Signatory organizations are responding to the closure of a mental health unit at the Ivane Bokeria Referral Hospital. We consider this decision a setback in the process of deinstitutionalization of mental health facilities. The closing down of the mental health unit jeopardizes the right of persons with psychosocial needs to access healthcare services. It also elevates the risk that patients will be unable to access proper service and/or will have to return to the already overcrowded psychiatric facilities, where their rights are more likely to be violated. This is precisely the purpose for which the process of deinstitutionalization and reorganization of mental healthcare resources has commenced.

The Ivane Bokeria Tbilisi Referral Hospital offered individuals an opportunity to access the service in the community during a mental health crisis. The hospital decided to close down the mental health unit in July, citing problems with funding as the main reason. Signatory organizations hold that this decision points to mismanagement practices by the clinic as well as insufficient supervision over a state-funded health program on part of the Ministry of Internally Displaced Persons from the Occupied Territories, Health, Labour and Social Affairs of Georgia. 

Particularly concerning is the fact that following this decision, only one out of the three multi-profile hospitals established years ago - the 5th Hospital - will have a functioning mental health unit, which will remain open for an unspecified period.[1] Consequently, the number of people who receive inpatient mental health treatment in the community (rather than in large, specialized psychiatric institutions) has been steadily declining over the years, instead of increasing. Considering the dire scarcity of the mental health units in the multi-profile clinics in the country, we hold the Government of Georgia and the Ministry of Internally Displaced Persons from the Occupied Territories, Health, Labour and Social Affairs of Georgia directly accountable for allowing such units to be closed without finding a suitable replacement.

In this context, we wish to once again emphasize that there is no alternative to the process of deinstitutionalization in the field of mental health. We also underline the fact that the current flaws in the functioning of mental health units are the sole responsibility of the Government of Georgia, which highlight the shortcomings in governance and regulatory deficiencies.

We once again call for the Ministry of Internally Displaced Persons from the Occupied Territories, Health, Labour and Social Affairs of Georgia to acknowledge its responsibilities for proper implementation of the mental health policy and prompt conduct of deinstitutionalization and urge to use all available means for the progressive realization of its obligations. 

Based on these considerations, we urge

The Ministry of Internally Displaced Persons from the Occupied Territories, Health, Labour and Social Affairs of Georgia to:

• Use all available means to avoid the closure of mental health units in multi-profile hospitals and to regulate the conditions for private companies entering and leaving the state program;
• With the involvement of all interested parties (particularly the persons with mental health problems/psychosocial disabilities), develop a mechanism that will encourage opening up and maintenance of mental health units in multi-profile hospitals;
• Ensure proper execution and efficient implementation of the state mental health program through monitoring multi-profile hospitals;
• Develop a package of legislative changes that will ensure the establishment of mental health units in private multi-profile clinics and create the possibility of the permanent replacement of the out-of-program clinics;
• Swiftly elaborate a strategy for deinstitutionalization of psychiatric facilities that will include the measures to be taken by the Government in this field within a reasonable timeframe.

The Georgian Parliament to:

• Carry out its supervisory functions and properly monitor the process of deinstitutionalization of mental facilities by the executive branch of the Government.

Signatory Organizations:

• Social Justice Center (former EMC) 
• Alliance for Better Mental Health
• Georgian Network of Users and Survivors of Psychiatry
• Partnership for Equal Rights
• Georgian Mental Health Association
• Evidence-based Practice Center
• Coalition of Organizations of Disabled Persons and Parents “Movement for Changes”
• Fund Global Initiative on Psychiatry – Tbilisi

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