Patients' Limbs Tied with Sheets or Clothing at Sevan Mental Health Center: Ombudsman's Statement

The staff and experts of the National Preventive Mechanism of the Human Rights Defender's Office, along with the head of the Gegharkunik regional division, conducted an unannounced visit to the Sevan Mental Health Center on April 19, following the instructions of the Human Rights Defender. During the visit, the implementation status of the Defender's recommendations regarding previously identified issues was examined, and new problems were also raised.

It is concerning that a significant number of previously recorded issues remain unresolved. In particular, several departments of the center continue to be overcrowded, and the necessary residential area for patients' personal space has not been maintained. In the rooms, the beds are placed too close together, violating the right to private life. Some departments are in need of renovation, and conditions in certain patient rooms have been inadequate.

For physical restraint, only one of the nine sections of the Center has designated separate rooms. Other departments often carry out physical restraint in patient rooms in the presence of other patients. Issues have been recorded regarding the application of restraint measures on patients and their proper documentation. Although there have been reports of frequent use of physical restraint on patients, the records are absent in the logs, and physical restraint has been performed using mechanical devices that are not legally prescribed and difficult to release. In particular, patients' limbs have been tied with sheets or clothing (e.g., woolen tights), and in some cases, appropriate medical examinations for the application of medication for sedation were not carried out, and the results were not adequately documented. The logs only contained information about patients' blood pressure and body temperature, and there were issues related to informed consent for individuals recognized as incapacitated.

Specifically, their guardians did not present informed consent, and patients are not adequately informed about their rights. The improper implementation of the guardianship system remains concerning. There is insufficient oversight regarding the actual operation of guardians in the interests of the patients. Issues related to the individualization of clothing have been noted; patients who cannot individualize their clothing receive randomly assigned clothing after washing. There is an urgent need to ensure that patients can wash themselves without organizing it outside in the cold weather conditions, as not all departments of the center have accessible and suitable environments. For example, most department entrances lack ramps, resulting in mobility-challenged patients facing difficulties accessing restrooms and going for walks. The presence of expired and untagged food items (e.g., yogurt and soda) is unacceptable, as is the absence of food items specified in the menu. For instance, on April 21, the menu indicated cheese with banana, but cheese was unavailable.

Given that the following two days were non-working days and they could not acquire these items, a change to the upcoming menu was planned post the Defender's observations. There is a necessity to ensure that patients are engaged in activities. Despite the existence of an activity center, patients' engagement in departmental activities is still limited to watching the television placed in the hallways. Concerns remain regarding the involvement of patients in various tasks (cleaning tasks in departments and the yard, greenhouse, food carrying tasks, etc.) without time limitations and professional guidance as part of occupational therapy. No criteria have been identified for assessing the appropriateness of patient participation in occupational therapy, and attention has only been emphasized on patients' desires and the importance of their engagement in effective activities.

There have not been any provisions to organize psychological work with patients in the Center’s departments, and there are no unified procedures for documenting and monitoring the joint work of psychologists and psychiatrists. Psychologists mostly do not participate in the development of the patient's therapeutic strategy. In some of the Center's departments, telephones have been out of order, preventing patients without individual mobile phones from contacting relatives or reaching out to relevant authorities, including the Human Rights Defender. The necessity for retraining of both medical and non-medical staff in the center remains relevant, and there have been vacant positions for psychiatrists. Working conditions for staff at the psychiatric facility are in unacceptable states.

The revision of patients' medication treatment plans and the trend of reducing polypharmacy in the Center are commendable, as well as the inclusion of new generation medications in these plans. The Defender emphasizes that the protection of human rights is a comprehensive process, requiring the guarantee of rights of all participants in this process and ensuring dignified treatment of each individual while establishing relations based on mutual respect. A component of this principled approach is the status of the rights of the staff of the bodies entrusted with the protection of others' rights. The working dignified conditions and social guarantees, including salaries, for the employees of psychiatric institutions need to be continuously improved.

The major issues have a systemic nature and have been documented in detail along with proposed solutions in the 2023 annual report of the Human Rights Defender's National Preventive Mechanism. A document detailing the results of the visit, which includes proposals aimed at solving the identified issues, will be sent to the Ministry of Health of the Republic of Armenia. The Human Rights Defender emphasizes the importance of organizing constructive discussions with all interested parties regarding the raised issues.