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The letter of the Ministry of Health of the Russian Federation from 23-07-99 25108236-99-32 (2020) is relevant in 2018

4. Organization of outpatient compulsory observation and treatment of psychiatrist

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

If necessary, by decision of the chief psychiatrist of the relevant health management body, this measure of a medical nature can be carried out at the place of residence of the guardian or family members of the patient, which he temporarily lives. The psychoneurological dispensary (dispensary office, the office) sends written information to the body of the internal affairs at the place of residence of the person on its adoption for an outpatient compulsory observation and psychiatrist treatment. In the future, similar information is sent to the internal affairs body immediately upon obtaining a court definition about the extension, change or cancellation of a forced medical course.

4.2. Control maps dispensary observation (Form N OGO-I / Y) Behind persons on outpatient forced treatment are located in general card files of psychoneurological dispensaries with a note in the upper right corner of the front side of the Card "PL" (forced treatment) and color marking are either formed by a separate array with the same marked.

4.3. When adopting on outpatiently forced treatment, the patient explains the procedure for its implementation, the obligation to implement medical recommendations, and the corresponding regime corresponds to its state, the necessary treatment, diagnostic and rehabilitation (recovery) measures are appointed.

The patient should be examined by a doctor in the dispensary (dispensary office, office), and in the presence of testimony - at home, with a frequency that ensures the possibility of rehabilitation and diagnostic measures shown by the mental state, but at least once a month. The implementation of medical recommendations is controlled by the staff of the psychoneurological dispensary (dispensary branch, office) if necessary, with the involvement of family members, guardian, other persons of the nearest surroundings of the patient, and in cases of behavior of an antisocial nature, as well as evasion of the prescribed forced medical measures, and with The help of police officers.

4.4. In case the condition and behavior of the patient make it difficult to examine it (the long absence in the place of residence, the provision of resistance and the commission of other actions that threaten the life and health of medical workers, attempts to disappear from them), as well as when creating obstacles to surveys and treatment from family members, guardian or other persons medical personnel Resorts to the help of police officers.

Last, acting in accordance with the law Russian Federation "On the police" and the law of the Russian Federation "On psychiatric care and guarantees of citizens' rights in its provision", provide the necessary assistance in the search, detaining the face and ensure safe conditions for its inspection.

4.5. In relation to a person who is on an outpatient compulsory observation and treatment can be applied by any medical means and methods allowed in the manner prescribed by law as well different kinds Therapeutic - rehabilitation and socio-psychiatric assistance provided for by the Law of the Russian Federation "On psychiatric assistance and guarantees of the rights of citizens in its provision." To this end, it can be directed to any medicinal - rehabilitation division of the dispensary (specialized rooms, medical and production (labor) workshops, day hospital, etc.), and also placed in a psychiatric hospital without changing the form of forced treatment, if hospitalization is not caused by increasing the danger wearing a persistent character. This face enjoys right to free medicia treatment and other rights and benefits stipulated by the legislation of the Russian Federation, the constituent entities of the Russian Federation and other regulatory acts regarding the corresponding category of persons suffering from mental disorders.

4.6. In the presence of testimony, the person on an outpatient forced treatment can be directed to a psychiatric hospital (hospital, separation) both voluntarily and in the order of involuntary hospitalization. In the latter case, hospitalization is usually carried out with the promotion of militia. Psychiatric hospital (hospital, separation), which is placed in the patient, is notified in writing by a doctor who issued the direction to hospitalization that this person is on an outpatient coercion.

4.7. Wheating patients during outpatient forced treatment can, taking into account the state of their health, to work both under normal conditions and in the conditions of medical and production specialized enterprises and workshops using the work of persons suffering from mental disorders. Substitutions for official need in such cases, they coordinate with the attending physician of the psychoneurological dispensary (dispensary department, office). When a state changes, making them temporarily disabled, they get a hospital leaf, with a rack loss or disinfloyability - are sent to MCEC<*> And in case of recognition of their disabled people have the right to pension provision.

<*> Medico - Social Expert Commission.

4.8. If there is grounds for changing a medical course for stationary forced treatment, a psychoneurological dispensary (dispensary department, an office) can also resort to involuntary hospitalization. In this case, simultaneously with hospitalization by decision of the Commission of Doctors - Psychiatrists, a petition for the court on a change in forced measure is initiated, which the hospital administration is notified in writing. The question of the discharge of such a patient can be resolved only if the court is obtained on the refusal to change the compulsory measures of a medical nature.

Forced observation and treatment of a psychiatrist in outpatient conditions It may be assigned in the presence of grounds provided for in Article 97 of this Code, if the person does not need a premises in his mental state in medical organizationproviding psychiatric help in stationary conditions.

Comments to Art. 100 Criminal Code

1. Outpatient compulsory observation and psychiatrist's treatment is appointed to persons who committed a crime and suffering mental disorders that do not exclude changes, as well as persons who committed socially dangerous acts in the state of insaneness. As in one and in another case, this forced medical measure is applied to persons who, in their mental state, are able to comply with the treatment and observation regime. Their behavior is ordered, they are able to realize the importance of medical events applied to them.

2. When deciding on the appointment of this forced measure, the court takes into account: a) the nature and degree mental disorder; b) the ability to achieve the objectives of applying forced medical measures by outpatient compulsory observation and treatment; c) the influence of a mental disorder on the behavior of the patient (whether it is aggressive, is the real threat to it and the surrounding, if the probability of repetition of a socially dangerous act, etc.).

According to Art. On the Law of the Russian Federation "On psychiatric assistance and guarantees of citizens' rights, with its provision," dispensary observation may be established by a person suffering from chronic and protracted mental disorder with severely persistent or often exacerbating painful manifestations.

4. Persons convicted of imprisonment, arrest or restriction of freedom are outpatient treatment in institutions that perform these types of sentences (art. 18 PEC RF).

Persons convicted of punishments that are not associated with imprisonment or restriction of freedom are outpatient compulsory observation or treatment with a psychiatrist in medical institution at the place of residence. The specified institution uses the court decision on the application of this measure; This is also reported to the internal affairs body, the task of which is to control and ensure the person's appearance to the psychiatrist with the periodicity established by it.

New edition of Art. 100 Criminal Code

Forced observation and treatment of a psychiatrist in an outpatient basis can be appointed if there is grounds provided for in Article 97 of this Code, if the person does not need a premises to a medical organization that provides psychiatric assistance in inpatient conditions.

Comments on Article 100 of the Criminal Code of the Russian Federation

1. The overall reason for use PMMX, as already noted, is indicated in part 2 of Art. 97. However, if the legislator differentiates the possible types of PMMX (Article 99), the question of the objective criteria for the appointment by the court of one or another forced measure, designed to optimally ensure the implementation of the goals specified in Art. 98.

1.1. Such criteria can have both medical and social (diagnosis of disease predicted by its development, behavior of the face before, during and after the commission, the focus of its social properties, etc.) and legal signs (degree and nature of the socially dangerous act, Perfect by this face, the form of guilt, the commission of such acts is repeatedly, with special cruelty, etc.), comprehensively reflect the person of the person in need of use of PMMX, in all the diversity of its social, personal and legally significant properties.

1.2. Before specialists of forensic psychiatric expert commissions and employees of forensic authorities, there is a problem of a uniform understanding of these criteria, which allows us to correctly solve the question of the need and sufficiency of the use of one or another PMMX to implement the goal set before it. This problem Directimately related to the procedural principle of ensuring the legitimate interests of the individual in the criminal process, in accordance with which the rights, freedoms and interests of the person in the criminal process should not be rejected on the iota more than it requires the implementation of the goals and objectives of criminal proceedings.

1.3. When choosing one or another PMMX, it is necessary to objectively take into account the data available in the materials, reflecting the behavior and socially dangerous views of the patient as before and after the commission of a socially dangerous act, including during the inpatient forensic psychiatric examination. For example, if during the latter there were facts of aggression in relation to medical or service personnel or in relation to other patients, the facts of a systematic violation of the regime or an attempt of escape, etc., the court should not appoint outpatient compulsory observation and psychiatrist treatment.

1.4. The latter, in the sense of the norm of the law, can be appointed only to those who, according to their mental state and, taking into account the socially dangerous act, represent a minor danger to society or themselves.

2. The feasibility of introducing the above-mentioned measure in the Criminal Code of the Russian Federation is quite obvious, since now the court is not necessary in each case of a mental disorder to resort to the mandatory premises of the convicted in psychiatric hospital. Unloading the latter, indicated, on the one hand, allows you to mostly focus the basic efforts of psychiatric hospitals on the treatment and social redeasurement of persons who really need inpatient treatment and observation, on the other, allows during treatment without excessively not to destroy the established social relations and the usual lifestyle of a mentally ill person, that in some cases objectively contributes to its early recovery or permanent improvement mental state.

3. Outpatient psychiatric assistance includes a periodic psychic health examination of persons who need the use of PMMX, diagnosis of mental disorders, their treatment, psychoprophylactic and rehabilitation assistance, as well as special care for people suffering from mental disorders.

Such assistance can be provided in psychoneurological dispensaries, dispensary departments, consultations, centers, specialized offices (psychiatric, psycho-neurological, psychotherapeutic, suicidological, etc.), advisory-diagnostic and other ambulatory units of psychiatric hospitals.

4. Ambulatory observation and treatment with a psychiatrist is usually appointed against those persons who, in the opinion of psychiatrists and the court, is able to properly and positively assess their mental state, to voluntarily comply with the appointed regime and treatments that have a fairly ordered treatment. and predicted behavior that do not require constant control by medical personnel.

In particular, include: a) the accused, suffering from only temporary (reversible) disorder of mental activities, which ended with almost complete recovery of this person by the time the case consideration by the court and, according to psychiatrists, does not have obvious trends towards repetition, provided that the person will strictly observe the prescribed regime and treatment measures; b) accused, suffering from chronic mental disorders or dementia, which has undergone forced treatment in a psychiatric hospital with positive effectHowever, still needing during a certain time in medical control and supporting treatment, ensuring the prevention of sudden recurrences of the disease or hazardous changes in behavior.

5. In accordance with Art. 26 of the Law on Psychiatric Aid Ambulatory Assistance Depending on Medical Indications (the presence of mental disorder, its nature, severity, features of the flow and forecast, the impact on the behavior and social redeaptation of this person, its ability to properly and independently solve social and domestic issues, etc. p.) It turns out in the form of advisory and medical care or dispensary observation.

5.1. One day, the form of outpatient psychiatric care should not remain unchanged with a change in the mental state of the face or its behavior. The Criminal Code of the Russian Federation and the court decision (Art. 445 of the Code of Criminal Procedure) determine only the type of PMX. The transition from advisory-treatment assistance to dispensary observation and is also possible on the initiative of the Commission of Psychiatrists, since in this situation they act within the framework of the authority and the measures that are determined by the decision of the court entered into legal force.

5.2. It does not require voluntary (written) consent of the person to change this or that type of outpatient psychiatric care, since it is initially a forced legalization, arising from both the fact of the commission of a socially dangerous act of this person and from the objective public danger of this person. In this regard, the provisions of the Law on Psychiatric Assistance, pointing to an exclusively voluntary nature of the provision of advisory-medical outpatient psychiatric care (part 2 of article 26), not applicable to these patients.

5.3. The forced nature of the above-mentioned measure means that precisely the attending staff, and not the patient himself is entitled to determine (and require unconditional performance) time and frequency of contacts with the doctor, the list of necessary medical and rehabilitation measures, etc. At the same time, advisory-medical assistance depending on the state of the patient can be carried out in a fairly wide range of time - from a single or several inspections (examinations) per year to perennial and systematic contacts of the doctor with a patient.

6. Another (possible) type of outpatient psychiatric care is the dispensary observation, the essence and content of which are disclosed in Art. 27 of the Law on Psychiatric Assistance. The grounds for establishing this subspecies of psychiatric assistance are determined by the Commission of Psychiatre Doctors. As a result, these bases perform in the form of three dialectically interrelated criteria: a) mental disorder should be chronic or protracted; b) his painful manifestations should be severe; c) These painful manifestations must be persistent or often exacerbating.

6.1. Chronic (as a rule, irreversible) mental disorders (schizophrenia, manic-depressive psychosis, epilepsy, etc.) due to their inherent patterns have a long and difficult course (from several years to dozen years).

6.2. Protracted last for at least a year and differ from chronic features manifestations of painful states in each particular person under certain life circumstances. In this regard, their diagnosis requires a certain experience and professionalism from the medical personnel.

6.3. The severity of the mental disorder reflects the severity of painful manifestations and the degree of violation of mental activities in general, including understanding and evaluating the patient of what is happening, their own behavior, social properties of their personality, etc.

6.4. Painful manifestations can be considered persistent if during the examination of the patient they show themselves at least a year and if the prognostic signs of the flow of this mental disorder indicate their existence in the future throughout the year and more.

6.5. The exacerbations should be considered frequent if they exhibit themselves annually or more than once a year. The frequency of exacerbations is determined by analyzing clinical picture Diseases in the past and (or) on the basis of the forecast of its flow.

6.6. Only the presence of all three indicated criteria can serve as a basis for establishing dispensary outpatient surveillance and treatment. Since individual mental disorders, including chronic, can under the influence of treatment have a favorable outcome, previously established dispensary observation may also be changed to the consultative and treatment solution by the Commission of Psychiatrians.

7. Dispensary monitoring of the patient's condition is carried out by regular inspections by a psychiatrist and providing a patient with the necessary medical and social assistance. The establishment of a dispensary observation gives the authority of the psychiatrist's doctor to conduct inspections of the patient with both visits at home and invitations to receive with the frequency, which, in his opinion, is required to assess changes in the state of the patient and the full provision of psychiatric care. At the same time, the question of the frequency of inspections against each patient is solved purely individually.

8. Forced outpatient observation and psychiatrist treatment can be established in relation to persons suffering from mental disorders that do not exclude the beams. In this case, in the sentence of the court on the basis of the existing experts, it must necessarily indicate that outpatient compulsory observation and treatment with a psychiatrist at the place of serving the sentence is prescribed.

Another comment to Art. 100 Criminal Code of the Russian Federation

1. The type of compulsory medical measures under consideration is applied to two categories of mentally unhealthy persons who have committed socially dangerous acts: a) to persons who do not need indoors in psychiatric hospital; b) to persons who have passed forced treatment in psychiatric hospitals, To adapt them to life in society and to secure its results.

2. Persons who, in their mental state, do not need inpatient treatment, in turn, are divided into two groups: the first is the persons recognized by the court inequiencies in relation to the incriminated act, or exempt from punishment on the basis of Part 1 of Art. 81 of the Criminal Code; The second - persons suffering from mental disorders that do not exclude the savers, to which, along with punishment, apply an outpatient observation and treatment with a psychiatrist.

3. Outpatient observation and psychiatrist treatment may be provided both in the form of consultative and treatment assistance and in the form of dispensary observation. The latter implies the regular inspection by a psychiatrist, during which not only medical, but also social help. Inspection by a psychiatrist may be held at home, in a psychoneurological dispensary or an inven institution, providing outpatient psychiatric assistance (for example, a psychoneurological office of polyclinics) at the place of residence of the patient. The frequency of such inspections depends on the mental state of the person, the dynamics of mental disorder and the need for this assistance. In the joint instruction of the Ministry of Health of the Russian Federation and the Ministry of Internal Affairs of the Russian Federation (approved on April 30, 1997 by order N 133/269) it is envisaged that the doctor must personally examine the patient with the necessary frequency, but at least once a month.

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