CPT _2010_ 82 - EN - Report Armenia 2010 _2_ - The Government ...

- 61 -148. The delegation’s findings suggest that the court procedure for civil commitment to apsychiatric hospital was rarely used in practice and the patients who had been placed in apsychiatric facility against their will could not benefit from appropriate safeguards. At YerevanNork Centre of Mental Health, this procedure had been initiated only in respect of one patient at thetime of the visit (out of 63 “civil” patients). From discussions with the hospital management itbecame apparent that the involuntary placement procedure was only initiated in respect of thosepatients who did not want to sign a paper on “voluntary” admission within the first 72 hours and/orwho actively resisted their hospitalisation. 96 However, as already mentioned, patients were kept inlocked wards and many patients with whom the delegation spoke declared that they were being heldin the institution against their will, and wished to be discharged.No precise statistics on the number of involuntary admissions according to the procedureprovided for in the LPA were available, but it was indicated to the delegation that there were about10 patients throughout Armenia hospitalised under this procedure at the time of the visit.The CPT reiterates the recommendation made in the report on its 2006 visit that stepsbe taken to ensure that the provisions of the LPA on involuntary civil hospitalisation are fullyimplemented in practice. This will involve training of all structures and persons concerned (inparticular, health-care staff, hospital management and judges). To monitor theimplementation of the new legislation, statistics on involuntary admissions (which could bebroken down by diagnosis, gender, hospital, length of stay, etc.) should be compiled atnational and establishment level.149. Concerning a patient’s consent to treatment, Section 15 (3) of the LPA stipulates thatpatients (including involuntary patients) have the right to refuse treatment, except in the case of“forensic” patients.In the Committee's opinion, the admission of a person to a psychiatric establishment on aninvoluntary basis, whether the person concerned be a civil or a “forensic” patient, should not beconstrued as authorising treatment without his/her consent. Every competent patient, whethervoluntary or involuntary, should be given the opportunity to refuse treatment or any other medicalintervention. If a patient is to be medicated against his/her informed consent, there should be clearcriteria for this and procedures by which this can be authorised (which should allow for a second,independent, medical opinion in addition to that of the doctor(s) proposing the treatment). The CPTrecommends that the Armenian authorities take steps to reflect, in both law and practice, theprinciple of a patient’s consent to treatment and the above-mentioned requirements asregards treatment without consent.150. The above-mentioned amendments to the LPA include the right of psychiatric patients toreceive legal assistance, 97 but the practical provision of free legal assistance remains to be regulated.The CPT would like to receive further information on this subject. Further, it would like toreceive information on whether free legal assistance can also be provided to “forensicpatients”.9697Pursuant to the 2009 amendments to the LPA, discharge of a voluntary patient is to be done according to amedical opinion or upon the patient’s request if he/she does not present a danger to society. Otherwise,pursuant to a doctor's request, he might be transferred to involuntary placement (Section 21 of the LPA).Section 22, paragraph 1.6, of the LPA.