Outpatient compulsory observation and treatment by a psychiatrist may be prescribed if there are grounds provided for in Article 97 of this Code, if the person’s mental state does not require placement in a psychiatric hospital.

• 1. Outpatient compulsory observation and treatment by a psychiatrist may be prescribed if there are grounds provided for in Art. 97 of the Criminal Code, if a person, due to his mental state, does not need to be placed in a psychiatric hospital. Outpatient compulsory observation and treatment by a psychiatrist, as well as inpatient compulsory treatment, is prescribed by a court decision based on the recommendations of a forensic psychiatric expert commission, in which, along with a conclusion on the sanity or insanity of a person, an opinion must be expressed on the need to apply PMMH to him and the type such measures. The conclusion of psychiatric experts is subject to careful evaluation by the court in conjunction with all the materials of the case. The recommendations of psychiatric experts are not binding for the court, although, naturally, they are taken into account when making a judicial decision.
• 2. When deciding on the appointment of outpatient compulsory observation and treatment by a psychiatrist, in addition to establishing the grounds for the use of PMMH, the court takes into account the nature of the person’s mental disorder, the social danger of the crime, as well as the possibility of carrying out his treatment and observation on an outpatient basis. The mental state of a person, in particular, the nature of his mental disorder, must be such that treatment and rehabilitation measures can be carried out without placement in a psychiatric hospital.

For example, according to the court's ruling, R. was exempt from criminal liability for committing a socially dangerous act in a state of insanity, provided for in Part 3 of Art. 30, paragraph "c" part 2 art. 105 CC; She was prescribed compulsory medical measures - outpatient compulsory observation and treatment by a psychiatrist. She, in a state of insanity, attempted to kill her infant. The state prosecutor raised the issue of canceling the ruling and sending the case for a new trial, believing that the court unreasonably applied compulsory outpatient observation and treatment by a psychiatrist, whereas, according to the conclusion of psychiatrist experts, R. needs compulsory treatment in a psychiatric hospital general type. According to the state prosecutor, the court did not take into account the nature and degree of social danger of the act, the severity of the consequences, and the likelihood of a repetition of the unlawful behavior.

The Judicial Collegium for Criminal Cases of the Armed Forces of the Russian Federation left the court's ruling unchanged, indicating the following. According to the conclusion of forensic psychiatrists, R. suffers mental disorder in the form of depressive-paranoid syndrome. At the time of the offense, she could not understand the actual nature and social danger of her actions and control them; she was declared insane and in need of compulsory treatment in a general psychiatric hospital. However, resolving issues of insanity and imposing a type of compulsory medical measures falls within the competence of the court. As established in the case, R., being in a state of insanity, attempted to kill her infant child, and then herself attempted to commit suicide. According to the testimony of the victim’s representative and witnesses, R. has been living with her family since the crime was committed, her health has improved, she is taking care of the child, is aware of what happened, and is under the supervision of relatives. Taking into account the opinion of the doctor treating R., the court came to the correct conclusion about the possibility of curing R. without placing her in a psychiatric hospital (determination of the RF Armed Forces dated December 7, 1999).

• 3. In terms of its content, outpatient compulsory observation and treatment by a psychiatrist involves monitoring the mental state of a person through regular examinations by a psychiatrist and providing this person with the necessary medical and social assistance, i.e. mandatory medical observation. Such observation is established regardless of the patient's consent. The frequency of such inspections depends on mental state person, the dynamics of his mental disorder and needs for psychiatric care. Dispensary observation also includes psychopharmacological and other treatment, including psychotherapy, as well as social rehabilitation measures.
• 4. The difference between the legal status of mentally ill patients who are under outpatient compulsory observation and other patients receiving outpatient psychiatric care lies in the impossibility of ending such observation without a court decision. Patients to whom this compulsory measure is applied do not have the right to refuse treatment: in the absence of their consent, treatment is carried out according to the decision of a commission of psychiatrists. In addition, a transition from outpatient compulsory treatment to inpatient treatment is possible, which involves such a change in the mental state of a person when it becomes impossible to carry out compulsory treatment without placement in a psychiatric hospital, as well as in cases of gross violations of the regime of outpatient compulsory treatment or when evading it.
• 5. Outpatient compulsory observation and treatment by a psychiatrist is associated with significantly fewer restrictions on a person’s personal freedom. It can be used, firstly, as a primary measure of compulsory treatment, for example, when a socially dangerous act was committed in a state of temporary painful mental disorder, the repetition of which is unlikely. Secondly, this measure may become the last step during the transition from inpatient compulsory treatment to the provision of psychiatric care necessary for a person suffering from a mental disorder in the general manner.

Reasons for outpatient compulsory treatment at the psychiatrist

Application of measures medical direction Forcibly, it is possible only to those persons who have committed acts characterized by public danger and enshrined as features of certain articles of the Criminal Code. Such measures take the form of providing medical care aimed at curing the subject of the crime, improving his mental indicators, which is necessary to prevent him from committing criminal acts in the future.

Persons who have become subjects of crimes, in relation to whom there are doubts regarding the usefulness of their mental state, are subject to referral for forensic psychiatric examination. The expert's conclusion about the person's insanity is the basis for the termination of the case. In this situation, the subject of the crime is subject to mandatory compulsory medical intervention.

Legislators have identified an exhaustive range of grounds that may affect the need to use compulsory medical actions:

• the presence of a state of insanity in the person who committed the act of a socially dangerous nature;
• the presence of a mental disorder, which excludes the possibility of both determining the level of punishment and its execution upon conviction;
• establishment of a mental disorder that does not exclude sanity;
• establishing the need for compulsory treatment for diseases associated with alcoholism or drug addiction.

The appointment of compulsory treatment measures can be carried out in cases where the presence of a mental disorder becomes the basis for the emergence of confidence in the social danger of a person and the possibility of causing harm to himself and to people around him. Thus, the purpose of medical intervention is justified by the need to protect society not from a criminal act, but from the possibility of its commission.

At the time of imposing compulsory treatment measures, the court is obliged to take into account the existing medical indicators person and his social danger. The level of gravity of the committed act is not taken into account. The act itself can only be perceived as a symptom of a disease.

The court does not have the right to establish compulsory treatment measures in relation to persons who have become subjects of crimes, in the absence of one of the four above grounds.

Appointment and visit of treatment with a psychiatrist

Considering the materials of each specific criminal case, and studying the characteristics of the person who committed the criminal act, the court is obliged to make a decision on the need to apply compulsory treatment measures to the offender.

In cases where one of the grounds for prescribing such measures exists, the court is obliged to refuse to establish a punishment and determine medical measures that must be forcibly applied to the person in order to recover and prevent such crimes from happening in the future.

When assessing the social danger of the subject himself, the court determines the measures of medical intervention that may be expressed in the prescription:

• outpatient compulsory observation by a psychiatrist or treatment by him;
• inpatient treatment in a psychiatric clinic;
• inpatient treatment in a specialized medical institution;
• inpatient treatment in a specialized psychiatric clinic, combined with high intensity observation.

The court determines the type of treatment required based on recommendations that are justified by the result of a forensic psychiatric examination. According to its internal conviction, the court may go beyond the recommendations.

The appointment of outpatient compulsory observation and treatment is carried out by the court, regardless of his sanity or insanity. Compulsory observation and treatment by a psychiatrist on an outpatient basis is a measure that is necessary to create security for both the subject of the crime and the society around him.

Persons in respect of whom a decision has been made to recognize their insanity may be transferred to guardianship. At the same time, the application of compulsory psychiatric treatment measures to them may not be mandatory. In such cases, the court orders compulsory medical observation, with the person being registered with a medical institution that provides psychiatric treatment, in accordance with his place of residence.

Providing psychiatric medical care is mandatory for medical institutions.

Persons whose insanity has not been recognized and for whom a non-custodial sentence has been imposed may be required to undergo outpatient compulsory observation and treatment procedures. This duty must be fulfilled regardless of the wishes of the convicted person.

The time period required for the complete recovery of persons who have committed criminal acts cannot be established court decision. The reason for this is the impossibility of determining the specific period of time required for the complete cure of the criminal subject.

Such a period can be determined exclusively by a medical institution on the basis of indications that are noted during the process of its treatment.

On the part of the administration of the psychiatric clinic, a submission is sent to the court indicating the cure of the criminal. Completion of compulsory treatment, which has positive result, is the basis for its termination on the basis of a procedural document issued by a judicial authority.

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LETTER from the Ministry of Health of the Russian Federation dated 07/23/99 25108236-99-32 (2020) Relevant in 2018

4. Organization of outpatient compulsory observation and treatment by a psychiatrist

4.1. Outpatient compulsory observation and treatment by a psychiatrist is carried out by a psychoneurological dispensary (dispensary department, office) at the patient’s place of residence.

If necessary, by decision of the chief psychiatrist of the relevant health authority, this medical measure can be carried out at the place of residence of the guardian or family members of the patient with whom he temporarily resides. A psychoneurological dispensary (dispensary department, office) sends written information to the internal affairs body at the person’s place of residence about his acceptance for outpatient compulsory observation and treatment by a psychiatrist. In the future, similar information is sent to the internal affairs body immediately upon receipt of a court ruling on the extension, modification or cancellation of a compulsory medical measure.

4.2. Control cards dispensary observation(form N OZO-I/U) for persons undergoing outpatient compulsory treatment are located in the general file cabinets of psychoneurological dispensaries with a mark in the upper right corner of the front side of the card “PL” (compulsory treatment) and color markings, or are formed in a separate array with the same marked.

4.3. When accepted for outpatient compulsory treatment, the patient is explained the procedure for its implementation, the obligation to follow medical recommendations, and is also prescribed a regimen appropriate to his condition, necessary treatment, diagnostic and rehabilitation (restorative) measures.

The patient must be examined by a doctor at a dispensary (dispensary department, office), and if indicated, at home, with a frequency that ensures the possibility of carrying out treatment, rehabilitation and diagnostic measures indicated for his mental state, but at least once a month. The implementation of medical recommendations is monitored by employees of the psychoneurological dispensary (dispensary department, office), if necessary, with the involvement of family members, guardians, and other persons in the patient’s immediate environment, and in cases of behavior of an antisocial nature, as well as evasion of the prescribed compulsory measure of a medical nature - and with with the help of police officers.

4.4. If the patient’s condition and behavior make it difficult to examine him (prolonged absence from his place of residence, resistance and other actions, life-threatening and the health of medical workers, attempts to hide from them), as well as when family members, guardians or other persons create obstacles to his examination and treatment, medical personnel resort to the help of police officers.

The latter, acting in accordance with the Law Russian Federation“On the Police” and the Law of the Russian Federation “On Psychiatric Care and Guarantees of the Rights of Citizens in its Provision”, provide the necessary assistance in searching for, detaining a person and provide safe conditions for his examination.

4.5. In relation to a person undergoing outpatient compulsory observation and treatment, any medical supplies and methods permitted in established by law okay, and also different kinds medical - rehabilitation and social - psychiatric care provided for by the Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens during its provision." For this purpose, it can be sent to any treatment and rehabilitation unit of the dispensary (specialized offices, medical and industrial (labor) workshops, day hospital, etc.), and also placed in a psychiatric hospital without changing the form of compulsory treatment, if hospitalization is not caused by an increase in danger that is persistent. This person enjoys the right to free drug treatment and other rights and benefits provided for by the legislation of the Russian Federation, constituent entities of the Russian Federation and other regulations in relation to the corresponding category of persons suffering from mental disorders.

4.6. If there are indications, a person undergoing compulsory outpatient treatment may be sent to a psychiatric hospital (hospital, department) either voluntarily or through involuntary hospitalization. In the latter case, hospitalization is usually carried out with the assistance of the police. The psychiatric hospital (hospital, department) in which the patient is placed is notified in writing by the doctor who issued the referral for hospitalization that this person is undergoing compulsory outpatient treatment.

4.7. Able-bodied patients during outpatient compulsory treatment can, taking into account their health status, work as in normal conditions, and in the conditions of medical and industrial specialized enterprises and workshops that employ the labor of persons suffering from mental disorders. In such cases, visits for official reasons are coordinated with the attending physician of the psychoneurological dispensary (dispensary department, office). If there is a change in their condition that makes them temporarily unable to work, they receive a sick leave certificate; if there is a permanent loss or reduction in their ability to work, they are sent to MSEC<*>and if they are recognized as disabled, they have the right to pension benefits.

<*>Medical and social expert commission.

4.8. If grounds arise for changing a medical measure to inpatient compulsory treatment, a psychoneurological dispensary (dispensary department, office) may also resort to involuntary hospitalization. In this case, simultaneously with hospitalization, by decision of the commission of psychiatrists, a petition is filed with the court to change the compulsory measure, of which the hospital administration is notified in writing. The issue of discharge of such a patient can only be resolved if a court ruling is received to refuse to change the compulsory medical measure.

Some people who commit an illegal act are insane or mentally ill.

Naturally, in this state they cannot be sent to correctional institutions, but releasing into freedom seems dangerous to the life and health of respectable citizens.

What to do in such cases? Chapter 15 of the Criminal Code of the Russian Federation provides for the possibility of applying medical measures to them. There are several types of them, but in this article we will analyze in detail the features of compulsory treatment in a general psychiatric hospital.

general review

Compulsory psychiatric treatment is a measure of state coercion for persons suffering from any mental disorder and who have committed a crime.

It is not a punishment and is imposed solely by court decision. The goal is to improve the condition or complete cure sick people in order to prevent them from committing new acts dangerous to society.

According to Art. 99 of the Criminal Code of the Russian Federation (as amended on July 6, 2020) There are 4 types of compulsory medical measures:

1. Compulsory outpatient observation and treatment by a psychiatrist.
2. Treatment in a general psychiatric hospital.
3. Treatment in a specialized psychiatric hospital.
4. Treatment in a specialized psychiatric hospital with intensive supervision.

Compulsory treatment is used when a person with a mental disorder requires such maintenance, care and supervision that can only be provided in an inpatient setting.

The need for treatment in a hospital arises if the nature of the disorder of a mentally ill person poses a danger to both him and others. In this case, the possibility of treatment with a psychiatrist on an outpatient basis is excluded.

The nature of the mental disorder and type of treatment are determined by the judge. He makes a decision based on expert opinion, which states what medical measure is required for a given person and for what reason.

Psychiatric expert commissions act on the principle of sufficiency and necessity of the chosen measure to prevent new crimes by a sick person. It also takes into account what treatment and rehabilitation measures he needs.

What is a general psychiatric hospital?

This is an ordinary psychiatric hospital or other medical organization that provides appropriate inpatient care.

Here Ordinary patients are also being treated according to the direction of a specialist.

Compulsory treatment is given to patients who have committed an unlawful act that does not involve an attack on the lives of other people.

Due to their mental state, they do not pose any danger to others, but they require compulsory hospitalization. Such patients do not require intensive monitoring.

The need for compulsory treatment lies in the fact that there remains a high probability of a mentally ill person committing a repeat crime.

Staying in a general hospital will help consolidate the results of treatment and improve the patient’s mental state.

This measure is prescribed to patients who:

1. Committed an illegal act while insane. They do not have a tendency to violate the regime, but there is a high probability of recurrence of psychosis.
2. suffer from dementia and mental illness of different origins. They committed crimes as a result of the influence of external negative factors.

Issues regarding extension, change and termination of treatment are also resolved by the court based on the conclusion of a commission of psychiatrists.

The duration of compulsory measures is not indicated when making a decision, since it is impossible to establish the period necessary to cure the patient. That's why the patient undergoes examination every 6 months to determine your mental state.

Treatment in a general hospital combined with execution of punishment

If the offender is serving a prison sentence and there is a deterioration in his mental state, then in this case The law provides for the replacement of the term with compulsory treatment.

This is enshrined in Part 2 of Art. 104 of the Criminal Code of the Russian Federation. In this case, the convicted person is not released from punishment.

The time spent in a psychiatric hospital is counted towards the term of serving the assigned sentence.. One day of hospitalization is equal to one day of imprisonment.

When the convicted person recovers or his mental health improves, the court terminates treatment in a general hospital on the recommendation of the body executing the punishment and on the basis of the conclusion of the medical commission. If the term has not yet expired, the convicted person will continue to serve it in a correctional institution.

Compulsory treatment in a psychiatric hospital

Dangerous persons can be referred to a special clinic for such treatment only by a court ruling. Based on a statement from relatives or a call, a person cannot be admitted to a mental hospital. That's why In court you need to provide serious and compelling evidence.

Most alcoholics and drug addicts deny their addiction, while turning the lives of their loved ones into a complete nightmare. Naturally, they are confident in their adequacy and refuse treatment voluntarily.

Living with a dependent person brings many problems, quarrels, and material problems. That is why relatives are wondering how to send him for compulsory treatment to a mental hospital.

If pronounced mental abnormalities are observed in drug and alcohol addiction, then only then is treatment possible without the consent of the patient.

To be sent for compulsory treatment to mental asylum general type The following documents are needed:

• statement from relatives;
• doctor's conclusion about the presence of signs of inadequacy.

How to send for treatment

First of all, the psychiatrist must determine whether there is mental disorders or not.

In addition, it must be established whether their actions pose a danger to other people.

To determine a person’s mental state, you need to seek clarification from your local doctor. He will write a referral to a psychiatrist.

If the patient cannot go to him, then he is obliged to come to the house himself. If deviations are detected, the doctor writes out a document that allows send a person for compulsory treatment involuntarily.

If the condition worsens, you should call ambulance. They need to show a certificate from a psychiatrist. After this, the staff must take the patient to a mental hospital for further treatment.

From the moment a mentally ill person is placed in a general hospital, relatives have 48 hours to file a claim for referral for compulsory treatment.

So it goes are considered as special proceedings. The application is written in any form in compliance with the requirements of Art. 302, 303 Code of Civil Procedure of the Russian Federation.

The claim is filed in the district court at the location of the psychiatric hospital. The applicant must indicate all the reasons for placement in a mental hospital, citing the rules of law. The claim must be accompanied by the conclusion of a psychiatric commission.

The law defines special conditions legal proceedings in such cases:

• the application is reviewed within 5 days;
• a mentally ill citizen has the right to be present at trial;
• The court decision is made on the basis of a medical psychiatric examination.

The Russian Constitution includes rights such as personal integrity and freedom of movement. In order to comply with them, the law strictly prescribes place citizens for compulsory treatment in psychiatric hospitals only by court decision. Otherwise, criminal liability arises.

Video: Article 101. Compulsory treatment in a medical organization providing psychiatric care

$1. Outpatient compulsory observation and treatment by a psychiatrist

Outpatient compulsory observation and treatment by a psychiatrist in accordance with the law (Article 100 of the Criminal Code) “may be prescribed if there are grounds provided for in Article 97 of this Code, if the person, due to his mental state, does not need to be placed in a psychiatric hospital.”

The general basis for prescribing compulsory measures of a medical nature is “danger to oneself or other persons” or “the possibility of causing other significant harm” by the insane, of limited sane, alcoholics and drug addicts who have committed crimes, as well as by persons whose mental disorder occurred after committing crimes. According to experts, outpatient compulsory observation and treatment by a psychiatrist can be prescribed to persons who, due to their mental state and taking into account the nature of the act committed, pose a low social danger or do not pose a danger to themselves and other people. The last statement clearly contradicts the law (Part 2 of Article 97) that compulsory medical measures are prescribed only in cases where mentally ill persons can cause harm or are dangerous to themselves or others.

The legislator, as a circumstance allowing the court to prescribe compulsory outpatient treatment and treatment with a psychiatrist, provides for a mental state in which the person who committed a dangerous act does not need to be placed in a psychiatric hospital. The Criminal Code does not provide criteria for this mental state. Forensic psychiatrists believe that outpatient compulsory treatment can be applied to persons who, due to their mental state, are able to independently satisfy their life needs, have sufficiently organized and orderly behavior and can comply with the outpatient treatment regimen prescribed to them. Availability indicated signs allows us to conclude that mentally sick face does not require inpatient compulsory treatment.

However, the legal criteria for a mental state in which the patient does not require inpatient treatment are:

1. the ability to correctly understand the meaning and significance of the outpatient observation and treatment used by a psychiatrist;

2. the ability to manage one’s behavior during the process of compulsory treatment.

The medical criteria for the mental state in question are:

1. temporary mental disorders that do not have a clear tendency to recur;

2. chronic mental disorders in remission due to compulsory treatment in a psychiatric hospital;

3. alcoholism, drug addiction, other mental disorders that do not exclude sanity.

In accordance with the law, for persons who have committed a crime in a state of sanity, but suffer from alcoholism, drug addiction or other mental disorder within the limits of sanity, if there are grounds, the court may prescribe compulsory medical treatment only in the form of outpatient observation and treatment by a psychiatrist (Part 2 of Art. 99 of the Criminal Code).

The location of compulsory outpatient treatment depends on the type of punishment imposed by the court:

o persons sentenced to imprisonment undergo outpatient treatment at the place of serving their sentence, that is, in correctional institutions;

o persons sentenced to non-custodial sentences receive compulsory treatment from a psychiatrist or narcologist at their place of residence.

In essence, compulsory outpatient observation and treatment by a psychiatrist is a special type of dispensary observation and as such consists of conducting regular examinations by a psychiatrist (in a dispensary or other medical institution providing outpatient psychiatric care) and providing a mentally ill person with the necessary medical and social assistance (Part 3 of Article 26 of the Law of 1992). Such observation and treatment by a psychiatrist is established regardless of the patient’s consent and is carried out compulsorily (Part 4 of Article 19 of the 1992 Law). Unlike ordinary dispensary observation, compulsory observation and treatment is canceled only by a court decision, and in necessary cases may be changed by the court to another measure - compulsory treatment in a psychiatric hospital. The basis for replacing outpatient treatment with inpatient treatment is the representation of a commission of psychiatrists about the deterioration of the person’s mental state and the impossibility of carrying out compulsory treatment without placement in a hospital.

Outpatient compulsory observation and treatment by a psychiatrist in some cases can be used as a primary measure of compulsory treatment, in other cases this measure can act as the last stage of compulsory treatment after compulsory treatment in a psychiatric hospital.

As a primary measure, compulsory outpatient observation and treatment by a psychiatrist can be used in relation to persons who have committed socially dangerous acts in a state of short-term mental disorder caused by pathological intoxication, alcohol, intoxication, exogenous or postpartum psychosis.

As the last stage of compulsory treatment, experts propose the use of outpatient observation and treatment by a psychiatrist for persons who have committed socially dangerous acts in a state of chronic mental disorder or dementia, after undergoing compulsory treatment in a psychiatric hospital due to the fact that these persons need medical supervision and supportive treatment regimen.

The introduction into the Criminal Code of such compulsory medical measures as outpatient observation and treatment by a psychiatrist is aimed at reducing the number of people subject to compulsory treatment in psychiatric hospitals and maintaining them social adaptation during outpatient treatment with a psychiatrist in the patient’s usual living conditions.