For the first time, “Regulations on the conditions and procedure for providing psychiatric care aimed at protecting the rights of the mentally ill” were adopted by the Decree of the Presidium of the Supreme Soviet of the USSR on January 5, 1988. Subsequently (1993), a special law “On psychiatric care and guarantees of the rights of citizens” was adopted when providing it,” according to which qualified psychiatric care is provided free of charge, taking into account all the achievements of science and practice. This law is based on regulations according to which the dignity of the patient must not be violated when providing psychiatric care. This law also regulates the procedure for conducting psychiatric examinations. This law states that psychiatric examination and preventive examinations are carried out only at the request or with the consent of the person being examined, and examinations and examinations of a minor under 15 years old - at the request or with the consent of his parents or legal representative.
When conducting a psychiatric examination, the doctor is obliged to introduce himself to the patient, as well as his legal representative, as a psychiatrist. The exception is those cases when the examination can be carried out without the consent of the subject or his legal representative: in the presence of a severe mental disorder with an immediate danger of the patient to himself and others, if the subject is under dispensary observation. Outpatient psychiatric care for people with mental illness is provided depending on medical indications and is carried out in the form of consultative and therapeutic assistance and dispensary observation.
Persons with mental disorders are placed under dispensary observation, regardless of their consent or the consent of their legal representative (in cases where they are declared legally incompetent). At the same time, the attending physician carries out constant monitoring of their condition. mental health through regular examinations and provision of necessary medical and social assistance.
In cases of inpatient treatment of a patient with mental disorders, consent is required. this treatment in writing, with the exception of patients undergoing compulsory treatment by court decision, as well as patients involuntarily hospitalized by law enforcement agencies. Without the consent of the patient, i.e. involuntarily, persons with mental disorders that make them dangerous to themselves and others, as well as patients in conditions where they are unable to satisfy basic life needs (for example, catatonic stupor, severe dementia) and can cause significant harm to their health due to deterioration mental state if they are left without psychiatric help.
A patient admitted to hospital as a result of involuntary hospitalization, within 48 hours must be examined by a commission of doctors, which determines the validity of hospitalization. In cases where hospitalization is considered justified, the commission’s conclusion is submitted to the court to decide the issue of the patient’s further stay in the hospital at the location of the hospital.
The patient's involuntary stay in a psychiatric hospital lasts as long as the reasons for the involuntary hospitalization remain (aggressive actions due to delusions and hallucinations, active suicidal tendencies).
To extend involuntary hospitalization, a re-examination by the commission is carried out once a month for the first six months, and then once every 6 months.
Psychiatric care is guaranteed by the state and is provided on the basis of legality, humanity and respect for human and civil rights.
The diagnosis of mental disorder is made in accordance with international standards.
Psychiatric help can be provided
state, non-state psychiatric and psychoneurological institutions, as well as private practicing psychiatrists. Without a state license this type activities providing psychiatric care are prohibited. The license is issued by a licensing commission, which must review the submitted documents and make a decision within 2 months. The commission's refusal must be in writing, justified and can be appealed in court.
Institutions and privately practicing psychiatrists are included in the unified state register.
Psychiatrists with a higher education degree have the right to practice medicine. medical education And special training. Other specialists, in order to participate in the provision of medical psychiatric care, must undergo appropriate specialization in order to be allowed to work with persons suffering from mental disorders.
When providing psychiatric care, a psychiatrist is independent in his decisions and is guided only by medical indications, medical duty and the law.
Psychiatric assistance can be provided voluntarily or compulsorily.
When voluntarily seeking psychiatric help, the relationship between the patient and the institution or private practitioner is formed on the basis of an agreement to provide medical care. Treatment is carried out ONLY after receiving written consent. Psychiatric assistance is provided to a minor under the age of 15 years, as well as to a person recognized as legally incompetent in accordance with the established procedure, at the request or with the consent of their legal representatives.
Psychiatric care can be provided without the consent of a mentally ill person or his legal representatives in two cases:
- when applying compulsory measures of a medical nature, on the grounds provided for by the Criminal Code and the Code of Criminal Procedure of the Russian Federation,
- during involuntary psychiatric examination, clinical observation, hospitalization on the grounds provided for by the law “On psychiatric care and guarantees of the rights of citizens during its provision.”
Compulsory measures are applied by court decision in relation to persons suffering from mental disorders who have committed socially dangerous acts, on the grounds and in the manner provided for by the Criminal Code and the Code of Criminal Procedure. Compulsory medical measures are carried out in psychiatric institutions of health authorities.
Persons placed in a psychiatric hospital by a court decision to apply compulsory medical measures enjoy the rights of patients in psychiatric hospitals. They are recognized as disabled for the entire period of their stay in hospital and are entitled to benefits for social insurance or to retire on a general basis. DISCHARGE of such patients is also carried out by decision of the COURT.
An involuntary psychiatric examination can be carried out in cases where there is data on the patient’s dispensary observation or if he commits actions that make it possible to suspect that he has a serious mental disorder, which determines:
- his immediate danger to himself or others,
- his helplessness, i.e. inability to independently meet basic life needs
- in the event of significant harm to health due to a deterioration in mental condition, and if the person is left without psychiatric help.
In these cases, the psychiatrist makes a decision independently or with the sanction of a judge.
If a person poses an DIRECT danger to himself or others, then an application for involuntary examination can be submitted orally by relatives, doctors of other specialties, officials, and other citizens. The decision must be made by a psychiatrist and documented by a medical doctor. documentation.
If there is no immediate danger, the application must be in writing and contain detailed explanations substantiating the need for such an examination and indicating the refusal of the person or his legal representatives to consult a psychiatrist.
Dispensary observation involves monitoring the state of mental health through regular examination by a psychiatrist and providing social assistance. Dispensary observation is established regardless of the consent of the person suffering from chronic and protracted mental disorders with severe persistent or often exacerbating painful manifestations. The decision on the need for clinical observation and its termination is made by a commission of psychiatrists. The reasoned decision is formalized by recording in medical documentation.
A person suffering from a mental disorder may be hospitalized in a hospital by decision of a psychiatrist, pending a court order. This is possible in the same cases as an involuntary psychiatric examination.
A person admitted to a psychiatric hospital must be in mandatory examined by a commission of psychiatrists within 48 hours. The commission makes a decision on the validity of placing the patient in a hospital. If a commission of doctors determines that there are insufficient grounds for placing a patient in a hospital, the latter, with his consent, is immediately discharged. If the commission finds the psychiatrist’s decision justified, then within 24 hours the documents are sent to the court for final decision the question of the patient's stay in a hospital. The patient may be present at the court hearing when deciding on his hospitalization. A prosecutor, a representative of the given medical institution, the patient himself or his legal representative. The case must be considered within 5 days. If the patient’s condition does not allow his presence in court, then this meeting should
be carried out in a hospital. The judge either grants the application and then makes a decision on the person’s stay in hospital, or rejects it. Then the patient is either discharged or the commission insists on its conclusion and appeals the judge’s decision to court.
Inpatient care should be provided with minimal restrictions for the patient and with staff respecting his rights and interests. Measures of physical restraint and isolation should be used only in those cases and at a time when, in the opinion of the psychiatrist, it is impossible to prevent the patient’s actions that pose a danger to him or others by other methods. The forms and time of tightness are recorded in the medical documentation.
Patients undergoing voluntary treatment, as well as somatic patients, are discharged on the basis of their application in the event of recovery (improvement), in which hospital treatment is no longer required, or upon completion of examination and examination. If the patient is involuntarily admitted to a hospital, he is discharged based on the conclusion of a commission of psychiatrists or a judge’s decision to refuse to extend hospitalization.
Control and supervision over the provision of psychiatric care should be carried out by territorial self-government bodies, health authorities, the prosecutor’s office, public organizations. You can appeal the actions of doctors, commissions, and other specialists providing mental health care to an official, a prosecutor, or to court. The complaint is considered within 10 days.
Types of mental health care and social protection guaranteed by the state
(1) The state guarantees:
emergency psychiatric care;
consultative and diagnostic, therapeutic, psychoprophylactic, rehabilitation assistance in out-of-hospital and inpatient settings;
all types of psychiatric examination, determination of temporary disability;
social - domestic assistance and assistance in employment of persons suffering from mental disorders;
resolving custody issues;
consultations on legal issues and other types legal assistance in psychiatric and psychoneurological institutions;
social and living arrangements for disabled people and the elderly suffering from mental disorders, as well as care for them;
training for people with disabilities and minors suffering from mental disorders;
psychiatric assistance during natural disasters and catastrophes.
(2) To provide persons suffering from mental disorders with psychiatric care and their social support state:
(as amended by Federal Law dated August 22, 2004 N 122-FZ)
creates all types of institutions providing out-of-hospital and inpatient psychiatric care, if possible at the place of residence of patients;
organizes general educational and vocational training for minors suffering from mental disorders;
creates medical and production enterprises for occupational therapy, training in new professions and employment in these enterprises of persons suffering from mental disorders, including people with disabilities, as well as special production facilities, workshops or areas with easier working conditions for such persons;
establishes mandatory quotas of jobs in enterprises, institutions and organizations for the employment of persons suffering from mental disorders;
applies methods of economic incentives for enterprises, institutions and organizations that provide jobs for people suffering from mental disorders;
creates hostels for people suffering from mental disorders who have lost social ties;
takes other measures necessary for social support of persons suffering from mental disorders.
(3) The organization of the provision of psychiatric care is carried out by federal specialized medical institutions, the list of which is approved by the Government Russian Federation, and specialized medical institutions of the constituent entities of the Russian Federation.
Solving issues of social support and social services persons suffering from mental disorders, in difficult life situation, is carried out by state authorities of the constituent entities of the Russian Federation.
(Part three as amended by Federal Law dated August 22, 2004 N 122-FZ)
Compulsory medical measures may be appointed by the court to persons:
a) who committed acts provided for in the articles of the Special Part of the Criminal Code, in a state of insanity;
b) who, after committing a crime, have developed a mental disorder that makes it impossible to impose or carry out punishment;
c) who have committed a crime and suffer from mental disorders that do not exclude sanity;
For these persons, compulsory medical measures are prescribed only in cases where mental disorders are associated with the possibility of these persons causing other significant harm or with a danger to themselves or other persons.
d) who have committed a crime and are recognized as needing treatment for alcoholism or drug addiction.
The purposes, types, procedure for application and termination of these measures are determined by criminal law; the procedure for their appointment is regulated by the criminal procedure law; compulsory measures against specific persons who have committed socially dangerous acts, as well as crimes, are prescribed by the court; the court also considers further decisions on the extension, modification and termination of compulsory measures; supervision over the legality of the use of coercive measures is entrusted to the prosecutor's office.
As for committing a socially dangerous act in a state of insanity, the analysis of expert materials allowed specialists from the State Scientific Center for Social and Forensic Psychiatry named after. Serbsky to identify several groups of such connections when committing public dangerous actions: 1) influence crazy ideas and hallucinations (most often in schizophrenia) at the time of committing murder and other crimes against the person; 2) thoughtlessness, characteristic of mental retardation, unable to understand real events, most often when committing thefts and hooliganism; 3) weakening of control over one’s instincts, most often sexual desires (rape, sexual perversion, corruption of minors); 4) affective disorders, characterized by emotional dullness of persons (committing murder, hooliganism, causing harm to health, etc.); 5) a true lack of motives in a state of disturbed consciousness (for example, a twilight state of consciousness, pathological intoxication), most often during murders, commission of other impulsive socially dangerous actions, which may be the only episode in life.
With such a basis for the use of compulsory treatment as a mental disorder after the commission of a crime, making it impossible to assign and serve a sentence, two options are possible: 1) when, after committing a crime, a person develops a mental disorder that turns out to be incurable. Compulsory treatment is applied to such a person, as in relation to a person who has committed a socially dangerous act in a state of insanity; 2) when a person has a temporary mental disorder after committing a crime, for example, he is in a state alcoholic psychosis or fell into a reactive state due to the initiation of a criminal case and the threat of punishment. As with the first option, criminal proceedings are suspended; If a person’s painful condition persists, he is prescribed compulsory treatment in accordance with the established procedure. If the person recovers, the decision to suspend the case is canceled, it is investigated and considered in the general manner.
Compulsory treatment can also be prescribed to a person whose mental disorder occurred while serving a sentence for a crime committed in a state of sanity. Here, too, two options are possible: either the person falls ill and, instead of punishment, the court assigns compulsory treatment to him, or, when the disorder mental activity It was temporary and is recovering. In the latter case, compulsory treatment is canceled and the person is returned to continue execution of the sentence.
The court may order the following types of compulsory medical measures:
A) outpatient compulsory observation and treatment by a psychiatrist;
b) compulsory treatment in a general psychiatric hospital;
V) compulsory treatment in a specialized psychiatric hospital;
G) compulsory treatment in a specialized psychiatric hospital with intensive supervision.
Extension, modification and termination of the use of compulsory medical measures are carried out by the court upon the proposal of the administration of the institution providing compulsory treatment, based on the conclusion of a commission of psychiatrists.
Rights of persons with mental disorders
(1) Persons suffering from mental disorders have all the rights and freedoms of citizens provided for by the Constitution of the Russian Federation, the Constitutions of the republics within the Russian Federation, the legislation of the Russian Federation and the republics within the Russian Federation. Restriction of the rights and freedoms of citizens associated with mental disorder is permissible only in cases provided for by laws Russian Federation.
(2) All persons suffering from mental disorders, when provided with psychiatric care, have the right to:
respectful and humane treatment, excluding humiliation of human dignity;
receiving information about their rights, as well as, in a form accessible to them and taking into account their mental state, information about the nature of the mental disorders they have and the treatment methods used;
mental health care in the least restrictive setting, preferably in the community;
all types of treatment (including sanatorium and resort treatment) for medical reasons;
provision of psychiatric care in conditions that meet sanitary and hygienic requirements;
preliminary consent and refusal at any stage from use as a test object medical supplies and methods scientific research or educational process, from photography, video or filming;
inviting, at their request, any specialist involved in the provision of mental health care, with the latter’s consent, to work on the medical commission on issues regulated by this Law;
assistance of a lawyer, legal representative or other person in the manner prescribed by law.
(3) Restriction of the rights and freedoms of persons suffering from mental disorders only on the basis psychiatric diagnosis, facts of being under dispensary observation in a psychiatric hospital or in a psychoneurological institution for social security or special training is not permitted. Officials those guilty of such violations are liable in accordance with the legislation of the Russian Federation and the republics within the Russian Federation.
Rights of patients in psychiatric hospitals
(1) The patient must be explained the reasons and purposes of his placement in a psychiatric hospital, his rights and the rules established in the hospital in the language he speaks, which is recorded in the medical documentation.
(2) All patients undergoing treatment or examination in a psychiatric hospital have the right to:
contact directly the chief physician or head of the department regarding treatment, examination, discharge from psychiatric hospital and compliance with the rights granted by this Law;
submit uncensored complaints and statements to the bodies of representative and executive power, prosecutor's office, court and lawyer;
meet with a lawyer and a clergyman alone;
perform religious ceremonies, observe religious canons, including fasting, and, in agreement with the administration, have religious paraphernalia and literature;
subscribe to newspapers and magazines;
receive education according to the program secondary school or special school for children with intellectual disabilities, if the patient is under 18 years of age;
receive, on an equal basis with other citizens, remuneration for work in accordance with its quantity and quality, if the patient participates in productive work.
(3) Patients also have the following rights, which may be limited on the recommendation of the attending physician by the head of the department or chief physician in the interests of health or safety
patients and in the interests of the health or safety of others:
conduct correspondence without censorship;
receive and send parcels, parcels and money transfers;
use the telephone;
receive visitors;
have and purchase basic necessities, use their own clothing.
(4) Paid services(individual subscriptions to newspapers and magazines, communication services, etc.) are carried out at the expense of the patient to whom they are provided.
Administration and medical staff psychiatric hospitals are obliged to create conditions for the exercise of the rights of patients and their legal representatives provided for by this Law, including:
- provide patients in psychiatric hospitals with the necessary medical care;
- provide the opportunity to familiarize yourself with the text of this Law, the internal regulations of a given psychiatric hospital, addresses and telephone numbers of state and public bodies, institutions, organizations and officials who can be contacted in case of violation of the rights of patients;
- provide conditions for correspondence, sending complaints and statements from patients to representative and executive authorities, the prosecutor's office, the court, and also to a lawyer;
- within 24 hours from the moment the patient is admitted to a psychiatric hospital on an involuntary basis, take measures to notify his relatives, legal representative or other person at his direction;
- inform the patient’s relatives or legal representative, as well as another person at his direction, about changes in his health status and emergency incidents with him;
- ensure the safety of hospitalized patients, control the contents of parcels and deliveries;
- perform the functions of a legal representative in relation to patients recognized as legally incompetent, but who do not have such a representative;
- establish and explain to religious patients the rules that must be observed in the interests of other patients in a psychiatric hospital during the performance of religious rites, and the procedure for inviting a clergyman, to promote the exercise of the right to freedom of conscience of believers and atheists;
- perform other duties established by this Law.
The problem of the rights of mentally ill people in our country remains in the center of attention of the domestic and foreign public. Many abuses in this area have been exposed and condemned, but it is too early to talk about complete prosperity.
In general, ensuring the rights of citizens when providing mental health care is extremely difficult. Firstly, people generally have a negative attitude towards mental patients. The word "psycho" is offensive in Russian. Many people simply do not realize how many people suffer from mental disorders there are around. Most of these patients adapt well to harsh reality. And most of all they are afraid that they will not find out about their illness at work. Secondly, mentally ill people have traditionally had their rights limited, and this has been the basis for the abuse of psychiatry for centuries. The diagnosis of mental illness, both 300 years ago and more recently in our country, was a reason for placing unwanted people in a hospital. It doesn't matter whether they criticized the party or the farm director. Even the World Psychiatric Association wanted to exclude Soviet psychiatrists from among its members, since the use of medicine for political purposes is unacceptable. To avoid this, the Soviet Society of Psychiatrists itself left the association.
Currently, the question of the possibility of using PSYCHOSURGICAL treatment methods for mentally ill patients remains highly controversial. They mean a destructive effect on the brain or its pathways. Destruction can be carried out by mechanical methods, injections chemical substances, electric current, laser, ultrasound, cryotherapy methods. Proponents of such treatment methods note that the disease process is either interrupted or the person becomes much more manageable. However, they themselves note a significant percentage of failures, i.e. high risk percentage.
Opponents of these methods believe that the patient is not able to give informed consent to such an operation and therefore it will be illegal. The right of the family to give such consent is questionable.
IN Russian legislation such operations and other manipulations that cause irreversible phenomena in the event of involuntary placement of a patient in a hospital are prohibited.
It seems that such treatment methods should not be used at the current level of medical development, because It is not human health that is restored, but an artificially altered human personality that is created.
Human rights activists have been defending the rights of people with mental illness for a long time and persistently. And in Lately laws have appeared that give such people much more freedom and opportunities.
It would seem that one can only rejoice at this. But free will for the mentally ill turns into a huge danger. For others, for loved ones, but first of all - for themselves. Because a mentally ill person, left to his own devices, becomes easy prey for unscrupulous people, and most often for criminals. Especially in our country. The circle closes: in an effort to protect the rights of the patient, on the contrary, he is deprived of the protection he needs so much.
This is that rare case when the sweet word “freedom” has a very bitter aftertaste. I will say more - when it is generally inappropriate.
Since the late 90s, changes have been made to the Law on Psychiatric Care and Guarantees of Citizens' Rights in its Provision almost every year. They touch on many things. For example, in most cases, psychiatric care in our country is provided only when a person voluntarily turns to specialists. A doctor cannot even simply give an injection to a patient with PND without the patient’s consent. And before starting treatment, the doctor is obliged to tell the patient “about the goals, methods and duration of the recommended treatment, as well as pain, possible risk, side effects and expected results”... However, nowhere is it said who should determine whether the patient is able to correctly understand the doctor...
And getting doctors to hospitalize those whose condition has become dangerous for themselves or those around them is generally a disastrous endeavor.
That is, the mentally ill were given the right to decide for themselves whether to be treated, whether to take medications... But people with a disordered psyche who refused necessary medications, not only destroy themselves, but are sometimes deadly to others. They can commit any crimes, including the most terrible ones. And only after a great disaster can the patient be hospitalized without his consent.
According to many psychiatrists, the struggle for the rights of the mentally ill led, in essence, to the collapse of the system of dynamic monitoring of them - as a result, all more people those with a disturbed psyche were at risk. In 2011, the Constitutional Court of the Russian Federation went even further, adopting a resolution allowing persons suffering from mental disorders to participate in court hearings to declare them incompetent on an equal basis with other participants in the process.
According to the law, bypassing guardians, doctors and guardianship authorities, incompetent citizens can apply to the courts to restore their legal capacity, which they do. Guardians, accordingly, are exempt from protecting sick people.
And that's what's scary. Having become capable, patients with persistent mental disorders receive the right to refuse to visit the ICP, to declare their deregistration and refusal of treatment. Everything is according to the law.
For many, restoring their rights becomes a road to nowhere.
“People with an unhealthy psyche do not consider themselves sick. Having given up the pills, they begin to look for enemies and grab knives - there are enough such cases. Relatives, neighbors, and random passersby can become enemies,” says Mikhail Vinogradov, Doctor of Medical Sciences, forensic psychiatrist, about the results of the ongoing reorganization. “Without drug support, they will do whatever they want.”
Inga Sergeevna Kulikova (name and surname have been changed), a 74-year-old Muscovite who has long suffered from a severe form of schizophrenia, no longer takes medications. It turned out to be beneficial for someone that she became “healthy” - and now the expert’s conclusion is ready for the court, confirming her adequacy, and soon a decision will be made to recognize Kulikova as legally competent.
Of course: Inga Sergeevna lives alone in a three-room apartment in Moscow.
And if the patient’s adequacy is judged not by expert opinions, but by her behavior and actions, then it becomes clear that Kulikova is a very tasty morsel for apartment swindlers.
* * *
“God forbid I go crazy, no, it’s better to have a staff and a bag” - Pushkin wrote this. But almost more than the mentally ill themselves, their relatives suffer. Responsibility for inadequate, but still loved and close people is a heavy burden that not everyone can bear.
Viktor Kulikov is one of those who survived. In recent years, he has been patiently and tenderly caring for his mother. Inga Sergeevna was declared incompetent in 2011, Victor became her guardian.
“Mom’s problems with her head began 25 years ago,” he says. “She started saying that they were following her, beating her in the subway, putting razors in her shoes, and following her. She burned the materials of her recently defended dissertation. She developed an insurmountable fear of infection - she called the SES, believing that the water was contaminated, and took a dosimeter with her everywhere. I didn’t allow my husband, my father, Georgiy Petrovich, to keep his things in the bathroom, since they were also “infected.” By the way, she simply hated her father, called him an informer, separated herself from him in the room with a curtain, and threw stones at his car. She wrote complaints and statements to the prosecutor's office, the Minister of Defense, the UN, even Prince Charles - against her husband, against me, against her brother. She demanded from all of them that my father be evicted from the apartment. She kept saying that her family wanted to sell her to Arab countries, that they were hanging her from a chandelier by her legs, etc.
In August 1991, Inga left for the village where the Kulikovs have a house. Neighbors called from there and said that she was walking around naked with a backpack on her back, climbing onto the roof and not allowing herself to be filmed. The husband and son called a medical team and took Inga to a psychiatric hospital, where she was diagnosed with “paroxysmal-progressive schizophrenia, affective-delusional attack.”
She was discharged under the guarantee of her husband and registered with PND No. 17.
“Our life turned into a kind of swing,” recalls ex-husband Ingi Georgy Petrovich Kulikov. - For some time, the wife took medication and behaved quietly. Then the aggression and delirium returned. Her hatred for me grew, she demanded a divorce, I considered myself responsible for my wife, but in the end she kicked me out of the house and filed for divorce. I left with only the essentials. The son was already living separately at that time. Inga was left alone in the three-ruble ruble, believing that everything around her belonged to her, and only to her.
Later, the court recognized the ex-husband’s right to half the apartment and house in the village. But he only had housing on paper - Inga changed the locks and shouted through the door that she wouldn’t let anyone in. Georgy Petrovich had to leave the apartment he had earned at one time and rent a room.
“I, of course, could insist on an exchange,” recalls Georgy Petrovich. - But I imagined what would happen to Inga... To move her, real violence would have to be used. I could not agree to this: after all, despite creepy character and behavior, she is the mother of my child...
After Inga felt like a complete housewife, a difficult time began for the housemates. They tell how a crazy woman poured urine from the windows onto passers-by, at night she pulled the wire in front of the entrance, and in the morning she watched people stumble and fall. Inga covered the staircases with powder and broken glass as punishment for the cleaning lady who “cleaned up poorly.” And she wrote, wrote, wrote complaints to various authorities - about her ex-husband, about neighbors at the entrance, about the management of the housing cooperative, about her son, who allegedly keeps weapons and drugs at home, called riot police to his address, etc. 
Behind Last year Inga Sergeevna became addicted to alcohol.
“I have been living in an apartment since 2004. Until 2010, Kulikova did not let us live,” says Nastya, Inga Sergeevna’s neighbor. “At least once a week she called the local police officer and stated that I was a Mujahideen, Ukrainian or Belarusian. In short, the enemy. A squad arrived with machine guns, and I was pregnant at that time. Inga Sergeevna said that my husband and I “buried a child” under the windows, that I had a T-shirt with radioactive signs, that we sprinkled various mixtures with radiation on it. She accused us of climbing into her window every odd day at the beginning of the month, and climbing out a few days later. These days we steal her bed linen and medicine. She asked my husband to pull out snakes, etc., from under her bed.
Only at the end of 2010 was Inna able to be hospitalized - after her neighbors contacted the police with a collective letter. After long-term treatment and observations in the hospital. Gannushkina and in the 10th psychiatric hospital in 2011, she was declared legally incompetent, since the mental illness had no longer become paroxysmal, but continuous.
At the end of 2011, the woman returned home. The son, who took on the duties of a guardian, constantly came, looked after her, made sure that her mother visited doctors and took medications, fully supported her, and took her for walks and to the village. It seemed that everyone had somehow adapted to the difficult life with a mentally ill patient...
* * *
About a year ago, a new wave began in Inga Sergeevna’s condition: the 74-year-old woman developed an uncontrollable sexual attraction to young men. Products from sex shops and related literature began to appear in the apartment. Without hesitation, the mother began to turn to her son with requests to find her a “cowboy” for an intimate relationship...
Then she moved from talk to action. Neighboring young men from the category of those who are called asocial personalities often visited her home.
“I didn’t know what to do,” says son Victor. “Mom began to see me as an enemy who stood in her way to happiness. At first, she studied dating advertisements, hoping for a long-term relationship with a wealthy man. Then she began to become more and more fixated on intimacy itself. Neighbors reported that drunk men often come out of her apartment and spend the night there. Then, in an indecent state, they lie on the floor in the common vestibule. The guests extorted money from the pensioner and demanded that she buy vodka and beer. And it’s scary to remember her partners in the village where her mother spends the summer. Completely degraded homeless people with whom she drank alcohol and “consoled” almost every day.
Nastya, a neighbor next door, says: “For the past year now, men of about forty, drunk, dirty, smelly, looking like homeless people or drug addicts, have been constantly visiting her at night. They talk loudly and make noise, so I hear them coming. Early in the morning, around seven o'clock, they leave the apartment. Then they sit in our yard all day, smoke, drink, and wait until evening to go to Kulikova. They discuss her among themselves, they say that she is a crazy old woman, she is ready to do anything for the sake of intimacy. She buys them alcohol, food, and demands that they do this with her all night. They boast that they will soon move into her apartment. Inga Sergeevna has changed a lot this year, she has dropped. She was well-groomed, but now she is becoming like her drinking buddies...
By the way, none of the drugs prescribed by PND No. 17, where Kulikova is observed, can be combined with alcohol. Inga Sergeevna knows this and prefers alcohol - it helps to improve her personal life...
Victor repeatedly informed the attending physician T.V. Peregudin about what was happening to his mother. and guardianship authorities: “...due to the patient’s refusal to take medications prescribed by doctor PND No. 17, her mental state has deteriorated significantly... Kulikova I.S. needs supervision by a psychiatrist at a dispensary, as well as psychiatric care in outpatient setting, she was recommended to continue taking drug therapy, but the patient does not take any of the prescribed medications.”
* * *
But it turned out that this is not the worst thing.
Thunder struck in the spring of 2015, when Victor learned that his mother, who was in the already described “excellent” condition, filed an application with the Tushinsky District Court to recognize her as legally competent.
Who helped Inga Sergeevna collect all the documents? Who taught her how to write a statement correctly? Who put her in touch with lawyer Lomteva, who took on this case?
Further more. At dispensary No. 17, the district doctor Peregudina, who knew Inga Sergeevna well, quit. And the new doctor E.A. Kochurina, who observed her for only three weeks, concluded that the patient with continuous flow chronic mental disorder is observed in “persistent remission.”
“All through May 2015, I ran to the PND, trying to get an appointment with the new district police officer to tell me what was really happening,” says Victor, “but Dr. Kochurina categorically refused to meet with me.
Further - even more. The examination ordered by the court was carried out at the Center. Serbian. Victor says that on the day of the examination, they prevented him from going with his mother in every possible way; they demanded that he give her his passport, although all the other subjects of the examination went through with their guardians and relatives without hindrance.
For such an important examination, the center needed only a few hours. No surveillance. No analysis of documents about the extremely painful and ridiculous behavior of a very elderly patient. There just happened a miraculous transformation of a woman suffering from a chronic and protracted mental disorder with persistent painful manifestations, into absolutely normal person. Experts recognized Kulikova as unexpectedly cured. With full criticism and understanding of what she is doing.
And further important point. Someone clearly prepared Kulikova to communicate with the commission of experts. In her notes made in the spring of 2015, Victor found a multi-page “cheat sheet” on how to behave during the examination at the Serbsky Center. And the woman tried very hard to follow the recommendations.
From the conclusion:
“The expert characterizes herself as calm, non-conflict, and indicates that she prefers to resolve complex issues “by good reasoning“,” “always thinks about her actions,” emphasizes that she “likes to live positively”... Indicates that she currently leads an active lifestyle, takes full care of herself, strives to improve herself, reads books, goes to literary evenings.”
And - no reaction to any document that would prevent Kulikova from being restored to legal capacity. On Inga Sergeevna’s painful sexual behavior, her connections with degenerate alcoholics and the emerging craving for alcohol. To her own statements that she was allowed to rent out Georgy Petrovich’s room to a young resident of Tula at the PND, and her husband’s cousin (?!) also gave his consent. In response to Kulikova’s claim that her ex-husband registered her with the PND in order not to repay a debt in the amount of 9,000 rubles, which were allegedly given to him in the late 80s. Her plans to fight in court with the head of Sberbank German Gref, because the “electronic queue” introduced by Sberbank is her invention, which Gref “stole” from her. The intention, having become legally capable, is to start suing almost all relatives and relatives of relatives, because they are all rich and greedy... 
At the same time, from the board of the housing cooperative of the house where the “non-conflict” and “emotionally restrained” Kulikova lives, complaints are received from her guardian Viktor:
“... your ward Kulikova I.S. pours out the products of his own vital activity on the landing of the first floor and in the elevator... places unknown substances near mailboxes, motivating his actions by the need to fight rats and dogs.”
For some reason, all these facts from documents and court records did not become the subject of research by experts, and there is not a word about them in the conclusion.
* * *
Despite the right of the legal representative to familiarize himself with all the materials of the case, including documents on the state of health of his mother and ward, Judge Moiseeva persistently does not allow the guardian to familiarize himself with the medical records and does not attach to the case those documents that would be very important for the experts to read.
Viktor Kulikov has repeatedly applied to Judge Moiseeva to provide him with copies to review and make copies of medical card from PND No. 17, where his mother is observed and where it should be reflected how changes occurred in the consciousness of the once seriously ill patient.
The applications were denied.
Everything suggests that there are interested parties in this matter. The scheme is well known: a mentally ill grandmother is given back her legal capacity and passport and married to one of her favorite “cowboys.” Then the “young wife” will be persuaded to transfer her share of the apartment to the so-called. husband, after which it will be removed forever, the housing will be occupied, and the co-owner of the apartment, Georgy Petrovich, will have no choice but to transfer his share to the scammers for symbolic money. All this is a classic of the genre, as a result of which the housing ends up with the author of the entire scam.
“For almost a year now, Mikhail, born in 1974, has been regularly visiting his mother during the day and at night,” says Victor. - This is confirmed, among other things, by recordings from the CCTV camera at the entrance. This comrade does not work, drinks alcohol, moves in a criminal environment, and is registered with the PND. He drinks and eats at his mother's expense, and has sex with her. intimate relationships, regularly receives money from her. She also has another boyfriend - Maxim, born in 1967. He knows that his mother is mentally ill, but neither he nor his friends care. Alcohol as a condition for sex is what he needs. He not only comes himself, but also brings his drinking companions to her for drinking and sexual intercourse.
Victor wrote a statement about this to the local police department.
And on October 2 of this year, when the son came to visit his mother, at the door of her apartment he found a strong man behind him. He explained his presence in the entrance by the fact that he, being a student at VGIK, was filming the windows of Inna Sergeevna’s apartment, where there were still old frames. Victor was unable to find out why he had to go into the entrance to do this. But we managed to find a note: “Call this phone, you won’t regret it”...
Where does negligence and indifference end in this story? government agencies, and where crime begins is difficult to understand. But it seems like both are happening. We really hope that specialists both in the field of psychiatry and the law enforcement system will understand all its details.
In the interests of Inga Sergeevna. In the interests of her family and neighbors. It is in the interests of all Moscow residents, each of whom may be unexpectedly affected by the fact that a mentally ill person is left to his own devices.
IN in this case everyone's interests coincide. They do not coincide only with the interests of criminals.
Reference
According to research, most criminals have various types of mental disorders. According to the results of forensic psychiatric examinations, almost 70% of convicts were found to have neuropsychiatric disorders. Among murderers, more than 71% have various mental illnesses.
Reference
According to the chief psychiatrist of the Ministry of Health of the Russian Federation, Zurab Kekelidze, in Russia the number of people suffering from mental disorders (who are registered) exceeds four million. At the same time the doctor Science Center mental health at the Research Institute of Psychiatry of the Ministry of Health of the Russian Federation Olga Shchelokova says that in our country there are about 21 million 680 thousand people with mental illnesses, which is 14% of the Russian population.
all types of treatment (including sanatorium-resort treatment) for medical reasons;
preliminary consent or refusal at any stage from the use of medical devices and methods, scientific research or educational process, photo, video or filming as an object of testing;
assistance of a lawyer or legal representative;
maintaining medical confidentiality when providing psychiatric care, etc.
Officials guilty of restricting the rights and freedoms of citizens only on the basis of a psychiatric diagnosis are liable in accordance with the legislation of the Russian Federation
Rights of patients in psychiatric hospitals.
The patient must be explained the reasons and purposes of his placement in a psychiatric hospital, his rights and the rules established in the hospital in the language he speaks, which is recorded in the medical documentation (Article 37).
In addition, all patients have the right to:
Contact the head physician or department head directly
Submit complaints and statements without caesura to the authorities, the prosecutor's office, the court and the lawyer;
Meet with the lawyer and the clergyman alone;
Perform religious rituals, canons, including fasting;
Subscribe to newspapers and magazines.
Rights that may be limited due to mental state:
Conduct correspondence without censorship;
Receive and send parcels, parcels and money transfers;
Use the telephone;
Receive visitors.
On July 2, 1992 the ball was accepted The federal law“On psychiatric care and guarantees of the rights of citizens during its provision,” the provisions of which form the basis of the activities psychiatric service. (full text of the law)
Psychiatric assistance is provided upon the voluntary application of a citizen or with his consent, with the exception of the cases provided for in Articles 23 and 29 on involuntary examination and hospitalization, if the mental disorder is severe and causes:
a) the patient poses an immediate danger to himself or others, or
b) his helplessness, that is, his inability to independently satisfy the basic needs of life, or
c) significant harm to his health due to a deterioration in his mental state if he is left without psychiatric help.
Involuntary initial examination.
The decision to conduct a psychiatric examination of a citizen without his consent is made psychiatrist at the request of the interested party, which must contain information about the existence of grounds for such an examination.
Having established the validity of the application for the need for a psychiatric examination without the consent of the citizen, the doctor sends his reasoned conclusion about this need to the court. The judge decides whether to issue a sanction and a three-day period from the date of receipt of the materials.
If, based on the application materials, the signs of point “a” are established, the psychiatrist may decide to examine such a patient without the sanction of a judge.
Involuntary hospitalization.
In case of involuntary hospitalization for the reasons stated above, the patient must be examined by a commission of hospital psychiatrists within 48 hours.
If hospitalization is recognized as unfounded and the hospitalized person does not want to remain in the hospital, he is subject to immediate discharge.
Otherwise, the commission’s conclusion is sent to the court within 24 hours. The judge, within 5 days, considers the hospital’s application for involuntary hospitalization and, in the presence of the inpatient, gives or does not authorize the further detention of the person in a psychiatric hospital.
Subsequently, the involuntarily hospitalized person is subject to monthly examination by doctors, and after six months, the commission’s conclusion, if there is still a need to continue treatment, is sent by the hospital administration to the court at the location of the psychiatric hospital to obtain permission to extend treatment
It should be noted that staying in a psychiatric hospital or being registered at a psychoneurological dispensary due to a mental illness does not automatically make the patient incompetent unless a special commission of psychiatrists gives its opinion in the prescribed manner and there is a court decision. Art. 15 of the Civil Code of the RSFSR states: “A citizen who, due to mental illness or dementia, cannot understand the meaning of his actions or manage them, may be declared incompetent by the court in the manner established by the Civil Procedure Code of the RSFSR.”
4. Rights of mentally ill people
When conducting a psychiatric examination, the doctor is obliged to introduce himself to the patient, as well as his legal representative, as a psychiatrist. Outpatient psychiatric care for persons with mental illnesses is provided depending on medical indications and is carried out in the form of consultative and therapeutic care and dispensary observation.
In cases of inpatient treatment of a patient with mental disorders, written consent to this treatment is required, with the exception of patients undergoing compulsory treatment by a court decision, as well as patients involuntarily hospitalized by law enforcement agencies.
Vladimir Rotshtein: “Attitude towards the mentally ill is a moral barometer of society”
Only they are inherited not like eye and hair color, but randomly. And, alas, it is impossible to predict this.V.R.: No. Mental illness not much different from physical ones. For example, there are a lot of people whose stomach ulcers have healed, and they don’t remember about it. Exactly the same is the case with schizophrenia. When its course is paroxysmal, approximately 30% of patients recover after the first and only attack.
Legal capacity - when do you lose your rights?
Civil rights give a person the opportunity to make various decisions and carry out activities in his personal and public life, adhering to the laws of a given country.But in some cases, a person, due to his state of health, cannot make any decisions and take actions, then the question arises of depriving him of such an opportunity, that is, the question of how capable this person is.
Does a mentally ill person have the right to write a will?
I don’t want him to know about this - Can a marriage be dissolved unilaterally if the husband is a mentally ill person? I don't want him to know about it. Further1 answer. Moscow Viewed 266 times. Asked 2011-11-27 10:43:32 +0400 in the topic “Family Law” Will they give me a divorce if my husband is a mentally ill person, - Will they give me a divorce if my husband is a mentally ill person. Further
1 answer.
The Ministry of Health and the Ministry of Internal Affairs refused to tighten control over the mentally ill
The Ministry of Internal Affairs reported that their powers are limited by law and at the same time complained about the position of the Ministry of Health on medical confidentiality: “When local departments of the Ministry of Internal Affairs request information about persons suffering from mental disorders and posing a danger to others, medical institutions All over the country they refuse to provide such information. Doctors refer to medical confidentiality.”
Rights of mentally ill people
This law is based on regulations according to which the dignity of the patient must not be violated when providing psychiatric care. This law also regulates the procedure for conducting psychiatric examinations. This law states that psychiatric examinations and preventive examinations are carried out only at the request or with the consent of the person being examined, and examinations and examinations of a minor under 15 years of age - at the request or with the consent of his parents or legal representative.Rights of the mentally ill
37).On July 2, 1992, the Federal Law “On Psychiatric Care and Guarantees of the Rights of Citizens in its Provision” was adopted, the provisions of which form the basis of the activities of the psychiatric service. (full text of the law)
Psychiatric assistance is provided upon the voluntary application of a citizen or with his consent, with the exception of the cases provided for in Articles 23 and 29 on involuntary examination and hospitalization, if the mental disorder is severe and causes:
The decision to conduct a psychiatric examination of a citizen without his consent is made by a psychiatrist upon the application of the interested person, which must contain information about the existence of grounds for such an examination.
