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

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

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

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

4.2. Dispensary observation control cards (form N OZO-I / U) for persons on outpatient compulsory treatment are located in the general card files of neuropsychiatric dispensaries with a mark in the upper right corner of the front side of the card "PL" (compulsory treatment) and color marking or are formed separately an array with the same mark.

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

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

4.4. If the patient's condition and behavior complicate his examination (prolonged absence from the place of residence, resistance and other actions that threaten the life and health of medical workers, attempts to hide from them), as well as when creating obstacles for his examination and treatment from outside family members, guardian or others medical staff resorts to the help of police officers.

The latter, acting in accordance with the Law Russian Federation "On the police" and the Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens during its provision ", provide the necessary assistance in the search, detention of a person and provide safe conditions for his examination.

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

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

4.7. Able-bodied patients during outpatient compulsory treatment may, taking into account their state of health, work both in normal conditions and in the conditions of medical and production specialized enterprises and workshops using the labor of persons suffering from mental disorders. In such cases, they agree with the attending physician of the neuropsychiatric dispensary (dispensary department, office) on business trips. When the state changes, making them temporarily incapacitated, they receive a sick leave, with a persistent loss or decrease in working capacity, they are sent to MSEC<*> and if recognized as disabled, they are entitled to pension benefits.

<*> Medical and social expert commission.

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

In some cases, a person needs treatment, as he is a danger to himself and to others. This happens not only with drug addiction or alcohol dependence, which lead to a loss of control over their behavior, but also in the presence of contagious diseases that require the patient to be isolated from society.

Legislation

The issue of compulsory treatment is rather difficult. Indeed, in essence, a person is deprived of freedom, although he did not commit an illegal act. IN different countries the world this issue is solved in different ways.

Compulsory medical measures in the legislation of the world

Medical measures are provided for by the legislation of most countries of the world. According to international law, criminals suffering from mental illness must undergo compulsory treatment. It is believed that a criminal who suffers from a mental disorder cannot be held accountable and fully aware of the significance of his actions.

Usually, treatment is viewed as a “safety measure,” that is, an opportunity to protect citizens from a person who is dangerous to them. In a similar sense, the law on compulsory treatment is interpreted by the legislation of most European countries.

Compulsory measures of a medical nature in the criminal law of Russia

In Russian legislation, the first mention of the compulsory treatment of insane criminals appeared in 1823. The criminals were to be housed in homes for the mentally ill, where they were kept separate from other patients.

In 1845, this law was amended: now people who were insane from birth, or sick people who committed murder, arson or attempted suicide had to undergo treatment.

In 1923, a law was passed, according to which compulsory treatment was considered as “a measure social protection". In 1960, involuntary hospitalization was described in more detail. In particular, criminals under the new law, depending on the severity of the offense, could be kept either in a regular psychiatric hospital or in a hospital that is part of the Ministry of Internal Affairs.

Compulsory Measures of a Medical Nature Combined with the Execution of Punishment

Currently, the order of rendering medical care under duress is considered by criminal, executive and procedural legislation, in particular, it is described in the law "On the basics of protecting the health of citizens in the Russian Federation." The decision to impose punishment is made by the court: otherwise, the provision of medical care without the consent of the citizen is illegal.

The best developed legislation is in the area of \u200b\u200bthe provision of compulsory mental health care. Depending on the severity of the disorder and the act committed, either outpatient or inpatient treatment is prescribed. A stay in a specialized hospital can also be assigned. This is done in the event that the offender must be under round-the-clock supervision of specialists. In this case, the time spent in the hospital is included in the term of serving the sentence. In the event that the need for maintenance in a medical and prophylactic institution disappears, the offender is discharged from the hospital, and an examination of his condition is carried out before discharge.

IMPORTANT! The decision to terminate therapy combined with punishment is made only by the court.

Principles of compulsory treatment

According to the Criminal Code, measures of compulsory treatment can be taken in the following cases:

• a person has committed a dangerous act, while being in an insane state, for example, in a state of passion, which must be proven in the course of a forensic psychological examination;
• a mental disorder developed after the commission of a crime, as a result of which the punishment provided for by the Criminal Code of the Russian Federation is impossible;
• a person who has committed a crime suffers from a mental illness, which does not exclude sanity;
• the offender committed an encroachment on the sexual integrity of a person under the age of consent.

When making a decision, the court must take into account how dangerous the criminal is for society and whether he is capable of committing similar acts in the future. The question of predicting the behavior of a criminal with a mental disorder is rather complicated. Abroad, it is believed that involuntary hospitalization should be carried out in all cases when the offender manifests elevated level aggression. In this regard, compulsory treatment as a punishment is widely used. In our country, judges and experts take into account the severity of the condition, the prognosis, the presence of drug or alcohol dependence, the presence of a family, their own housing, and a number of other factors. At the same time, as practice has shown, social indicators (the commission of criminal acts in the past, relationships with loved ones, the level of social adaptation) have the maximum value for predicting the behavior of a criminal.

Compulsory treatment measures

On an outpatient basis, a criminal can be treated if the person does not need constant monitoring by doctors. This usually happens if a person is aware of the presence of a mental disorder, follows the doctor's recommendations, and also has no pronounced deviations in behavior. Outpatients are treated for people whose mental disorder was of a transient nature and ended by the time of the court decision.

Hospitalization is required if the offender's disorder requires constant monitoring. In this case, the type of hospital (general, specialized, with intensive supervision) is determined by the court.

IMPORTANT! As a rule, the choice of a hospital is carried out depending on the place of residence of the patient, which allows maintaining social ties and receiving the necessary support from relatives.

Types of compulsory treatment

The type of compulsory treatment depends on the disorder identified in the offender.

Drug addicts

Compulsory rehabilitation of drug addicts is carried out in drug treatment clinics and rehabilitation centers. At the same time, treatment can be prescribed not only after the consideration of criminal cases: rehabilitation can be prescribed also after administrative offenses. In this case, the treatment is carried out both outpatient and inpatient.

The issue of compulsory drug addiction treatment is rather controversial: experts say that in order to achieve desired effect motivation on the part of the patient is required, which, as a rule, experienced drug addicts do not have.

Alcoholics

In the USSR, there was a system of dispensaries, in which alcoholics who committed administrative or criminal offenses underwent compulsory treatment and rehabilitation. However, at present, such a system has been abolished, in connection with which criminals suffering from alcoholism can, by a court decision, be treated in drug treatment clinics or centers. Compulsory treatment is possible only if experts have established the fact of alcohol dependence.

If the offender has committed an illegal act while intoxicated, but does not suffer from alcoholism, it is impossible to send him for compulsory treatment.

Mentally ill

Mentally ill criminals are most often undergoing compulsory treatment. At the same time, treatment does not cancel the fact of serving the sentence, if the offender was recognized as sane. The period of hospitalization can be counted towards serving the sentence.

Tuberculosis patients

According to paragraph 2 of Article 10 of the Law "On Preventing the Spread of Tuberculosis in the Russian Federation", people suffering from open forms of tuberculosis and violating the sanitary and epidemiological regime, as well as avoiding examinations and therapy, can be hospitalized forcibly. Compulsory hospitalization of tuberculosis patients is carried out after a court decision, an application to which is submitted by the leadership of the organization in which the patient is under supervision.

Compulsory treatment for tuberculosis in Russia is a rather acute issue. Can a tuberculosis patient refuse hospitalization? It depends on the form of the disease, the presence or absence of the release of Koch's sticks and the accuracy in performing medical appointments and examinations.

Other types

In a number of countries, rape and other sex offenses are punished chemical castration... The offender is obliged to take drugs that reduce sex drive or make it impossible to have sexual intercourse. This practice is widespread in the United States, but it is not used in Russia.

Why do you need involuntary hospitalization?

Compulsory hospitalization is needed in the following cases:

• the offender is a danger to others (due to the presence of a mental disorder, dependence on drugs and psychotropic substances etc.);
• the patient is suffering from a contagious disease (for example, an open form of tuberculosis), and hospitalization is necessary to prevent the spread of the infection;
• the offender is not aware of his actions and cannot be punished while serving time in prison.

Grounds for the application of compulsory medical measures

Compulsory hospitalization can be ordered in the following cases:

• a crime was committed in a state of insanity;
• after committing a crime, a mental disorder was found in the offender;
• the offender suffers from a disease that does not exclude sanity;
• a criminal over 18 years of age has committed an act against the sexual inviolability of a person under the age of 14.

Application of compulsory treatment

The decision to cancel their compulsory treatment is taken by the court on the basis of a petition from the medical and prophylactic institution where the patient is being held. Treatment can also be given to criminals who are already serving a sentence in prison: a person may contract a mental disorder or tuberculosis while in prison.

The term of treatment is counted for the term of serving the sentence (one day of treatment for one day of imprisonment).

Statement of claim for compulsory hospitalization

A lawsuit for involuntary hospitalization can only be filed by a representative of the medical and preventive institution where the person is being treated. This usually happens if the doctor discovers that the patient is a danger to himself or others, is incapable of self-care, or is suffering from a serious mental disorder without realizing it and refusing to be admitted to hospital.

The court made a positive decision: what's next

If the court made a positive decision, according to the law on involuntary hospitalization, the patient must go to the appropriate institution for treatment, or must begin outpatient treatment.

Consequences of evading hospitalization

In case of evasion of hospitalization, the court may reconsider its decision. For example, instead of outpatient treatment stationary can be assigned. The period of treatment can also be extended.

Terms of application of compulsory medical measures

As a rule, the application of measures of compulsory treatment begins immediately after the sentencing of the court. Moreover, these measures are unlimited, that is, they can have any duration. Termination of treatment is possible if the patient's condition improves.

Extension, modification and termination of compulsory medical measures

It is possible to extend, change or terminate compulsory medical measures only at the request of a doctor who noted a positive trend in the patient's condition and filed a corresponding statement of claim. The question of converting the treatment is decided by the court.

It is possible to forcibly hospitalize a criminal only by a court decision. In all other cases, treatment without the patient's consent is illegal. It is impossible to avoid court-ordered hospitalization, especially if the perpetrator is recognized as posing a danger to society.

New edition of Art. 100 of the Criminal Code of the Russian Federation

Compulsory observation and treatment by a psychiatrist on an outpatient basis may be prescribed if there are grounds provided for in Article 97 of this Code, if the person, due to his mental state, does not need a room in medical organizationproviding psychiatric care in an inpatient setting.

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

1. The general basis for the use of PMMH, as already noted, is indicated in Part 2 of Art. 97. However, if the legislator differentiates the possible types of PMMH (Art. 99), the question arises about the objective criteria for the appointment by the court of one or another coercive measure designed to optimally ensure the implementation of the goals specified in Art. 98.

1.1. Similar criteria can have both medical and social (diagnosis of the disease, its predictable development, the behavior of a person before, during and after the commission of the act, the orientation of its social properties, etc.), and legal signs (the degree and nature of a socially dangerous act, committed by this person, the form of guilt, the commission of such acts repeatedly, with particular cruelty, etc.), comprehensively reflect the personality of the person who needs the use of PMMH, in all the variety of its social, personal and legally significant properties.

1.2. The specialists of forensic psychiatric expert commissions and employees of the forensic authorities are faced with the problem of a uniform understanding of the above criteria, which makes it possible to correctly resolve the issue of the necessity and sufficiency of the use of one or another PMMH for the implementation of the goal set for it. This problem directly related to the procedural principle of ensuring the legitimate interests of the individual in the criminal process, according to which the rights, freedoms and interests of the individual in the criminal process should not be infringed on one iota more than the implementation of the goals and objectives of criminal proceedings requires.

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

1.4. The latter, within the meaning of the norm of the law, can be assigned only to those persons who, due to their mental state and taking into account the socially dangerous act committed by them, pose an insignificant danger to society or themselves.

2. The expediency of introducing this measure into the Criminal Code of the Russian Federation is quite obvious, since now the court does not need to resort to the obligatory placement of convicts in a psychiatric hospital in every case of a mental disorder. By unloading the latter, this measure, on the one hand, makes it possible to maximally concentrate the main efforts of psychiatric hospitals on the treatment and social rehabilitation of people who really need inpatient treatment and observation, on the other hand, allows during treatment without unnecessary need not to destroy the established social ties and the habitual way of life of a mentally ill person, which in some cases objectively contributes to his speedy recovery or a stable improvement in his mental state.

3. Outpatient psychiatric care includes periodic examination of the mental health of persons requiring the use of PMMH, diagnosis of mental disorders, their treatment, psychoprophylactic and rehabilitation assistance, as well as special care for persons with mental disorders.

Such assistance can be provided in neuropsychiatric dispensaries, dispensary departments, consultations, centers, specialized offices (psychiatric, neuropsychiatric, psychotherapeutic, suicidological, etc.), consultative and diagnostic and other outpatient departments of psychiatric hospitals.

4. Outpatient observation and treatment by a psychiatrist, as a rule, is prescribed for those persons who, in the opinion of psychiatrists and the court, are able to adequately assess their mental condition, voluntarily comply with the prescribed regimen and means of treatment that have a fairly orderly and predictable behavior that does not require constant monitoring by medical personnel.

These persons include, in particular: a) the accused who suffer only from a temporary (reversible) mental disorder, which ended in almost complete recovery of the person by the time the case was considered by the court and, in the opinion of psychiatrists, has no obvious tendencies to repetition, provided that the person concerned strictly adheres to the prescribed regimen and treatment measures; b) defendants suffering from chronic mental disorders or dementia who have undergone compulsory treatment in a psychiatric hospital with positive effect, however, still needing medical supervision and supportive treatment for a certain period of time to prevent sudden relapses of the disease or dangerous changes in behavior.

5. In accordance with Art. 26 of the Law on Psychiatric Care, outpatient care depending on medical indications (the presence of a mental disorder, its nature, severity, features of the course and prognosis, the impact on the behavior and social rehabilitation of a given person, his ability to solve social and everyday issues quite correctly and independently, etc.) is provided in the form of consultative and medical assistance or dispensary observation.

5.1. Once established, the type of outpatient mental health care should not remain unchanged with a change in a person's mental state or behavior. The Criminal Code of the Russian Federation and the court decision (Article 445 of the Criminal Procedure Code) determine only the type of PMMH. The transition from consultative and medical assistance to dispensary observation and vice versa is also possible at the initiative of the commission of psychiatrists, since in this situation they act within the framework of those powers and measures determined by the court decision that came into force.

5.2. At the same time, no voluntary (written) consent of a person is required to change one or another type of outpatient psychiatric care, since it is initially of a compulsory law-limiting nature, arising both from the fact of committing a socially dangerous act by this person, and from the objective social danger of this person. In this regard, the provisions of the Law on Psychiatric Care, indicating an exclusively voluntary nature of the provision of consultative and medical outpatient psychiatric care (part 2 of Art. 26), are not applicable to these patients.

5.3. The compulsory nature of this measure also means that it is the attending staff, and not the patient himself, who has the right to determine (and demand unconditional fulfillment) the time and frequency of contacts with the doctor, a list of necessary medical and rehabilitation measures, etc. At the same time, consultative and medical assistance, depending on the patient's condition, can be carried out in a fairly wide range of time - from a single or several examinations (examinations) per year to long-term and systematic contacts between a doctor and a patient.

6. Another (possible) type of outpatient psychiatric care is dispensary observation, the essence and content of which are disclosed in Art. 27 of the Law on Mental Health Care. The grounds for establishing this type of psychiatric care are determined by a commission of psychiatrists. As a result, these grounds appear in the form of three dialectically interrelated criteria: a) mental disorder must be chronic or protracted; b) its painful manifestations should be severe; c) these painful manifestations should be persistent or often exacerbated.

6.1. Chronic (usually irreversible) mental disorders (schizophrenia, manic-depressive psychosis, epilepsy, etc.), due to their inherent patterns, have a long and complex course (from several years to tens of years).

6.2. Prolonged lasting at least a year and differ from chronic features manifestations of painful conditions in each specific person under certain life circumstances. In this regard, their diagnosis requires a certain experience and professionalism on the part of medical personnel.

6.3. The severity of a mental disorder reflects the severity of the painful manifestations and the degree of impairment of mental activity in general, including the patient's understanding and assessment of what is happening, their own behavior, social properties of their personality, etc.

6.4. Painful manifestations can be considered persistent if, during examinations of the patient, they manifest themselves for at least a year and if the prognostic signs of the course of this mental disorder indicate their existence in the future for a year or more.

6.5. Exacerbations should be considered frequent if they manifest themselves annually or more than once a year. The frequency of exacerbations is determined by analysis clinical picture diseases in the past and (or) based on the prognosis of its course.

6.6. Only the presence of all three of these criteria can serve as a basis for establishing dispensary outpatient observation and treatment. Since certain mental disorders, including chronic ones, can have a favorable outcome under the influence of treatment, the previously established dispensary observation can also be changed to a consultative and therapeutic decision of the commission of psychiatrists.

7. Dispensary observation the patient's condition is carried out through regular examinations by a psychiatrist and providing the patient with the necessary medical and social assistance. The establishment of dispensary observation gives the psychiatrist the right to examine the patient through both home visits and invitations to an appointment with the frequency that, in his opinion, is required to assess changes in the patient's condition and provide full-fledged psychiatric care. In this case, the question of the frequency of examinations in relation to each patient is decided purely individually.

8. Compulsory outpatient supervision and treatment by a psychiatrist may be established in relation to persons suffering from mental disorders that do not exclude sanity. In this case, the court's verdict, on the basis of the available expert opinion, must necessarily indicate that, along with the punishment, the convict is assigned outpatient compulsory observation and treatment by a psychiatrist at the place of serving the sentence.

Another commentary on Art. 100 of the Criminal Code of the Russian Federation

1. The considered type of compulsory medical measures is applied to two categories of mentally unhealthy persons who have committed socially dangerous acts: a) to persons who, due to their mental state, do not need to be placed in a psychiatric hospital; b) to persons who have undergone compulsory treatment in psychiatric hospitals, to adapt them to life in society and to consolidate its results.

2. Persons who, due to their mental state, do not need inpatient treatment, in turn, are divided into two groups: the first consists of persons who have been recognized by the court as insane in relation to the accused act, or released 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 sanity, to whom, along with punishment, outpatient observation and treatment by a psychiatrist are applied.

3. Outpatient observation and treatment by a psychiatrist can be provided both in the form of counseling and treatment assistance, and in the form of dispensary observation. The latter involves regular examinations by a psychiatrist, during which not only medical, but also social assistance can be provided. An examination by a psychiatrist can be carried out at home, in a neuropsychiatric dispensary or other institution providing outpatient psychiatric care (for example, a neuropsychiatric office of a polyclinic) at the patient's place of residence. The frequency of such examinations depends on the mental state of the person, the dynamics of the mental disorder and the need for this assistance. 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 No. 133/269) stipulates that the doctor must personally examine the patient with the necessary frequency, but at least once a month.

• Up

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

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

For example, by the ruling of the court, R. was released from criminal liability for committing in a state of insanity a socially dangerous act under Part 3 of Art. 30, item "in" part 2 of Art. 105 of the Criminal Code; she was assigned compulsory medical measures - outpatient compulsory observation and treatment by a psychiatrist. She, in a state of insanity, attempted to kill her infant... The state prosecutor raised the issue of canceling the determination and sending the case for a new trial, believing that the court unreasonably applied compulsory outpatient observation and treatment by a psychiatrist, while, according to the opinion of psychiatrists, R. needs compulsory treatment in a psychiatric hospital general type... According to the public prosecutor, the court did not take into account the nature and degree of public danger of the act, the severity of the consequences that followed, the likelihood of a repetition of illegal behavior.

The Judicial Collegium for Criminal Cases of the Armed Forces of the Russian Federation upheld the ruling of the court, indicating the following. According to the conclusion of forensic psychiatrists, R. suffers from a mental disorder in the form of a depressive-paranoid syndrome. At the time of the offense, she could not understand the actual nature and social danger of her actions and control them, she was recognized as insane, in need of compulsory treatment in a psychiatric hospital of a general type. However, the decision of the issues of insanity, the appointment of a type of compulsory medical measures is within the competence of the court. As established in the case, R., being in a state of insanity, attempted the murder of her nursing child, and then she herself tried to commit suicide. According to the testimony of the representative of the victim and witnesses, R. has been living with her family since the act of committing the act, her health has improved, she is taking care of the child, realizes what has happened, and is under the supervision of her relatives. Taking into account the opinion of the doctor attending R., the court came to the correct conclusion about the possibility of R.'s cure without placing her in a psychiatric hospital (definition of the RF Armed Forces dated 07.12.1999).

• 3. In terms of its content, outpatient compulsory observation and treatment by a psychiatrist involves monitoring the mental state of a person through regular examinations by a psychiatrist and providing this person with the necessary medical and social assistance, i.e. compulsory dispensary observation. Such observation is established regardless of the patient's consent. The frequency of these examinations depends on the mental state of the person, the dynamics of his mental disorder and the need for mental health care. Dispensary observation also includes psychopharmacological and other treatment, including psychotherapy, as well as social rehabilitation measures.
• 4. The difference between the legal status of mentally ill patients who are under compulsory outpatient supervision from other patients receiving outpatient psychiatric care lies in the impossibility of terminating such supervision without a court decision. Patients to whom this compulsory measure is applied have no right to refuse treatment: in the absence of their consent, treatment is carried out by decision of a commission of psychiatrists. In addition, a transition from outpatient compulsory treatment to inpatient treatment is possible, which implies such a change in the mental state of a person when it becomes impossible to carry out compulsory treatment without placement in a psychiatric hospital, as well as in cases of gross violations of the compulsory outpatient treatment regime or in case of evading it.
• 5. Outpatient compulsory observation and treatment by a psychiatrist is associated with significantly less restrictions on the personal freedom of a person. It can be applied, firstly, as a primary measure of compulsory treatment, for example, when a socially dangerous act was committed in a state of temporary painful mental disorder, the repetition of which is unlikely. Secondly, this measure can become the last step in the transition from inpatient compulsory treatment to the provision of mental health care necessary for a person suffering from a mental disorder in a general manner.

In case of doubt about the mental usefulness of a person who has committed a socially dangerous act provided for by the Special Part of the Criminal Code, in relation to him, by virtue of paragraph 2 of Art. 79 of the Code of Criminal Procedure, a forensic psychiatric examination should be necessarily appointed, which solves the issues of the sanity or insanity of a person, or the presence of mental disorders that do not exclude sanity.
If a person is declared insane, the court shall issue a ruling on the termination of the criminal case and at the same time prescribe a compulsory medical measure.

Outpatient compulsory observation and treatment by a psychiatrist as a compulsory medical measure is prescribed if a person, due to his mental state, does not need to be placed in a psychiatric hospital. The mental state of the person must be stated in the conclusion of the forensic psychiatric examination and assessed by the court.
It should be noted that in accordance with the law, the application of compulsory medical measures is a court right. Therefore, the court, evaluating the conclusion of the forensic psychiatric examination, must decide whether to apply or not to apply such a measure, based on the requirements of Art. 98 of the Criminal Code, bearing in mind both the medical and legal purposes of applying such measures.
Compulsory observation and treatment by a psychiatrist is carried out only on the condition that the person does not need to be placed in a psychiatric hospital. The provision of this measure should be entrusted by the ruling of the court to the internal affairs bodies.
Compulsory treatment in a psychiatric hospital
When applying compulsory treatment, the law provides for the possibility of assigning various types of psychiatric hospitals.
In accordance with Art. 101 of the Criminal Code of the Russian Federation, compulsory treatment in a psychiatric hospital is prescribed in cases where a person, due to his mental state, can cause significant harm or pose a danger to himself and others, and outside the conditions of a psychiatric hospital he cannot be provided with the necessary treatment.
A general psychiatric hospital is an ordinary psychiatric hospital where treatment is voluntary. However, the mental state of a person who is forcibly undergoing treatment in it should allow for the possibility of keeping him without special security measures, i.e. not requiring intensive supervision. In practice, persons to whom such a compulsory medical measure has been applied are held in ordinary psychiatric hospitals along with the patients admitted to them on a general basis.
Compulsory treatment in a psychiatric hospital specialized type assigned to persons who, due to their mental state, require constant monitoring, i.e. they need appropriate treatment and their mental disorder is such that they pose a public danger to themselves and those around them.
Therefore, such hospitals have special security departments, the activities of which are accordingly regulated. Patients in such hospitals are kept in conditions that exclude the possibility of committing socially dangerous acts.
Compulsory treatment in a psychiatric hospital of a specialized type with intensive supervision is assigned to persons who, in their mental state, pose a particular danger to themselves and others. When deciding on the appointment of treatment in a psychiatric hospital of a specialized type with intensive supervision, the court must take into account the recommendations contained in the conclusion of the forensic psychiatric examination. Such hospitals accommodate persons suffering from severe mental disorders, prone to committing grave and especially grave crimes, or systematically committing socially dangerous acts. Extension, change and termination of application of compulsory medical measures

The time for the application of compulsory medical measures in connection with mental disorders is not limited by any time. Therefore, in order to monitor the course of treatment, the law provides for the examination of persons to whom compulsory medical measures have been applied at least once every six months.
Issues related to the extension, change of the type and cancellation of compulsory measures of a medical nature are decided by the court upon the conclusion of a commission of psychiatrists.
If the commission of psychiatrists concludes that there are no grounds for terminating the application of a compulsory medical measure, the administration of the institution that carries out compulsory treatment shall submit to the court an opinion on the extension of compulsory treatment. The first examination is made after six months from the start of treatment. If the court extended compulsory treatment on the basis of the first conclusion, then in the future it is carried out annually upon the availability of a corresponding submission from the administration. medical institutionbased on the opinion of the commission of psychiatrists.
In the event that the commission of psychiatrists comes to the conclusion that there are no grounds for continuing compulsory treatment or changing the compulsory medical measure, the court, upon the proposal of the administration of the institution carrying out compulsory treatment, based on a medical opinion, may issue a ruling to terminate the use of compulsory treatment, or to change a compulsory medical measure. Since the mental state of a person to whom a compulsory medical measure is applied can change both for the better and for the worse, the court has the right to choose any of the compulsory medical measures provided for in Art. 99 of the Criminal Code.
When the application of compulsory medical measures is terminated, the court may transfer materials against this person to the health authorities to resolve the issue of his treatment in accordance with the Law of the Russian Federation dated 02.07.1992 No. 3185-1 "On psychiatric care and guarantees of citizens' rights during its provision."
Upon termination of compulsory treatment due to the recovery of persons who have been temporarily released from serving their sentence, they are sent to serve the sentence.
In cases where the criminal case was suspended due to mental illness a person after he has committed a crime, upon termination of the application of compulsory medical measures, the court decides the issue of sending the case for an inquiry or preliminary investigation.