric hospitals immediately after the rulings of the Court of Appeals. One of them was
also entitled to receive compensation in the amount of GEL 5 000 for the moral damages incurred (this
case has been discussed in detail in the above section on moral damages).

Analysis of these cases demonstrate that the first instance courts mostly concur with the expert-psychi-
atric conclusions and fail to take into account the reasoning offered by individuals who are subjected
to involuntary psychiatric treatment. They are also less keen on examining the evidence and the extent
to which the preconditions provided for by the legislation are met. In all of the cases handled by PHR
the courts have failed to question if the placement of the individual in a psychiatric institution had been
induced by family members or third parties and if the individual had been subjected to psychological
or physical violence by their family member or a third party. Moreover, in 2 cases out of the three the
claimants were recognized as victims of domestic violence. In one case a warrant had been issued and
the claimant was subjected to involuntary treatment based on the allegation that they caused harm to
their family members. In the second case the warrant was issued against the mother in order to protect
the child who was institutionalized based on the mother’s demand.

In all of the three cases the Court of Appeals changed the rulings of the first instance courts. The court
clarified that according to the current legislation, during provision of involuntary in-patient psychi-
atric care, the higher weight of evidence is assigned to the conclusions of the commission of doctors
and psychiatrists, however, it is not the only evidence that is needed for decision-making. Judges are
required to carefully examine the circumstances and establish if the legally determined criteria for in-
stitutionalization of the patient for involuntary treatment are in place, namely, if the patient is harmful
for the society28.
26 Public Defender of Georgia. National Prevention Mechanism, Monitoring Report of Psychiatric Institutions, 2015, p. 11
27 Coalition for Equality. The Right to Non-discrimination in Practice for Various Groups in Georgia, 2017, p. 39
28 Tbilisi Court of Appeals ruling on the case N3b/2442-17, p. 6

18
The Court of Appeals stressed that drawing only from the patient’s diagnosis cannot serve as the
grounds for their institutionalization for involuntary psychiatric treatment29. The clarification of the
Court of Appeals that past treatments at a psychiatric institution must not carry decisive importance in
the assessment of current mental health conditions of the individual is in compliance with the standard
established by the European Court of Human Rights. In the case Varbanov vs. Bulgaria the court em-
phasizes that in the efforts to establish whether an individual is capable of doing harm to themselves
and/or others, the assessment must focus on the current situation and not draw conclusions from
events that have occurred in the past30.

Furthermore, in the case Stanev vs. Bulgaria, the European Court of Human Rights posited that only
witness reports and/or aggressive behavior from the part of the individual were not sufficient to assess
the potential harmfulness of the individual with mental health disorders31.

Legislation addressing involuntary treatment

Ambiguous and unpredictable provisions in the national legislation encourage the practice of unlawful
institutionalization for involuntary treatment.

Article 18 of the law of Georgia on ‘Psychiatric Care’ specifies the terms for institutionalization of
individuals without their consent. Namely, it lists three allowable grounds for exercising involuntary
in-patient psychiatric care32: when due to mental health disorder the patient is not capable of making
conscious decisions and:

• Psychiatric care cannot be provided other than at the in-patient unit of a psychiatric institution;
• Delay in providing psychiatric care jeopardizes the life and health of the person in question
and/or others;
• Patient can cause significant material loss for themselves or others due to their behavior.

The ambiguity and unpredictability of this provision are in their turn sustained by the following:

• The law does not specify criteria for examining, assessing and establishing the ‘danger’ posed
by or expected from someone with mental health disorders; therefore, it provides opportunities
for their involuntary institutionalization;

29 Tbilisi Court of Appeals ruling on the case N3b/1180-19, p. 7

30 October 5, 2000 ruling of European Court of Human Rights on the case Varbanov vs. Bulgaria, p. 47. Available at:http://hudoc.echr.
coe.int/eng#{“tabview”:[“document”],”itemid”:[“001-58842”]})
31 January 17, 2012 ruling of European Court of Human Rights on the case Stanev vs. Bulgaria, p. 157. Available at: http://hudoc.echr.
coe.int/eng#{“tabview”:[“document”],”itemid”:[“001-108690”]}))
32 Law of Georgia on Psychiatric Care, Article 18, paragraph 1

19
 • Through the failure to specify criteria, which would define ‘danger’, the law allows institution-
alization of a person with mental health disorders without their consent and only based on the
prevalence of their disorder.

In order to establish the extent to which this provision is constitutional, PHR appealed to the Consti-
tutional Court33. PHR believes that the provision is unconstitutional and in violation of the right to
free development enshrined in the Constitution of Georgia as well as the right to dignity, the right to
freedom and freedom of belief. The Constitutional Court has not yet completed hearings of the case.

III. Discriminatory State Policies towards Individuals under the State

Care

The human rights situation of elderly populations

• International standards

Older persons are some of the most vulnerable groups in Georgia whose rights should receive in-
creased attention from the State.

For the purpose of ensuring equal and full realization of the rights and fundamental freedoms of the
elderly, in 2014 the Committee of Ministers of the Council of Europe issued a recommendation re-
garding promotion of human rights of older persons.34 As emphasized in the recommendation, older
persons should enjoy their rights and freedoms without discrimination, including on the grounds of
age. They must be safeguarded from violence, abuse and intentional neglect or negligent behavior,
regardless of where such actions may occur: at home, at an institution or beyond. Older persons who
have experienced violence must receive adequate support and care from the State.

Governments must carry out all necessary measures to raise awareness of medical personnel, carers
and others engaged in issues related to the elderly in order to enable them to detect and expose vio-
lence, provide guidance to older persons on actions that need to be taken when they feel that they have
been subjected to violence35.

Prompt notification systems have been built in order to combat violence against older persons. For
example, in Belgium, Czechia, Finland and France hot line services have been set up for reporting

33 Constitutional law-suit on the case Mariana Manveliani vs. Parliament of Georgia

34 Recommendation CM/Rec(2014)2 of the Committee of Ministers to member States on the promotion of human rights of older
persons.
35 Recommendation CM/Rec(2014)2 of the Committee of Ministers to member States on the promotion of human rights of older
persons.

20
violence. Local support groups visit families and offer various methods for problem-solution in order
to improve the living conditions of older persons. They also offer free consultations and training36.

The recommendation prepared by the Committee of Ministers of the Council of Europe also stress-
es the right of older persons to independent living and independent decision-making; the right to
participate in public, cultural, educational and other types of activities. They should have access to
consultations and information about their rights. States must spare resources to ensure participation
of older persons in public life; to meet their needs of dignified living; to incorporate issues of security
and healthcare of older persons in state programs, action plans and other policies. States must ensure
sufficient and adequate living conditions for those older persons who are unable or unwilling to live
in their own homes.

The resolution of the parliamentary assembly of the Council of Europe37 is another important docu-
ment for safeguarding the rights of older persons. The document requires from the Council member
States to take steps against age discrimination, social exclusion of older persons and for improving
relevant care systems; to secure subsistence minimum and adequate living conditions for their digni-
fied living; to raise awareness of media, service providers and society at large; empower older persons
and ensure independent monitoring of long-term care institutions.

These documents describe the range of obligations that the international regulations introduce along-
side national legislations. Therefore, States must make all the arrangements to ensure unobstructed
and full realization of their rights by older persons; they must create all necessary conditions for
adequate medical care and housing for the elderly; for their full participation in the society and for
preventing their isolation due to their age or any other characteristic.

36 Recommendation CM/Rec(2014)2 of the Committee of Ministers to member States on the promotion of human rights of older
persons.
37 Council of Europe, Human rights of older persons and their comprehensive care, Resolution N2168, 2017 - http://assembly.coe.int/
nw/xml/XRef/Xref-XML2HTML-EN.asp?fileid=23768&lang=en

21
• The situation in Georgia

Neither the State agencies, nor the civil society has yet studied the situation of older persons in Geor-
gia sufficiently or adequately. Analytical documents regarding this situation are lacking, even though
the social and economic hardships faced by older persons in Georgia and their rights violations are
clearly visible for everyone. Fragmented information can be found in the reports of the Public De-
fender who points to the prevalence of discrimination on the grounds of age as one of the systematic
problems faced by older persons; violence, including domestic violence towards them; detrimental
social-economic and living conditions; risks of poverty and homelessness; inaccessibility of physical
infrastructure; the lack of a long-term care strategy for older persons, etc.38

During the report period PHR started examining the human rights situation of older persons in Geor-
gia. The presented report offers description of findings as a result of PHR efforts in this direction,
however, they are not completely illustrative of all the aspects but are rather an attempt at the analysis
of the situation of older persons under the State care and at identification and exposure of major sys-
temic challenges.

Residential care for older persons is provided by the State through operating two types of institutions
– those run by the State (under the State Fund for Protection and Assistance of (Statutory) Victims
of Human Trafficking - ATIPFUND) and those managed by community organizations (hereinafter
referred to as private residential homes).

Presently there are two State-run large care institutions for older persons in Georgia: in Tbilisi and
Kutaisi where in total more than 100 older persons receive care. In terms of private residential homes,
12 community organizations were registered as providers with the government in 201839. By 2019,
109 older persons were enrolled in their services. As for the waiting lists, as of March 2019 there were
80 older people on the list.40

During the report period PHR visited a number of care institutions for the elderly: Basiliada, Barbare
XXI, My Warm Family and Tbilisi Home for the Elderly. In order to comprehensively analyze the
issues and double-check the information collected from visits at these locations, PHR met with the
Director of ATIPFUND and a representative of the LEPL Social Service Agency under the Ministry
of Internally Displaced Persons from the Occupied Territories, Labor, Healthcare and Social Affairs.
Additional information was also requested from various responsible agencies.

These meetings and visits revealed that the conditions at these homes vary. Some of the buildings are
not physically accessible to meet the needs of older persons, due to which they are unable to navigate
or leave the buildings independently. Courtyards of the institutions are also in need of refurbishment.
38 Public Defender of Georgia, Parliamentary Report on the Situation of Human Rights and Fundamental Freedoms in Georgia, 2018, p.
282
39 N04/67776 correspondence with LEPL Social Service Agency
40 N01/5407 Correspondence with the Ministry of Internally Displaced Persons from the Occupied Territories, Labor, Healthcare
and Social Affairs

22
They lack guidelines for detecting and reporting possible instances of violence. Due to varying fund-
ing models, the quality of care provided at these homes is different as well as the composition and
diversity of the staff and services in rehabilitation and cultural entertainment.

• Private residential Homes

The biggest challenge for private residential homes is scarce funding because of which they are un-
able to hire sufficient number of staff including doctors, psychologists, nurses and carers. Despite the
state-covered insurance, older persons often have to buy mediations out of pocket. These institutions
cannot provide transportation services to their residents and municipal transport is not always avail-
able near the homes, which further complicates mobility of the resident older persons. The road in one
of the homes is in need of repair, which poses another set of obstacles for the safe movement of their
clients. PHR appealed to the local government with the request to repair the road and address the lack
of transportation.41 As a result, the road to one of the private homes was rebuilt and the relevant mu-
nicipal agency modified the route of the municipal transport in order to enable resident older persons
to use public transport without delay. However, more proactive cooperation is necessary to ensure full
and prompt implementation of the interests of older persons.

Most of these homes have courtyards, albeit all of them in need of refurbishment. There are no bench-
es and other necessary infrastructure in the yards due to which residents have to spend most of their
time indoors.

N.G. lives in one of the private homes. PHR met with N.G. on a site visit to the institution one day.
S/he had a broken leg and needed to visit a hospital for examination but as the home where N.G. was
staying in could not provide transportation, N.G. was unable to go to the hospital independently. In
such cases residents of private homes have to pay for taxi services whether they are able to move in-
dependently or with others’ support.

41 http://phr.ge/home/content?content_id=869

23
• Large state-run institutions for the elderly

Conditions at the state-run care homes for older persons are different from those at private institutions.
They own vehicles, which can be used by the residents when needed. They offer services of a doctor
and a psychologist who provide support to the residents on a daily basis. The state-run homes have
supplies of medication, which can be accessed when the state insurance policies do not meet the med-
ication needs of older persons. Unlike the private homes for the elderly, the state-run institutions also
offer seasonal holidays for their residents. Even though the Tbilisi Home for the Elderly is a large care
institution, the environment and the services offered by them is relatively better than those observed
by PHR at private homes.

Differences in offered services are also highlighted in the Public Defender reports, who argue that the
service portions of the budgets of these institutions are insufficient. Older persons are not provided
with medications and support from doctors and psychologists that are needed for their specific health
conditions (except for the Tbilisi Home for the Elderly). The infrastructural issues such as courtyards
in need of repair and limited physical accessibility are also important. Finally, lack of access to trans-
portation options restricts mobility of the beneficiaries within their communities.42

Residential institutions including homes for the elderly are also critically described in the 2018 report
of the independent UN expert who examined the conditions at both private and state-run care insti-
tutions. According to the report, the quality of the care provided at these homes is alarming, living
conditions at some of them are not adequate and the matter of detecting and exposing violence is also
troublesome. The report also stresses the scarcity of funding, poor monitoring and the lack of the
knowledge among older persons about their rights.43

• State funding system and the monitoring outcomes

Funding mechanisms for care homes vary: the daily amount per one beneficiary is GEL 1644 for those
at the state-run institutions and GEL 20 at private homes, unless the poverty score of the beneficiary
does not exceed 65 000. In case when the beneficiary’s score falls between 65 001 and 100 001, the
State subsidizes the daily amount with GEL 3 at the state-run homes and with GEL 4 at private homes.
When the score is between 100 001 and 150 001, the daily subsidized amount reaches GEL 5 and GEL
6 for beneficiaries at state-run and private care institutions respectively.

42 Ibid. p. 285
43 Report of the Independent Expert on the enjoyment of all human rights by older persons on her mission to Georgia, p.13
44 Ibid. Article 4

24
The budget of the Subprogram for Service Provision by Community Care Organizations allocated for
persons with disabilities and older persons amounted to GEL 2 276 500 in 201945. Although at a glance
the daily funding per beneficiary granted by the State for private care institutions may seem more than
that paid to the state-owned homes, it must be highlighted that private homes are completely depen-
dent on the State program vouchers for older persons while the state-run institutions enjoy additional
budgetary resources. They have their separate budget which by 2019 reached GEL 1 100 000, how-
ever, the amount is shared across all of the state-run care institutions. Monitoring has revealed that
the entire budget managed by ATIPFUND allows for covering other services for older persons when
needed and these are precisely the services which distinguish the state-run care homes from the private
ones; namely, those offered by doctors and psychologists, transportation services, etc.

Examining the results of monitoring conducted by the Ministry of Internally Displaced Persons from
the Occupied Territories, Labor, Healthcare and Social Affairs is also important. Monitoring took
place at 5 private care homes for older persons in 2017 and 2 homes in 2018.46

Analysis of the monitoring documents demonstrates that the majority of care institutions do not have
guidelines for service provision, which would describe the contents and timeframes of services. The
lack of cultural and entertainment activities that would sustain intellectual, physical or social skills of
older people is also troublesome; absence of individual plans for service provision is problematic and
the need for refurbishing the courtyards of these institutions is also crucial to ensure free movement
and leisure of resident older persons.

As a result of analyzing the state funding mechanisms, the regulations operating in and for state-run
care homes and monitoring of the situation in the residential institutions, it can be argued that the state
care policies are inadequate, incomplete and at the same time discriminating towards private care
homes as opposed to those managed by the state.

45 State Program on Social Rehabilitation and Childcare, Appendix 1.12, Article 5, paragraph 1
46 N01/5407 correspondence of the Ministry of Internally Displaced Persons, Labor, Health and Social Affairs

25
• Discriminatory policies

Although both types of care homes described above are financed by the State47 the actual situation in
these institutions and the existing legal regulations do not ensure adequate and equal care for each and
every older person living under their care. Namely, a whole range of services, which are necessary
and are available at the state-run residential institutions for the elderly are not accessible for residents
of private care homes, even though beneficiaries of both types of institutions face the same needs.
This includes services by a doctor or a psychologist; cultural and recreational activities; provision of
medication and items of personal hygiene, etc. Beneficiaries are placed in these care homes not based
on their circumstances but on their number in the list. Therefore, it is possible that two older persons
in similar conditions may end up in the State and private care home and thus be receiving different
services through different funding mechanisms.

We believe that in the light of such regulations the right to equal treatment is grossly violated. Since
both types of care homes are funded by the state, they both provide services to similar communities
and serve the same purpose, the support must be materialized in a way, which will ensure full and
dignified service provision for all older persons. Therefore, a unified standard should be established
which will be mandatory for all of the care institutions to follow and which will ensure that all older
persons are able to receive the services they need for dignified living.

PHR appealed to the Public Defender with the request to examine the prevalence of discrimination in
this practice. The situation described above exposes the failure of the State to fully meet the needs of
older persons. The state policies in residential care should be modified so that each and every older
person is provided with dignified living conditions and with services that will meet their individual
needs.

Residential care institutions for persons with disabilities

• Large residential institutions as a systemic discrimination

Although deinstitutionalization has begun in Georgia, persons with disabilities continue to live in large
residential institutions, which restricts their opportunities for free development and obstruct their inde-
pendent living. The UN Convention on the Rights of Persons with Disabilities stressed the importance
of independent living by means of defining the concept in a separate Article 19 and issuing a General
Comment #5, which elaborates and clarifies the particular significance of the right described above48.

47 January 27, 2010 Resolution of the Government of Georgia on Approving the Rules and Conditions for Financing (co-financing)
the Placement of Persons in Specialized Institutions
48 https://www.ohchr.org/en/hrbodies/crpd/pages/gc.aspx

26
As clarified by the Committee, independent living means that each person with disabilities must be
provided with all necessary resources and opportunities to be able to make decisions independently.
Personal autonomy and self-expression are fundamentally important to achieve independent living.
As for participation in public life, independent living implies access to all public or individual ser-
vices. According to the Committee, the belief that some persons with disabilities are unable to live
independently and residential institutions may be the best living arrangement for them, must not be
perpetuated.49

As of today, there are 3 large scale residential homes for adults with disabilities (Dusheti, Martkopi
and Dzevri) and one home for children in Kojori. Existence of such institutions itself is in contra-
diction with the UN Convention on the Rights of Persons with Disabilities and the internationally
recognized standards.

The institutional arrangements of these specialized residential homes, the lack of psycho-social ser-
vices they offer, the shortage of staff and the quality of their qualifications are some of the major chal-
lenges in providing persons with disabilities with the services they need. Inaccessible infrastructure,
limited communication with families, social passivity and isolation from the society at large are also
troublesome. The institutions are characterized with high risks of unequal treatment of beneficiaries
caused by differing circumstances.50

The rights of persons with disabilities living in residential institutions to privacy and family life are
restricted which serves as the grounds for their unequal treatment based on their place of residence.
Family members are separated, persons with disabilities are unable to maintain regular contact with
their children and the State fails to support integrity of their families. Consequently, persons with
disabilities who live in residential institutions are completely segregated from the society which is
against the recommendation issued by the UN Committee of the Convention on the Rights of Persons
with Disabilities; they are unable to access services that would promote their independent living and
inclusion in their communities. Residential institutions fail to engage their beneficiaries in cultural or
entertainment activities and majority of their residents do not receive the much needed medical and
rehabilitation services. Thus, persons with disabilities living in residential institutions are victims of
regular systemic discrimination.

49 https://www.ohchr.org/en/hrbodies/crpd/pages/gc.aspx
50 Public Defender of Georgia. Special Report on the Rights of Persons with Disabilities under State Care, 2016, p.30

27
• Unfavorable environment of the residential institutions

Throughout the report period the PHR lawyers visited the residential institutions for persons with dis-
abilities several times during which certain tensions and conflicts between the residents and the staff
could be observed. As described by the residents, different items are often stolen from their rooms,
however these claims have not been promptly investigated and no prevention steps have been taken
either by the administration or the staff. Conflicts are also frequent between the residents, which the
administrations of the institutions find hard to resolve.

Persons with disabilities living in these residential settings also insist that the situation at the institu-
tion often falls out of control as the administration fails to neutralize it. Notably, during one of the site
visits the PHR lawyers witnessed one such conflict between a resident and the staff and could observe
that the situation was rather neutralized by the residents than the administration. The staff at these care
institutions do not have professional knowledge and skills in conflict prevention and performance in
special circumstances which are crucial in order to manage conflict situations.

One of the residents of the institution also claimed that the director of the institution had conducted
an act of violence against them. PHR informed ATIPFUND, the Ministry of Internal Affairs and the
Public Defender of Georgia regarding this claim.51

The 2016 monitoring report by the Public Defender also stresses the prevalence of conflicts within
the care institutions.52 The Public Defender issued a recommendation for ATIPFUND where it called
for regular educational efforts to improve qualifications of the staff and for enhancing rehabilitation
programs, including social and psycho-rehabilitation activities.53

Nevertheless, as of today the situation at these institutions remains unchanged. The rights of persons
with disabilities are being violated not only because they have to live at these institutions, but also
because they are deprived of the opportunity to reside in a peaceful and safe environment. Administra-
tions of these care institutions have yet to develop guidelines and plans on how to manage and neutral-
ize conflict situations effectively so that residents are able to coexist in a safe and calm environment.

51 https://bit.ly/2krgRQF
52 Ibid. p. 10
53 The Public Defender of Georgia recommendation on the problems at Martkopi residential institution for persons with disabilities,
2017

28
• Neglecting needs of persons with disabilities by responsible state
agencies

During visits to the residential institutions for persons with disabilities PHR identified a number of
systemic and individual problems, which have not been promptly and effectively addressed by the
administrations and the responsible government agencies. One of the important challenges is the re-
striction of access to pension for residents of the care institutions. Those residents whose recognition
as support-recipients is pending at the courts do not have access to social benefits while persons with
disabilities who are not institutionalized but are similarly in need of status change, are able to collect
their social allowances without delay. Therefore, it can be argued that persons with disabilities who
live in residential settings and who have been deprived of their legal capacity before are placed in an
unequal situation as compared to those who have similar status but are not institutionalized.

Even though institutionalized persons with disabilities are completely under the state care, they still
may face other needs which are not met within the institutions; they are also entitled to access their
social benefits without delay, as other persons with disabilities. PHR appealed to the Public Defender
to examine the potential discriminatory nature of this restriction. The Public Defender is yet to make
its final judgment on this matter.

Administrative staff of the residential institutions sometimes fails to consider the residents’ require-
ments as well. One of the residents who had been granted a certain type of disability status several
years ago approached PHR for assistance. Since her/his health had deteriorated since receiving the
status, s/he believed that a change was needed in the status, which would also mean an increase of the
disability allowance. Despite several requests of the resident, the administration of the institution ig-
nored her/his appeals. Only after PHR addressed the administration on behalf of the resident it imme-
diately granted his/her request. Thus, her/his disability status was updated and the person in question
has been able to receive increased disability allowance.

PHR has handled another case, which also exposes the negligence of the administrations towards the
needs and requirements of their residents. A support-recipient individual who lived at a residential
institution informed PHR about delays in accessing the amount on their accumulated pension account
and asked for the PHR’s help. Even though the administrative staff of the institution had been familiar
with the needs of this individual for a long period of time, they had failed to take any action to address
the problem. Only after PHR addressed ATIPFUND, the latter appealed to the court and requested to
assign a supporter for the individual in accessing/managing their accumulated pension.

The cases and example described above illustrate the failure on the part of the administrations to act
proactively in order to meet the needs and interests of their residents promptly. They either completely
ignore these needs or address them with delay; their actions are mostly tokenistic and not goal-orient-
ed.

29
Conclusions

Issues discussed in the report expose the range of challenges in the human rights situation of disad-
vantaged groups in Georgia. None of these challenges have been completely addressed or improved
during the report period. The situation in terms of access to justice for disadvantaged communities
is particularly troublesome as the courts are the last resort for them to restore their rights, therefore
delayed court hearings are equal to delayed justice. Moreover, the national legislation and services/
programs offered to Georgian citizens, particularly children and persons with disabilities fail to meet
even their minimum needs.

Problems such as inconsiderate treatment of persons with psycho-social needs, the lack of required
services, delayed deinstitutionalization and inadequate living conditions remain to be unsolved. The
State must also pay due attention to assessing the needs of institutionalized persons with disabilities
and granting access to community-based services. In order to improve the living conditions and safety
of these individuals it is essential to ensure corresponding social and economic securities. The human
rights situation of older persons is similarly troublesome. The State fails to meet the needs of these
communities as well. Residential care policies should be fundamentally modified in order to ensure
that each and every older person is able to lead dignified lives and receive required services without
discrimination.

Even though deinstitutionalization has been initiated in Georgia, persons with disabilities continue to
live in large scale residential institutions which precludes them from free development and indepen-
dent living. Institutionalized persons with disabilities cannot exercise their right to privacy and family
life; most of them cannot access the much needed medical and rehabilitation services; they are unable
to participate in cultural, sports and social activities on an equal basis with others. Consequently, per-
sons with disabilities who live in residential care institutions are victims of systemic discrimination
due to their institutionalization.

30
Recommendations

• The High Council of Justice must develop regulations to prioritize particularly sensitive and
substantially important cases for quick and effective hearing in order to address the issue of
delays in court proceedings;

• In order to avoid occurrence of systemic discrimination, judges at common courts should take
into account the important precedents created by PHR when examining cases of institutional-
ization of individuals for involuntary psychiatric care;

• Government of Georgia must implement the activities listed in the 2015-2020 Mental Health
Strategy and the Action Plan in a timely and effective manner;

• The Ministry of Internally Displaced Persons from the Occupied Territories, Labor, Health and
Social Affairs must coordinate with local municipalities to develop housing services on the
local level in order to provide institutionalized individuals (psychiatric hospitals, residential
institutions for persons with disabilities) with adequate living conditions;

• The Ministry of Internally Displaced Persons from the Occupied Territories, Labor, Health and
Social Affairs must make sure that the needs of individuals who have been enrolled in a psy-
chiatric establishment are adequately assessed for the purposes of their discharge and referral
to community-based services;

• The State must take action to support inclusion and independent living of persons with disabil-
ities; build new community-based services on the one hand and further develop and improve
existing services on the other;

• Judges, doctors and psychiatrists, members of the expert commissions and the police must re-
ceive training in order to ensure that the mental health conditions of an individual are compre-
hensively assessed and that they are not subjected to involuntary treatment due to their mental
health diagnosis and past history of treatment without consent;

• Parliament of Georgia must revise Article 18 of the law of Georgia on Psychiatric Care and
specify the criteria for ‘danger’ to make sure that the law prohibits involuntary placement of
an individual under psychiatric care;

• The State must take actions to meet all of the interests of older persons. It must introduce
substantial changes in the residential care policies to ensure that each and every older person

31
 can enjoy dignified living conditions and can access services required to meet their individual
needs and that instances of granting privileges to one group over another are extensively ad-
dressed;

• For deinstitutionalization purposes the Ministry of Internally Displaced Persons from the Oc-
cupied Territories, Labor, Health and Social Affairs must close down the large residential in-
stitutions for persons with disabilities and take steps to develop family and community-based
services which will support reintegration with families, person-oriented living arrangements
and proactive promotion of the rights and securities of these communities;

• The State Fund for Protection and Assistance of (Statutory) Victims of Human Trafficking
(ATIPFUND) must take action to resolve and reduce conflict situations in the residential in-
stitutions of persons with disabilities, including by means of incorporating psychological ser-
vices in the process;

• The State Fund for Protection and Assistance of (Statutory) Victims of Human Trafficking
(ATIPFUND) must deliver training for professional and assisting staff at the residential insti-
tutions of persons with disabilities on their needs and on dealing with and managing difficult
behavior patterns.

32