Psychiatric care guaranteed by the state and carried out 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
- upon the occurrence of significant harm to health due to deterioration mental state, and if the person is left without mental health care.
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.
Clinical observation involves monitoring the condition mental health through regular examination by a psychiatrist and provision of 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 documented in the 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. The prosecutor, a representative of the given medical institution, the patient himself or his legal representative must be present in court. 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 socially 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 mental disorder was temporary, he recovers. 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 psychiatric hospital general type;
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 guilty of such violations bear responsibility 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 a 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.
The administration and medical staff of a psychiatric hospital 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 patient rights;
- 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.
(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 a psychiatric hospital and compliance with the rights granted by this Law;
submit uncensored complaints and statements to the bodies of representative and executive power, the prosecutor's office, the court and the lawyer;
meet with a lawyer and a clergyman alone;
perform religious rituals, 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 of a general education school or a 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 the health or safety of patients, as well as in the interests of the health or safety of other persons:
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.
Article 38. Service for protecting the rights of patients in psychiatric hospitals
(1) The state shall create a service to protect the rights of patients in psychiatric hospitals, independent of the health authorities.
(2) Representatives of this service protect the rights of patients in psychiatric hospitals, accept their complaints and statements, which are resolved with the administration of this psychiatric institution or sent, depending on their nature, to the bodies of representative and executive power, the prosecutor's office or the court.
Article 39. Responsibilities of the administration and medical staff of a psychiatric hospital
The administration and medical staff of a psychiatric hospital 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 law “On Psychiatric Care and Guarantees of the Rights of Citizens in its Provision” is based on regulations according to which the dignity of the patient must not be infringed upon in the provision of 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. 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 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 of mental state if left without psychiatric help.
A patient admitted to a hospital as a result of involuntary hospitalization must be examined within 48 hours 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.
An important achievement in respecting the rights of mentally ill citizens is the release of them from responsibility for social acts committed by them during their illness. dangerous actions(crimes).
6. Any determination that by reason of mental illness a person is incapacitated, and any determination that, as a result of such incapacity, a personal representative should be appointed shall be made only after a fair hearing by an independent and impartial judicial body established in accordance with domestic legislation. The person whose capacity is the subject of the proceedings has the right to be represented by a lawyer. If the person whose legal capacity is the subject of the proceedings cannot independently provide himself with such representation, the latter must be provided to that person free of charge if he does not have sufficient means for this. A lawyer must not, during the same proceedings, represent a mental health facility or its staff, and must not represent a family member of a person whose capacity is the subject of the proceedings, unless the judicial authority is satisfied that there is no conflict of interest. Decisions regarding capacity and the need for a personal representative are subject to review at reasonable intervals in accordance with domestic law. The person whose competency is the subject of the proceeding, his personal representative, if any, and any other interested person shall have the right to appeal any such decision to a higher court.
7. If the court or other competent judicial authority determines that the sick face is unable to conduct his business, measures are taken to the extent necessary and taking into account the condition of such person to ensure the protection of his interests.
Principle 2
Protection of minors
In accordance with the objectives of these Principles and in the context of domestic legislation relating to the protection of minors, attention should be paid to Special attention protection of the rights of minors, including, if necessary, the appointment of a personal representative who is not a family member.
Principle 3
Life in society
Every person with a mental illness has the right, to the extent possible, to live and work in the community.
Principle 4
Diagnosis of mental illness
1. The diagnosis that a person suffers from a mental illness is made in accordance with internationally recognized medical standards.
2. A diagnosis of mental illness is never made on the basis of political, economic or social status or membership in a cultural, racial or religious group or for any other reason not directly related to the mental health condition.
3. Family or work conflict or inconsistency with the moral, social, cultural or political values or religious views prevailing in the society in which the person concerned lives can never be a determining factor in making a diagnosis of mental illness.
4. History of past treatment or hospitalization as a patient does not, in and of itself, justify a diagnosis of present or future mental illness.
5. No person or authority may declare or otherwise indicate that a person is suffering from a mental illness, except for purposes specifically relating to the mental illness or the consequences of mental illness.
Principle 5
Medical checkup
No person may be forced to undergo medical examination for the purpose of determining whether he suffers from a mental illness, except in accordance with a procedure provided for by domestic law.
Principle 6
Confidentiality
The confidential nature of information relating to all persons to whom these Principles apply must be respected.
Principle 7
The role of community and culture
1. Every patient has the right, so far as possible, to receive treatment and care in the community in which he resides.
2. When treated in a mental health facility, the patient has the right, whenever possible, to receive treatment close to his own home or the home of his relatives or friends and has the right to return to his community as soon as possible.
3. Every patient has the right to treatment that is culturally appropriate.
Principle 8
Standards of care
1. Every patient has the right to such medical and social assistance necessary to maintain his health, and has the right to care and treatment in accordance with the same standards as other patients.
2. Every patient shall be protected from harm to his or her health, including the unnecessary use of medications, abuse by other patients, staff or others, and other acts causing mental suffering or physical discomfort.
Principle 9
Treatment
1. Every patient has the right to be treated in the least restrictive environment and by the least restrictive or invasive methods necessary to maintain his or her health and protect the physical safety of others.
2. The care and treatment of each patient is based on an individually developed plan, which is discussed with the patient, regularly reviewed, modified as necessary and provided by qualified medical personnel.
3. Psychiatric care is always provided in accordance with the applicable ethical standards for mental health professionals, including internationally recognized standards such as the Principles of Medical Ethics relating to the role of health professionals, especially doctors, in protecting prisoners or detainees from torture and other cruel, inhuman or degrading treatment or punishment adopted by the General Assembly of the United Nations. Abuse of knowledge and skills in the field of psychiatry is not allowed
4. Treatment of each patient should be aimed at maintaining and developing individual autonomy.
Principle 10
Medicines
1. Medicines must be best suited to the patient's health needs, should be prescribed for therapeutic or diagnostic purposes only, and should never be used as punishment or for the convenience of others. Except as provided in Principle 11, paragraph 15 below, mental health professionals shall use only medications of known or proven effectiveness.
2. All medications are prescribed by a legally authorized specialist working in the field of psychiatry and are recorded in the patient's medical history.
Principle 11
Consent to treatment
1. No treatment can be prescribed to a patient without his informed consent, except for the cases provided for in paragraphs 6,7,8,13 and 15 of this principle.
2. Informed consent is consent obtained freely, without threats or unjustified coercion, after the patient has been properly provided, in a form and language understandable to him, with sufficient and clear information about:
b) the purpose, methods, likely duration and expected results of the proposed treatment;
With) alternative methods treatments, including less invasive ones;
d) possible pain and feelings of discomfort, possible risk And side effects proposed treatment.
3. During the consent procedure, the patient may require the presence of a person or persons of his choice.
4. The patient has the right to refuse treatment or stop it, except for the cases provided for in paragraphs 6, 7, 8, 13 and 15 of this principle. The consequences of refusing or stopping treatment must be explained to the patient.
5. The patient should not be asked or encouraged to waive the right to informed consent. If the patient expresses a desire to waive this right, it must be explained to him that treatment cannot be carried out without his informed consent.
6. Except as provided in paragraphs 7, 8, 12, 13, 14 and 15 of this principle, a proposed course of treatment may be prescribed to a patient without his informed consent, subject to following conditions:
A) V this moment the patient is involuntarily hospitalized;
b) an independent authority, having all relevant information, including the information specified in paragraph 2 of this principle, is satisfied that the patient is not currently capable of giving or not giving informed consent to the proposed course of treatment or, if so provided by domestic law, that, having regard to the patient's own safety or the safety of others, the patient unreasonably refused to give such consent;
With) an independent authority has determined that the proposed course of treatment is in the best interests of the patient's health.
7. The provisions of paragraph 6 above do not apply to a patient who has a personal representative authorized by law to consent to treatment for the patient; however, except as provided in paragraphs 12, 13, 14 and 15 of this principle, treatment may be prescribed to such a patient without the patient's informed consent if the personal representative, having received the information specified in paragraph 2 of this principle, consents on behalf of the patient.
8. Except as provided in paragraphs 12, 13, 14 and 15 of this principle, treatment may also be administered to any patient without his or her informed consent if a legally authorized qualified mental health professional determines that it is urgently necessary to administer is treatment to prevent immediate or imminent harm to the patient or others. Such treatment shall not be extended beyond the period of time strictly necessary for this purpose.
9. Where any treatment is prescribed to a patient without his or her informed consent, every effort should nevertheless be made to inform the patient of the nature of the treatment and of any possible alternative methods and, to the extent possible, to involve the patient to develop a course of treatment.
10. Any treatment is immediately recorded in the patient's medical record, indicating whether the treatment is involuntary or voluntary.
11. Physical restraint or involuntary seclusion of a patient shall be used only in accordance with the officially approved procedures of the mental health facility and only when it is the only available means of preventing immediate or imminent harm to the patient or others. They shall not be extended beyond the period of time strictly necessary for that purpose. All cases of physical restraint or involuntary restraint, the reasons for their use, their nature and duration must be recorded in the patient's medical record. A patient subject to restraint or seclusion must be kept in humane conditions and provided with care and close and constant supervision by qualified personnel. medical workers. The personal representative, if available and as appropriate, shall be promptly informed of any instances of physical restraint or involuntary seclusion of a patient.
12. Sterilization is never used as a treatment for mental illness.
13. A mentally ill person may be subject to serious medical or surgical intervention only where permitted by domestic law, when it is considered to be in the best interests of the patient's health, and where the patient has given informed consent, but where the patient is unable to give informed consent, the intervention should only be ordered after an independent assessments.
14. Psychosurgery and other types of invasive and irreversible treatment of mental illness shall not, under any circumstances, be used in relation to a patient who has been involuntarily admitted to a psychiatric institution, and may be used, to the extent permitted by domestic law, in relation to any other patient only if case where the patient has given informed consent and independent external organ ensures that the patient's consent is truly informed and that the treatment is in the best interests of the patient's health.
15. Clinical trials and experimental treatments are under no circumstances applied to any patient without his or her informed consent, unless clinical experiences and experimental methods may only be used on a patient who is unable to give informed consent with the permission of a competent independent supervisory body specifically established for this purpose.
16. In the cases specified in paragraphs 6, 7, 8, 13, 14 and 15 of this principle, the patient or his personal representative, or any interested person, has the right to appeal to a judicial or other independent authority in relation to the application of any treatment to the patient .
Principle 12
Rights Notice
1. A patient in a psychiatric institution, to the maximum extent possible short term after hospitalization, he is informed, in a form and language that he understands, of all his rights under these Principles and under domestic law, which information includes an explanation of these rights and how to exercise them.
2. If and while the patient is unable to understand such information, such patient's rights shall be communicated to the personal representative, if available and as appropriate, and to the person or persons who can best represent the patient's interests and is willing to do so.
3. A patient who has the necessary legal capacity has the right to designate any person to inform on his behalf, as well as a person to represent his interests before the administration of the institution.
Principle 13
Rights and conditions of detention in psychiatric institutions
1. Any patient detained in a psychiatric institution has the right, in particular, to full respect for his:
A) universal recognition as a subject of law;
b) rights to privacy;
With) freedom of communication, which includes freedom of communication with other persons within a given institution; freedom to send and receive private messages not subject to censorship; freedom to receive in private a lawyer or personal representative and, at all reasonable times, other visitors; and freedom of access to postal and telephone services, as well as newspapers, radio and television;
d) freedom of religion or belief.
2. The environment and living conditions in a psychiatric institution should be as close as possible to the normal life conditions of persons of a similar age and, in particular, include:
A) opportunities for leisure and recreation;
b) educational opportunities;
With) the ability to buy or receive items necessary for Everyday life, leisure and communication;
d) opportunities - and encouragement to use such opportunities - to involve the patient in activities appropriate to his social situation and cultural characteristics, and to implement appropriate vocational rehabilitation measures for the purpose of his social reintegration. These measures should include career guidance, vocational training and placement services to enable patients to obtain or maintain employment in the community.
3. Under no circumstances should the patient be subjected to forced labor. To the extent consistent with the needs of the patient and the requirements of the administration of the institution, the patient should be able to choose the type of work he wishes to perform.
4. The labor of a patient held in a psychiatric institution must not be exploited. Any such patient has the right to receive for the work performed by him the same remuneration as, under domestic law or custom, would be received for similar work by a person who is not a patient. Any such patient shall in all cases be entitled to receive a fair share of any remuneration paid to the mental health facility for its services.
Principle 14
Mental Health Resources
1. A mental health facility must have access to the same resources as any other health care facility, including, but not limited to:
A) sufficient number of qualified medical personnel and other appropriate professionals and adequate facilities to provide each patient with privacy and the necessary and active course of treatment;
b) diagnostic and therapeutic equipment for the patient;
With) proper service by specialists;
d) adequate, regular and complex treatment, including the supply of medical supplies.
2. Every mental health establishment should be inspected with reasonable regularity by the competent authorities to ensure that the conditions of treatment and care for patients are in accordance with these Principles.
Principle 15
Principles of hospitalization
1. When a person requires treatment in a psychiatric institution, every effort must be made to avoid involuntary hospitalization.
2. Access to a mental health facility should be regulated in the same way as access to any other medical institution for any other disease.
3. Every non-involuntarily admitted patient has the right to leave the mental health facility at any time, unless the criteria for involuntary detention in principle 16 below apply, and he must be informed of this right.
Principle 16
Forced hospitalization
1. Any person may be involuntarily admitted to a psychiatric institution as a patient, or already hospitalized as a voluntarily patient, may be held as a patient in a psychiatric institution involuntarily, if and only if the person authorized for this purpose by law is qualified a mental health professional will determine, in accordance with principle 4 above, that the person is suffering from a mental illness and will determine:
A) that, as a result of this mental illness, there is a serious risk of immediate or imminent harm to that person or others; or
b) that in the case of a person whose mental illness is severe and whose mental faculties are impaired, refusal to hospitalize or maintain the person in a mental institution may result in a serious deterioration in his health or make it impossible to receive adequate treatment that could be provided by hospitalization in a mental health facility mental health facility in accordance with the principle of the least restrictive alternative.
In the case referred to in subparagraph b), it is necessary, if possible, to consult a second such specialist working in the field of psychiatry. In the event of such a consultation, hospitalization in a psychiatric institution or involuntary detention in it can only take place with the consent of a second specialist working in the field of psychiatry.
2. Hospitalization in a psychiatric institution or detention in it involuntarily is carried out initially for a short period determined by domestic legislation, for the purpose of observation and preliminary treatment before consideration of the issue of hospitalization or detention of the patient in a psychiatric institution by the supervisory authority. The reasons for hospitalization or detention are immediately communicated to the patient; the fact of hospitalization or detention and the reasons therefor shall also be reported promptly and in detail to the supervisory authority, the patient's personal representative, if any, and, if the patient does not object, to the patient's family.
3. A psychiatric institution may admit involuntarily hospitalized patients only if the institution has been designated for this purpose by a competent authority established in accordance with domestic legislation.
Principle 17
Supervisory authority
1. The supervisory authority is a judicial or other independent and impartial body established under domestic law and functioning in accordance with procedures established by domestic law. In preparing his decisions he shall obtain the assistance of one or more qualified and independent mental health professionals and take into account their advice.
2. Subject to principle 16, paragraph 2 above, the initial review by a supervisory authority of a decision to admit or involuntarily commit a patient to a mental health facility shall take place as soon as practicable after such decision is made and should be carried out in accordance with the simplified and expedited procedures provided for in domestic legislation.
3. The supervisory authority periodically, at reasonable intervals determined by domestic legislation, reviews cases of involuntary hospitalization.
4. A patient hospitalized involuntarily may, at reasonable intervals determined by domestic law, apply to the supervisory authority to be discharged or to obtain the status of a patient hospitalized voluntarily.
5. At each review, the supervisory authority should consider whether the criteria for involuntary admission set out in paragraph 1 of principle 16 above are still met and, if not, the patient should be discharged as an involuntary admission.
6. If at any time the mental health professional responsible for the case is satisfied that the conditions of the person's detention as an involuntary patient are no longer being met, that professional shall order the person's discharge as an involuntary patient. forcibly.
7. The patient, or his personal representative, or any interested person has the right to appeal to a higher court the decision to hospitalize the patient or to keep him in a psychiatric institution.
Principle 18
Procedural guarantees
1. The patient has the right to select and appoint counsel to represent the patient as such, including representation in any grievance or appeal proceedings. If the patient does not independently provide such services, the lawyer is provided to the patient free of charge insofar as the patient does not have sufficient funds to pay for his services.
2. The patient also has the right, if necessary, to use the services of an interpreter. When such services are necessary and the patient cannot provide them, they are provided free of charge to the patient to the extent that the patient does not have sufficient funds to pay for these services.
3. The patient and the patient's attorney may request and present at any hearing an independent psychiatric report and any other reports and written and oral evidence that are relevant and admissible.
4. Copies of the patient's medical history and any reports and documents to be submitted shall be served on the patient or the patient's attorney, except special occasions when it is determined that disclosing specific information to a patient would cause serious harm to the patient's health or jeopardize the safety of others. Domestic law requires that any document not provided to the patient must, where it can be done in confidence, be served on the patient's personal representative and attorney. In the event that any portion of any document is not provided to a patient, the patient or the patient's attorney, if any, will be notified of the failure and the reasons therefor, and the decision may be subject to judicial review.
5. The patient and the patient's personal representative and attorney have the right to attend, participate in, and be heard at any hearing.
6. If the patient, or the patient's personal representative or attorney, requests that a specific person be present at the hearing, that person shall be permitted to attend the hearing unless it is determined that his or her presence would cause serious harm to the patient's health or safety. other persons.
7. Any decision whether a hearing or part thereof will be open or closed and whether it will be communicated to the public must take into account the wishes of the patient, the need to respect the right of the patient and others to privacy, and the need to prevent serious harm to the patient's health or risk for the safety of others.
8. The decision made following the hearing and its reasons are stated in writing. Copies will be provided to the patient and the patient's personal representative and attorney. In deciding whether a decision will be published in whole or in part, full consideration should be given to the wishes of the patient, the need to respect his or her privacy and the privacy of others, the public interest in the open administration of justice and the need to prevent serious harm to the patient's health or safety. other persons.
Principle 19
Access to the information
1. The patient (a term which in this principle also includes former patients) has the right to access information concerning him in the medical record maintained by the mental health institution. This right may be limited in order to prevent serious harm to the patient's health and risk to the safety of others. Domestic law requires that any such information not provided to the patient must, where it can be done in confidence, be communicated to the patient's personal representative and attorney. In the event that any such information is not communicated to the patient, the patient or the patient's attorney, if any, will be notified of the failure to communicate the information and the reasons therefor, and the decision may be subject to judicial review.
2. Any written comments by the patient or the patient's personal representative or attorney may, at the patient's request, be included in the patient's medical record.
Principle 20
Criminals
1. This principle applies to persons who are serving a prison sentence for criminal offences, or to persons who are otherwise detained in the course of proceedings or investigations brought against them on a charge of a criminal offence, and who are found to have suffer from a mental illness or are expected to suffer from such an illness.
2. These persons should receive the best possible mental health care, as provided for in principle 1 above. These Principles apply to them to the fullest extent possible with only such limited modifications and exceptions as are necessary in the circumstances. None of such modifications or exceptions shall prejudice the rights of those persons as set out in paragraph 5 of principle 1 above.
3. Provisions of domestic law may authorize a court or other competent authority, on the basis of a competent and independent medical opinion, to order the placement of such persons in a psychiatric institution.
4. Treatment of persons diagnosed with a mental illness should, in all circumstances, be consistent with Principle 11 above.
Principle 21
Complaints
Every patient and former patient have the right to lodge a complaint in accordance with the procedures specified in domestic law.
Principle 22
Supervision and remedies
States shall ensure that appropriate mechanisms are in place to promote compliance with these Principles for the inspection of mental health facilities, for the presentation, investigation and resolution of complaints, and for the initiation of appropriate disciplinary or judicial proceedings in cases of breach of duty or patient rights.
Principle 23
Implementation
1. States shall give effect to these Principles through appropriate legislative, judicial, administrative, educational and other measures, which they review from time to time.
2. States shall make these Principles known to the general public through appropriate active means.
Principle 24
Scope of application of the principles in relation to mental health institutions
These Principles apply to all persons admitted to mental health facilities.
Principle 25
Retention of existing rights
No limitation or derogation of any existing rights of patients, including rights recognized in applicable international or domestic law, is permitted on the basis that these Principles do not recognize such rights or recognize them to a lesser extent.
4, appendix.
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 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:
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.
