Based on a Constitutional Court ruling, the Parliament of Georgia is considering a draft law under an expedited procedure. The legislation addresses changes to the rules for ordering and extending involuntary psychiatric treatment, as well as discharge procedures from inpatient facilities.
Eka Tchkonia, Associate Professor at Tbilisi State Medical University (TSMU) and psychiatrist, spoke with us about the specific changes regarding timeframes and procedures, and how these novelties will impact clinical practice.
What was the primary basis for the Constitutional Court’s decision that necessitated these amendments? What specific flaws existed in the previously active regulations?
First and foremost, I would like to distinguish between involuntary (court-ordered) and non-voluntary inpatient admission. Non-voluntary admission occurs when an individual has not (yet) committed a crime, but has a diagnosed mental disorder and poses a high risk of harming themselves or others.
Involuntary admission, on the other hand, applies only when a person with a mental health condition has already committed an offense (for example, murder, assault, domestic violence, bodily harm, or property damage). In Georgia, involuntary treatment is carried out exclusively at a single facility — the Khoni Psychiatric Institution.
The main flaw in the existing regulations was that the condition of a patient undergoing involuntary treatment was required to be reviewed by a commission only once a year. Although in practice doctors under the old system would sometimes request an early review, this was accompanied by serious bureaucratic and procedural barriers, which prolonged decision-making.
If the draft law is approved, what specifically changes in terms of timeframes, and how is the review frequency regulated?
Should the new legislative package be approved, the mandatory timeframe for convening the commission will be reduced from 12 to 6 months. In other words, a patient’s condition must be reviewed at least once every 6 months.
Furthermore, the attending physician will be granted the authority to initiate a commission meeting at any time prior to the 6-month mark — even within a month — if they deem that the patient’s acute condition has stabilized satisfactorily and discharge is possible. This significantly enhances the role of the treating physician.
This change is expected to remove existing bureaucratic obstacles and ensure that patients do not remain in an inpatient facility longer than clinically necessary.
There are approximately 500 individuals currently undergoing involuntary treatment, and naturally, no system can physically review all 500 cases every month. These timeframes establish the periodic review interval, and the process will be distributed over time — a case might come up after 4 months for one person and after 6 months for another. The critical shift is that the physician now has the right to raise the issue earlier than 6 months.
What is the primary objective of these legislative amendments, and in your assessment, how fully does the submitted bill address existing challenges?
The amendments contain nothing negative; on the contrary, their objective is to ensure the periodic review of a patient’s status and the timely making of discharge decisions.
While previously the primary emphasis and decision-making weight rested solely with the judge and the court, greater weight and responsibility are now placed directly on the institution and medical personnel. Physicians have been granted expanded authority to initiate this process at any point and strive to achieve a decision in the patient’s best interest. International practice (for instance, in European countries) also features models where decision-making authority is shared equally between the judiciary and medical boards. Thus, there is no incompatibility with psychiatric standards; rather, at first glance, the process becomes more humane and swift.
Who composes this special internal commission, and to what extent does the current model ensure the commission’s objectivity and independence?
The commission consists of 3 psychiatrists from the same institution.
In my view, the fact that the process is resolved solely at the internal clinical level without requiring an external, independent expert’s participation constitutes a certain drawback. International practice consistently emphasizes the presence of an independent expert who can evaluate the patient’s condition impartially. When decision-making remains entirely within an internal system, a higher risk of conflicts of interest and biased determinations naturally persists. However, as specified in the new draft law, the commission must comprise at least 3 psychiatrists to ensure that decisions do not rely on the subjective opinion of a single doctor.
Will this change help reduce inpatient overcrowding and free up beds for patients who genuinely require them?
Yes, that is likely another benefit. Previously, when a patient might remain in the facility longer than necessary, it naturally led to overcrowding and restricted bed availability for other patients. Now, with shortened review intervals and a streamlined process, doctors will have the opportunity to discharge patients in a more timely manner. Consequently, capacity will be managed more effectively.
Is there a risk that these commissions might create an additional bureaucratic burden for medical staff at the expense of direct clinical care?
No, I do not believe this will create any extraordinary administrative burden. Staff members already conduct patient evaluations and therapeutic work at regular intervals. Previously, doctors might have hesitated to initiate discharge due to concerns over relapse risks or limited statutory authority. Under a simplified procedure, this operational difficulty should no longer be an issue.
Naturally, the final decision remains with the court under both current and proposed regulations. The medical commission cannot discharge a patient independently — doctors issue a clinical assessment, while the judge renders the final ruling regarding discharge or continuation of treatment. The essential change is that the mandatory period for submitting cases to the court is reduced from 12 to 6 months, while the physician gains the right to appeal to the internal commission at any time prior to 6 months, enabling the internal commission to petition the court for the patient’s discharge.
What practical risks do you foresee in the real-world application of this mechanism?
On paper, these amendments appear positive — the process accelerates, simplifies, and places a clear emphasis on human rights, which is commendable.
However, the primary challenge will be their proper execution in practice. There is a risk that the mechanism could be used in bad faith; therefore, it is vital that every case is evaluated thoroughly and that decisions rest on objective medical and legal grounds. Ultimately, time and practice will demonstrate how effectively these changes operate in reality.
