How to put a person in a psychiatric hospital without his consent

When a person is in an inadequate state, family and friends call a doctor. Often, a visit from a specialist is not enough to return the patient to normal life, and hospitalization in a psychiatric department is required. This is where a very important question arises. How to put a person in a psychiatric hospital without his consent and whether this can be done.

A friend of mine faced a similar situation. His grandfather fell into an inadequate and dangerous state for others. An elderly man tried to set fire to the house, cursed and cried. A doctor was called, but he refused to hospitalize the man due to lack of consent on his part. It turned out that the doctor’s actions were unlawful, which I will discuss in this note.

On what basis can a citizen be placed in a mental hospital?

To commit a person to a psychiatric hospital without his consent, there must be compelling reasons. The procedure is regulated by the Law “On Psychiatric Care” in Articles 28-29. There are several reasons why such intervention may be required:

Availability of a referral issued by a psychiatrist.
A citizen approaches the emergency department of a mental hospital for help.

When it comes to placement in a hospital based on a personal request, the document is submitted in writing. When it is necessary to admit a child to a hospital, the consent of an official representative is required.

This person may be a parent or guardian. Sometimes the basis is a decision of the trustee body made on the basis of an appeal received from an interested person. If a person is hospitalized without his consent or without the permission of his legal representative, a number of documents will need to be submitted. The most important document is the decision of a psychiatrist, indicating that a person requires compulsory treatment.

Grounds for hospitalization according to the Criminal Code

Within the limits of the law, only a court can find a person in need of immediate treatment in a psychiatric hospital. The court must have serious reasons, which will serve as grounds for compulsory treatment.

Such grounds are:

criminal offenses of the Special Part of the Criminal Code under Articles 105-361 of the Criminal Code of the Russian Federation, committed in a state of insanity;
a mental disorder that a person develops after criminal acts on his part, which makes it impossible to assign and carry out punishment;
the offender has mental disorders and is completely insane, which do not exclude the possibility of his sanity.

All this is a reason for mandatory compulsory placement in a psychiatric hospital only if the person’s condition poses a threat of repeated crimes against himself and others or if his psychological state entails a complete or partial loss of legal capacity.

Compulsory medical measures under the Criminal Code are other measures of a criminal law nature. First, the case is investigated and the necessary examinations are carried out. If, based on their results, at least one of the grounds for the use of coercive measures is established, the investigation of the criminal case ends not, as always, with the drawing up of an indictment or report, but with the issuance of a decision on the use of compulsory measures of a medical nature.

The case is sent to the court, which considers this issue in a manner determined by the Code of Criminal Procedure, decides (mainly as the examination considers necessary) and makes a decision.

What if there is no specialist?

Only specialists of a certain profile can draw up a document that serves as the basis for referring a patient for treatment to a mental health clinic:

a doctor working in a psychiatric department or a psychoneurological dispensary;
psychiatrist of the emergency mental health team;
private practitioner in psychiatry.

If you cannot find a doctor, and the actions of a citizen suffering from mental disorders pose a threat, then you need to call a specialist to your home or contact the police. Representatives of the security forces have the right to detain a citizen, and then call a specialist and send the citizen for examination. Based on the evidence, it will be possible to make a decision on the need for a compulsory decision or to refuse one.

What is a general psychiatric hospital?

A general psychiatric hospital is a medical institution designed to treat ordinary patients. It is here that therapy is carried out for patients who have committed unlawful acts not related to murder. The citizen does not pose a danger to the people around him, but at the same time they must be forcibly kept in hospital custody. Intensive monitoring is not required. Compulsory hospitalization in a psychiatric hospital can reduce the likelihood of re-committing a crime and normalize the patient’s mental state.

The following persons are sent to undergo compulsory treatment in a general hospital:

those who committed an illegal act and were in a state of insanity;
those suffering from dementia and mental disorders;
who committed crimes under the influence of external negative factors.

The duration of therapy is not specified in court. As a result, the patient is required to undergo an examination every 6 months to determine his mental state.

Important ! In the hospital, patients cannot leave the walls of the building. They also eat in a hospital setting.

What to do if a mentally ill person is a relative?

Dementia often begins in old age. Often people seek help when their elderly relatives begin to pose a danger to others precisely due to a mental disorder. Since a mental health center is a medical institution, it will be possible to hospitalize a relative there only if there is a mental disorder. The diagnosis must be made by a doctor.

An important nuance is that the disease must be curable during the period of stay in a medical institution. In addition, some conditions must be met:

Relatives and friends do not have the opportunity to give injections at home, or relatives live in another area of the locality;
visiting emergency doctors does not give any results;
the patient does not receive the necessary treatment.

The fact that the applicant does not have the ability or desire to care for a sick relative cannot be considered as a basis. An important nuance is the presence of conscious consent from the patient for such hospitalization. It is unlikely that there will be people who would be willing to voluntarily go to a “psychiatric hospital.” A patient can be forcibly hospitalized only on the basis of a specialist’s referral. The doctor takes into account the severity of the disease and the degree of danger that the citizen poses to society.

On psychiatric care and guarantees of citizens’ rights during its provision

LAW OF JULY 2, 1992 N 3185-1 ON PSYCHIATRIC CARE AND GUARANTEES OF CITIZENS’ RIGHTS DURING ITS PROVISION (as amended by Federal Law of July 21, 1998 N 117-FZ)

Recognizing the high value for every person of health in general and mental health in particular; considering that a mental disorder can change a person’s attitude towards life, himself and society, as well as society’s attitude towards a person; Noting that the lack of proper legislative regulation of psychiatric care may be one of the reasons for its use for non-medical purposes, causing damage to health, human dignity and the rights of citizens, as well as the international prestige of the state; Taking into account the need to implement in the legislation of the Russian Federation the rights and freedoms of man and citizen recognized by the international community and the Constitution of the Russian Federation, the Supreme Council of the Russian Federation adopts this Law. Section I. GENERAL PROVISIONS Article 1. Psychiatric care and principles of its provision (1) Psychiatric care includes examination of the mental health of citizens on the grounds and in the manner established by this Law and other laws of the Russian Federation, diagnosis of mental disorders, treatment, care and medical care. — social rehabilitation of persons suffering from mental disorders. (2) Psychiatric care for persons suffering from mental disorders is guaranteed by the state and is carried out on the basis of the principles of legality, humanity and respect for human and civil rights. Article 2. Legislation of the Russian Federation on psychiatric care (1) The legislation of the Russian Federation on psychiatric care consists of this Law and other legislative acts of the Russian Federation and republics within the Russian Federation, as well as legal acts of the autonomous region, autonomous okrugs, territories, regions, cities Moscow and St. Petersburg. (2) The Government of the Russian Federation and the governments of the republics within the Russian Federation, as well as ministries and departments, have the right to adopt legal acts on psychiatric care within their competence. (3) Legislative and other legal acts adopted in the Russian Federation and republics within the Russian Federation, autonomous region, autonomous okrugs, territories, regions, cities of Moscow and St. Petersburg cannot limit the rights of citizens and guarantees of their observance in the provision of mental health care provided for by this Law. (4) If an international treaty to which the Russian Federation participates establishes rules other than those provided for by the legislation of the Russian Federation on psychiatric care, then the rules of the international treaty apply. Article 3. Application of this Law (1) This Law applies to citizens of the Russian Federation when providing them with psychiatric care and applies to all institutions and persons providing psychiatric care on the territory of the Russian Federation. (2) Foreign citizens and stateless persons located on the territory of the Russian Federation, when providing them with psychiatric care, enjoy all the rights established by this Law, on an equal basis with citizens of the Russian Federation. Article 4. Voluntary application for psychiatric help (1) Psychiatric help is provided upon voluntary application of a person or with his consent, except for the cases provided for by this Law. (2) A minor under the age of 15, as well as a person recognized as legally incompetent, is provided with psychiatric care at the request or with the consent of their legal representatives in the manner prescribed by this Law. Article 5 . Rights of persons suffering from 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 the laws of the 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; detention in a psychiatric hospital only for the period necessary for examination and treatment; 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 the use of medical devices and methods, scientific research or educational process, photo, video or filming as an object of testing; 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) Restrictions on the rights and freedoms of persons suffering from mental disorders solely on the basis of a psychiatric diagnosis or the facts of being under dispensary observation in a psychiatric hospital or in a psychoneurological institution for social security or special education are not allowed. Officials guilty of such violations bear responsibility in accordance with the legislation of the Russian Federation and the republics within the Russian Federation. Article 6. Restrictions on performing certain types of professional activities and activities associated with a source of increased danger (1) A citizen may be temporarily (for a period of no more than five years and with the right to subsequent re-examination) declared unfit to perform certain types of professional activities and activities due to a mental disorder associated with a source of increased danger. Such a decision is made by a medical commission authorized by the health authority, based on an assessment of the state of mental health of the citizen in accordance with the list of medical psychiatric contraindications and can be appealed to the court. (2) The list of medical psychiatric contraindications for carrying out certain types of professional activities and activities associated with a source of increased danger is approved by the Government of the Russian Federation and is periodically (at least once every five years) revised taking into account accumulated experience and scientific achievements. Article 7. Representation of citizens who receive psychiatric care (1) When receiving psychiatric care, a citizen has the right to invite a representative of his choice to protect his rights and legitimate interests. Registration of a representative office is carried out in the manner established by the civil and civil procedural legislation of the Russian Federation. (2) The protection of the rights and legitimate interests of a minor under the age of 15 and a person recognized as incompetent in accordance with the procedure established by law, when providing them with psychiatric care, is carried out by their legal representatives (parents, adoptive parents, guardians), and in their absence - by the administration of a psychiatric hospital or a psychoneurological institution for social welfare or special education. (3) A lawyer can protect the rights and legitimate interests of a citizen when providing him with psychiatric care. The procedure for inviting a lawyer and paying for his services is provided for by the legislation of the Russian Federation. The administration of an institution providing psychiatric care provides the opportunity to invite a lawyer, with the exception of urgent cases provided for in paragraph “a” of part four of Article 23 and paragraph “a” of Article 29 of this Law. Article 8. Prohibition of demands for information about the state of mental health When a citizen exercises his rights and freedoms, demands for information about the state of his mental health or an examination by a psychiatrist are allowed only in cases established by the laws of the Russian Federation. Article 9. Maintaining medical confidentiality when providing psychiatric care Information about the presence of a mental disorder in a citizen, the facts of seeking psychiatric help and treatment in an institution providing such care, as well as other information about the state of mental health are medical secrets protected by law. To realize the rights and legitimate interests of a person suffering from a mental disorder, at his request or at the request of his legal representative, he may be provided with information about the state of mental health of this person and about the psychiatric care provided to him. Article 10. Diagnosis and treatment of persons suffering from mental disorders (1) The diagnosis of a mental disorder is made in accordance with generally accepted international standards and cannot be based solely on the citizen’s disagreement with the moral, cultural, political or religious values accepted in society or on other reasons directly not related to the state of his mental health. (2) For the diagnosis and treatment of a person suffering from a mental disorder, medical means and methods are used that are permitted in the manner established by the legislation of the Russian Federation on healthcare. (3) Medical means and methods are used only for diagnostic and therapeutic purposes in accordance with the nature of the disease disorders and should not be used to punish a person suffering from a mental disorder or for the benefit of other persons. Article 11. Consent to treatment (1) Treatment of a person suffering from a mental disorder is carried out after receiving his written consent, except for the cases provided for in part four of this article. (2) A doctor is obliged to provide a person suffering from a mental disorder, in a form accessible to him and taking into account his mental state, information about the nature of the mental disorder, goals, methods, including alternative ones, and the duration of recommended treatment, as well as pain, possible risks, side effects and expected results. The information provided is recorded in the medical documentation. (3) Consent to the treatment of a minor under the age of 15, as well as a person recognized as incompetent in accordance with the procedure established by law, is given by their legal representatives after providing them with the information provided for in part two of this article. (4) Treatment may be carried out without the consent of a person suffering from a mental disorder, or without the consent of his legal representative, only when compulsory medical measures are applied on the grounds provided for by the Criminal Code of the Russian Federation, as well as in case of involuntary hospitalization on the grounds provided for in Article 29 of this Law. In these cases, except for emergencies, treatment is applied according to the decision of a commission of psychiatrists. (as amended by Federal Law No. 117-FZ dated 21.07.98) (5) In relation to the persons specified in part four of this article, the use of surgical and other methods for the treatment of mental disorders that cause irreversible consequences, as well as testing of medical devices and methods are not allowed. Article 12. Refusal of treatment (1) A person suffering from a mental disorder or his legal representative has the right to refuse the proposed treatment or terminate it, except for the cases provided for in part four of Article 11 of this Law. (2) The person refusing treatment or his legal representative must be explained the possible consequences of stopping treatment. Refusal of treatment, indicating information about possible consequences, is formalized by an entry in the medical documentation signed by the person or his legal representative and a psychiatrist. Article 13. Compulsory measures of a medical nature (1) Compulsory measures of a medical nature 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 established by the Criminal Code of the Russian Federation and the Criminal Procedure Code of the RSFSR. (as amended by Federal Law No. 117-FZ of July 21, 1998) (2) 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 provided for in Article 37 of this Law. They are recognized as incapacitated for work for the entire period of stay in a psychiatric hospital and have the right to state social insurance benefits or a pension on a general basis. Article 14. Forensic psychiatric examination Forensic psychiatric examination in criminal and civil cases is carried out on the grounds and in the manner provided for by the Criminal Procedure Code of the RSFSR and the Civil Procedure Code of the RSFSR. Article 15. Psychiatric examination to decide the issue of a citizen’s suitability for service as a military personnel. Grounds and procedure for outpatient and inpatient examination when deciding on the suitability of a citizen based on the state of his mental health to serve as a member of the Armed Forces, troops and security agencies, internal troops, railway troops and other military formations, commanding and rank and file personnel of internal affairs bodies, institutions and bodies of the criminal executive system are determined by this Law and the legislation of the Russian Federation on military service. (as amended by Federal Law dated July 21, 1998 N 117-FZ)

President of the Russian Federation B. YELTSIN Moscow, House of Soviets of Russia July 2, 1992 N 3185-1
Legislative information prepared and posted specifically for the website of the Kaslinskaya Central District Hospital

Symptoms for which a person may be forcibly hospitalized

There are several characteristic signs that allow a citizen to be placed for compulsory treatment in a mental hospital. In particular, we are talking about the following points:

aggressive behavior, when a person does not want to eat food, wants to commit suicide, fights and throws himself at others;
a person cannot take care of himself, is poorly oriented in the situation and in space;
public order disturbance. The state of health is constantly deteriorating.

The decision to place the patient in a hospital is made by a psychiatrist, but after a thorough examination of the patient and diagnosis.

Grounds for placing a person in a mental hospital

Outpatient treatment is excluded in situations where a person may harm himself or others. During the trial, the nature of the mental disorder is established, confirmed by an independent expert in the field of psychiatry. The judge determines the type of treatment depending on the psychiatrist's opinion. The grounds for placement in a psychiatric clinic are:

lack of the patient's ability to satisfy his own basic needs;
presenting a danger to society from the actions of the patient;
a situation where a patient’s refusal to help will cause significant harm to his health.

What problems may arise with hospitalization?

There are several nuances that may become an obstacle to prescribing compulsory treatment to a sick person, namely:

The person must give voluntary consent to the examination. If a citizen is already registered as a psychiatrist, then such consent is not required. In special cases, the specialist is obliged to request a court sanction.
Elderly people may also have somatic diseases that can lead to temporary psychoexcitation. In this case, before visiting a psychiatrist, you will need to undergo a number of other specialists. Without the conclusions of these specialists, hospitalization may be refused.
Patients over 65 years of age are not admitted to the hospital for treatment, although there are no such restrictions in the law and the actions of doctors are illegal.

Separately, it is worth mentioning the work of the ambulance. Psychiatrists only visit cases where a sick person poses a danger to others.

Punishment of the guilty persons

Committing an act under Art. 128 of the Criminal Code of the Russian Federation is the basis for bringing the guilty person to criminal liability.

A court verdict may impose the following sanctions on a defendant:

Unlawful hospitalization of a person in a psychiatric hospital	Restriction of freedom – up to 3 years; Forced labor – up to 3 years; Imprisonment – up to 3 years.
The above-mentioned act, but in the presence of the following qualifying criteria: – use of official position for its implementation; – which through negligence resulted in grave consequences for the victim, including his death.	Forced labor – up to 5 years; Imprisonment – up to 7 years. At the discretion of the judge, an additional sanction is imposed - exclusion from the ability to perform certain activities for a period not exceeding 3 years.

Duration of compulsory treatment of a mentally ill person

The appointment of a compulsory measure of hospitalization of a citizen for treatment in a mental hospital is carried out only if there is an examination by a commission of psychiatrists. The event is held every 6 months. The procedure allows you to assess a person’s condition and, if necessary, stop therapy or extend it for some more time. A representative of the clinic where the treatment is carried out may be present at the court hearing. He will most reliably tell you about the course of the disease. According to the law, the following must be present:

prosecutor;
advocate, who is the legal representative of the patient.

Important ! If there is a reason to extend treatment, the court will decide on further inpatient stay in the psychiatric department.