Organization of psychiatric care in Russia. General characteristics of psychiatric care Concept and types of psychiatric care

2. Organization of mental health care

The organization of psychiatric care in any country is based on the rights of citizens to whom this assistance is provided. It cannot be carried out without resolving the issues of the legal status of the mentally ill. According to the legislation of our state, which contains provisions concerning both the mentally ill person himself and the doctor and the psychiatric service, it is necessary to protect the interests of the mentally ill as much as possible and at the same time protect society from the dangerous actions of the mentally ill. Psychiatric assistance to the population can be provided both in inpatient and outpatient settings.

Inpatient psychiatric care

To provide inpatient care to the population, there are psychiatric hospitals and psychiatric departments that can be specialized for the treatment of patients with borderline non-psychotic conditions, neuroses and neurosis-like conditions, cerebroasthenic disorders, psychosomatic diseases, as well as patients suffering from psychosis and at the same time somatic diseases that require active therapy or surgical intervention.

Patients from a certain area or section of a psychoneurological dispensary are admitted to the same department of a psychiatric hospital (territorial principle of distribution of patients).

In addition, each hospital has departments for the treatment of elderly patients, children, adolescents, as well as persons with borderline conditions. More recently, special departments of psycho-reanimation began to appear in large psychiatric hospitals.

According to WHO experts, 1.0-1.5 beds per 1000 population is considered sufficient, in Russia there are 1.2 per 1000 population or 10% of the total number of beds. In children's and adolescent departments, patients not only receive treatment, but also study according to the mass school program.

For certain groups of patients, mainly those with borderline neuropsychiatric illnesses, in order to reduce the adverse effects of isolation of the mentally ill from society, in some departments of psychiatric hospitals, an "open door" system is used. In connection with the increase in life expectancy of the population, there is an urgent need for the development of psychiatric care for the elderly.

Outpatient care for the mentally ill

Psychoneurological dispensaries operating on a territorial basis were established in 1923. Currently, psychiatric care outside the walls of the hospital is developing in three directions: assistance to patients in the psychoneurological dispensary is being improved; a new type of advisory psychiatric care is being formed without registering the patient in this institution; psychiatric care is being improved outside the dispensary, in the system of general medical care - in the psychotherapeutic rooms of polyclinics - to provide it to patients with borderline disorders and early detection of patients with other mental illnesses.

In addition, treatment in day hospitals has recently begun to be practiced, where patients come in the morning, receive appropriate treatment, participate in work processes, entertainment, and return home in the evening. There are also night hospitals where patients stay after work in the evening and at night. During this time, they undergo therapeutic measures, for example, a course of intravenous infusions, acupuncture, therapeutic massage, and in the morning the patients return to work.

For children with various neurotic conditions, there are sanatorium, the so-called forest schools, in which weakened children receive appropriate therapy and study for one quarter.

In the prevention and treatment of mental illness, the creation of a regimen of work and rest, a long stay in the fresh air, and physical education are of great importance. Patients suffering from chronic mental illness are in neuropsychiatric boarding schools, where they receive the necessary treatment.

Children with mental retardation study in special auxiliary schools. They can come there from home or live permanently in boarding schools at schools, where constant special supervision and systematic treatment are carried out. Children with organic lesions of the central nervous system, as well as with stuttering, receive the necessary medical care in specialized nursery-kindergartens, where psychiatrists, psychologists and speech therapists work together with educators.

The psycho-neurological dispensary, in addition to the rooms in which the necessary medical care is provided, includes medical and labor workshops where mentally disabled people work. Being in medical and labor workshops makes it possible to carry out systematic treatment, provide patients with food, and also earn a small amount of money for the patients themselves.

In recent years, in connection with the increased incidence of suicides, a special service has been developed to combat suicides, mainly represented by the "Hotline", which any person who is in a serious mental state due to life's failures can contact at any time of the day. Qualified psychological assistance by telephone is provided by psychiatrists and psychologists who have undergone special training.

There are special rooms in general somatic polyclinics for providing psychotherapeutic and psychological assistance to adults and adolescents. In most large cities, there are special crisis departments, the work of which is aimed at preventing suicidal behavior.

In rural areas, there are psychiatric departments in the central district hospitals, as well as a network of psychiatric offices in rural hospitals and district clinics.

Narcological service

In 1976, a special narcological dispensary was introduced into the health care institutions, which is the basis of the narcological service.

The Narcological Service has stationary, semi-stationary and out-of-hospital units and is a network of specialized institutions that provide medical, legal, medical and social, as well as medical and preventive care to patients with drug addiction, alcoholism and substance abuse.

Rights of mentally ill people

For the first time, the "Regulations on the conditions and procedure for the provision of psychiatric care aimed at protecting the rights of the mentally ill" were adopted by the Decree of the Presidium of the Supreme Soviet of the USSR of January 5, 1988. Later (1993), a special law "On psychiatric care and guarantees of the rights of citizens" was adopted in its provision”, according to which qualified psychiatric care is provided free of charge, taking into account all the achievements of science and practice. This law is based on regulations according to which the dignity of the patient should not be infringed upon in the provision of psychiatric care. This law also regulates the procedure for conducting a psychiatric examination. This law states that psychiatric examination and preventive examinations are carried out only at the request or with the consent of the subject, and examination and examination of a minor under 15 years of age - at the request or with the consent of his parents or legal representative.

When conducting a psychiatric examination, the doctor is obliged to introduce himself to the patient, as well as his legal representative as a psychiatrist. The exception is those cases when the examination can be carried out without the consent of the subject or his legal representative: in the presence of a severe mental disorder with an immediate danger to himself and others, if the subject is under dispensary observation. Outpatient psychiatric care for persons with mental illness is provided depending on medical indications and is carried out in the form of consultative and therapeutic assistance and dispensary observation.

Persons with mental disorders are placed under dispensary observation, regardless of their consent or the consent of their legal representative (in cases where they are recognized as incompetent). At the same time, the attending physician constantly monitors the state of their mental health through regular examinations and the provision of necessary medical and social assistance.

In cases of inpatient treatment of a patient with mental disorders, consent to this treatment in writing is required, with the exception of patients who are in compulsory treatment by a court decision, as well as patients involuntarily hospitalized by law enforcement agencies. Without the consent of the patient, i.e. involuntarily, persons with such mental disorders are placed in a psychiatric hospital that make them dangerous to themselves and others, as well as patients in those states when they are unable to satisfy basic life needs (for example, with catatonic stupor, severe dementia) and can cause significant harm to their health due to the deterioration of their mental state if they are left without psychiatric help.

A patient admitted to a hospital as a result of involuntary hospitalization must be examined by a commission of doctors within 48 hours, which determines the validity of hospitalization. In cases where hospitalization is recognized as justified, the conclusion of the commission is submitted to the court to decide on the further stay of the patient in the hospital, at the location of the hospital.

The involuntary stay of a patient in a psychiatric hospital lasts as long as the grounds for involuntary hospitalization persist (aggressive actions in connection with delusions and hallucinations, active suicidal tendencies).

To prolong 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 observance of the rights of mentally ill citizens is their release from responsibility for socially dangerous actions (crimes) committed by them during their illness.

Time management Child's daily routine Maintaining a daily routine is important for all children, but for a child with autism syndrome, the creation of a special routine throughout life is of paramount importance - this is a necessary condition for development. The daily routine (as well as the order in the room) should

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Chapter 40 ORGANIZATION OF PSYCHIATRIC CARE The organization of psychiatric care in the Russian Federation is carried out in accordance with the Law of the Russian Federation "On Psychiatric Care and Guarantees of Citizens' Rights in its Provision". This law came into force on January 1, 1993.

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Chapter 1. Organization of surgical care for the wounded in war

Organization and conduct of qualified surgical care Triage and evacuation department Triage, assistance, treatment, preparation for evacuation and evacuation form the basis of the activity of the stage. Description of the work of functional units

Organization and content of medical care for chest injuries at the stages of medical evacuation First medical aid It consists primarily in the application of an aseptic bandage. Chest wounds with open pneumothorax are closed with sealing (occlusive)

Organization of medical care and treatment of the wounded in the limb at the stages of medical evacuation First aid for wounds in the limb is more often in the form of self- and mutual assistance and includes the following activities: 1. temporary stop of bleeding (tight pressing

3. Organization of first aid to the wounded and sick in the unit

Organization of rehabilitation Today, there are the following rehabilitation technologies: a psychological service at the oncology department, a family club, a rehabilitation camp or a sanatorium.

ORGANIZATION OF FIRST AID IN COMBAT In battle, each fighter has an individual dressing and anti-chemical packages. Therefore, with a slight wound, a fighter can bandage himself himself. If he is not able to do this, a comrade will bandage him with the permission of the commander.

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Lecture 2. Organization of psychiatric care for the population in the Russian Federation. Fundamentals of the legislation of the Russian Federation in the field of psychiatry. Ethics and deontology in psychiatry. Psychiatric examination.

PSYCHIATRY (from the Greek psyche - soul, iatreia - treatment) is a science that studies the issues of the clinic, etiology, pathogenesis, treatment and prevention of mental illness. It is divided into general and private psychiatry. n The object of study of psychiatry is a person suffering from a mental illness or disorder.

mental health. "The Presumption of Mental Health". n n General health is defined by WHO as a state of being characterized not only by the absence of disease or infirmity, but also by complete physical, mental and social well-being. Mental health is one of the most important components of overall health. Mental Health Day is celebrated worldwide on November 10th.

Mental health is a state of mental and emotional well-being in which an individual can use their cognitive and emotional abilities, function in society and fulfill their needs.

Mental health criteria (defined by WHO): n n n n awareness and sense of continuity, constancy and identity of one's physical and mental "I"; a sense of constancy and identity of experiences in situations of the same type; criticality to oneself and one's own mental production (activity) and its results; compliance of mental reactions (adequacy) with the strength and frequency of environmental influences, social circumstances and situations; the ability to self-govern behavior in accordance with social norms, rules, laws; the ability to plan one's own life and implement plans; the ability to change behavior depending on changing life situations and circumstances.

Stages of development of psychiatry as a medical science: VI. Psychopharmacological revolution (60s of the 20th century), postnosological, neosyndromic stage V. The era of nosological psychiatry (E. Kreplin, 1898) IV. 1798 -F. Pinnel reform (abolition of violence) III. Europe 15th -16th centuries (institutions with compulsory treatment) II. The era of ancient medicine I. Pre-scientific period

Sections and areas of modern psychiatry. General Child, adolescent and geriatric Private Social Forensic Biological Transcultural (cross-cultural) Administrative Orthopsychiatry Industrial psychiatry (employment psychiatry) Disaster psychiatry Narcology Military Sexual pathology Suicidology Psychotherapy Mental hygiene and psychoprophylaxis Psychosomatic medicine

Psychiatric care in the Russian Federation is aimed at: n n n early detection of mental disorders and clinical examination of patients; prevention of recurrence of the disease; improvement of working and living conditions; assistance in the adaptation of patients; optimization of the treatment process based on the integrated use of pharmacological and psychosocial methods of treating patients.

Organizational forms of psychiatric care Hospitals Psychiatric hospitals Psychoneurological dispensaries (PND) Day hospitals Departments and departments Rehabilitation rooms at polyclinics Specialized psychiatric hospitals Psychiatric departments in multidisciplinary hospitals Psychoneurological boarding schools (PNI)

Features of the organization of psychiatric care in the Russian Federation n n n variety of organizational forms, the ability to choose for the patient the organizational form of psychiatric care that best suits his condition, continuity in treatment, provided with operational information about the condition of patients and the treatment provided when it is transferred under the supervision of a psychiatrist of another institution in the psychiatric organization system assistance, patient care on a territorial basis; assistance is provided outside the systems of compulsory and voluntary honey. insurance, rehabilitation orientation of organizational structures.

Psychiatric hospitals are intended for the treatment of patients with mental disorders of the psychotic level. However, in modern conditions, not all patients with psychosis require mandatory hospitalization in a psychiatric hospital (PB), many of them can receive outpatient treatment.

Hospitalization in a hospital is justified in the following cases: 1. The patient refuses to be treated by a psychiatrist. In this case, subject to the conditions described in Art. 29 of the Law on Psychiatric Care, the court may order involuntary hospitalization and treatment: n Article 29. Grounds for hospitalization in a psychiatric hospital on an involuntary basis, if the mental disorder is severe and causes for the patient: a) his immediate danger to himself or others, b ) his helplessness, that is, the inability to independently satisfy the basic needs of life, c) significant harm to his health due to a deterioration in his mental state, if the person is left without psychiatric assistance. 2. The presence of psychotic experiences in the patient, which can potentially lead to life-threatening actions for the patient and the people around him (for example, depression with delusions of guilt can push the patient to commit suicide, even if he consents to treatment, etc.)

3. The need for treatment that cannot be done on an outpatient basis (high doses of psychotropic drugs, electroconvulsive therapy). 4. Appointment by the court of a stationary forensic psychiatric examination (for persons under arrest there are special "guard" departments of forensic psychiatric examination, for others - "non-guard"). 5. Appointment by the court of compulsory treatment of mentally ill people who have committed offenses. Patients who have committed especially serious crimes may be placed by the court in specialized hospitals with enhanced supervision. 6. Helplessness of the patient in the absence of relatives capable of caring for him. In this case, the registration of the patient in a psycho-neurological boarding school is shown, but before receiving a place in it, patients are forced to stay in a regular psychiatric hospital.

Features of the sanitary and epidemiological regime of psychiatric hospitals. n n The etiology of nosocomial infections (HAI) in psychiatric hospitals differs sharply from that in somatic hospitals. Among nosocomial infections in psychiatric institutions, traditional ("classic") infections dominate, among which the leading place is occupied by intestinal infections - salmonellosis, shigellosis; known outbreaks of typhoid fever. In the context of the epidemic spread of diphtheria in Russia in the early 90s of the last century, it was introduced into psychiatric hospitals with subsequent nosocomial spread of the infection. Against the background of an increase in the incidence of tuberculosis, the risk of hospitalization of patients with unrecognized forms and subsequent infection of other patients and medical personnel increases.

Features of the organization of infection control. n n In contrast to general hospitals, the use of invasive diagnostic and treatment procedures in psychiatric hospitals is extremely limited. Therefore, the risk of developing HAI associated with invasive procedures is very low; many patients in psychiatric hospitals are not able to observe basic rules of personal hygiene, which increases the risk of developing intestinal infections; patients are in close contact with each other; often patients are not able to provide adequate information about their infectious and somatic diseases.

Prevention measures for nosocomial infections: n n upon admission to a psychiatric hospital (department), especially for long-term treatment, it is advisable to bacteriologically examine patients for intestinal infections; until the results of the studies are obtained, they should not be sent to general wards, but placed in an isolation ward. Identified carriers should remain in the isolation room until negative results are obtained after sanitation. Chronic carriers of typhoid infection must be kept in an isolation ward during the entire stay in a psychiatric institution; healthcare professionals in psychiatric hospitals should be alert to the most common nosocomial infections. When febrile conditions, intestinal dysfunctions appear, it is advisable to call an infectious disease specialist for a consultation. Patients with fever for more than 3 days with an unclear etiology of the disease should be examined for suspected nosocomial infections (including typhoid fever);

n n n if a patient with typhoid fever is identified, all febrile patients and persons who have interacted with the patient should also be examined. Phage prophylaxis is recommended last; in relation to patients with nosocomial infections, appropriate isolation and restrictive measures should be taken; in the hospital, it is necessary to ensure compliance with the general sanitary and hygienic regime aimed at limiting the action of natural transmission mechanisms, creating conditions for maintaining personal hygiene rules, and providing qualified medical care; if it is necessary to use invasive medical and diagnostic procedures, the recommended protocols for their implementation and asepsis rules should be strictly observed; pay attention to the vaccination history of patients. In the absence of information about vaccinations against diphtheria, it is advisable to introduce the appropriate vaccine. This is especially important for patients on long-term treatment, as well as in an unfavorable epidemic situation among the population.

Therapeutic environment. n n n In the mental hygiene of the patient, a significant place is given to the atmosphere of the hospital, which should be conducive to recovery. The reality is that, in general, the state-owned environment of hospitals cannot but cause additional emotional oppression. Hence the special significance of the organization of a beneficial therapeutic environment in the hospital.

n Environment Therapy is a humanistic approach to inpatient care based on the belief that institutions can promote patient recovery by creating an environment that promotes self-respect, personal responsibility, and meaningful activity.

hospitalism. n is a deterioration in the mental state due to a long stay in a hospital, which is manifested by social maladaptation, loss of interest in work and work skills, deterioration in contact with others, a tendency to chronicity of the disease, and an increase in pathocharacterological manifestations.

The main factors contributing to the formation of hospitalism in patients are: n n n n loss of contacts with the outside world, imposed inactivity; authoritarian position of medical workers, loss of friends and lack of events in personal life; insufficiently controlled and mandatory intake of pharmacological agents; meager atmosphere and decoration of the chambers; lack of life prospects outside the hospital.

Deinstitutionalization. n n Releasing large numbers of patients from long-term psychiatric hospital treatment to receive treatment through community programs. The main content of deinstitutionalization is the maximum removal of patients from psychiatric hospitals and the replacement of long-term maladaptive hospital stay (leading to hospitalism) with various forms of medical, social and social legal assistance on an outpatient basis, as well as the placement of psychiatric beds in specialized psychiatric departments in general hospitals.

Strict supervision n n n assigned to patients whose mental state is a danger to themselves or to others. These are patients with aggressive behavior, in a delirious state, with hallucinatory-delusional disorders, tendencies to suicide, escape. The nature of supervision is established by the attending physician. In the ward where such patients are kept, there is a medical post around the clock, the ward is constantly lit, it should not contain anything but beds. Patients can leave the room only with an escort. Any change in the behavior of patients is immediately reported to the doctor.

Enhanced observation n n n is prescribed in cases where it is necessary to clarify the characteristics of painful manifestations (the nature of seizures, sleep, mood, communication, etc.). Patients receiving insulin therapy, electroconvulsive and atropinocomatous therapy, large doses of psychotropic drugs, and somatically debilitated patients also need enhanced monitoring. It is carried out in the general chambers.

General observation n n is assigned to those patients who do not pose a danger to themselves and others. They can move freely in the department, go for a walk, and are actively involved in labor processes. The attending physician is responsible for prescribing the observation regimen. The nurse does not have the right to independently change the mode of observation, except in cases where the patient's behavior changes dramatically and strict supervision must be established for him. But in these cases, you must immediately inform the doctor.

Psycho-neurological dispensaries (PND) n are organized in those cities where the population size allows allocating five or more medical positions. In other cases, the functions of a psycho-neurological dispensary are performed by a psychiatrist's office, which is part of the district polyclinic.

The functions of a dispensary or office include: n n n mental hygiene and prevention of mental disorders, timely identification of patients with mental disorders, treatment of mental illness, medical examination of patients, provision of social, including legal assistance, to patients, holding rehabilitation measures

Types of clinical examination: 1. Advisory supervision is established over patients with a non-psychotic level of disorders, in which a critical attitude towards the disease is maintained. In this regard, the time of the next visit to the doctor is determined by the patient himself, just as patients in the district clinic go to the doctors when they have any complaints. Advisory supervision does not imply "registration" of the patient in the IPA, therefore, persons who are registered with the advisory service most often do not have any restrictions "in the performance of certain types of professional activities and activities associated with a source of increased danger" and can obtain the right to drive a car , a license for weapons, work in dangerous jobs, in medicine, etc. , make transactions without any restrictions.

2. Dynamic dispensary observation is established for patients with a psychotic level of disorders, in which there is no critical attitude towards the disease. Therefore, it can be carried out regardless of the consent of the patient or his legal representative. With dynamic observation, the main initiative for the next examination comes from the district psychiatrist, who sets the date for the next meeting with the patient. If the patient did not appear for the next appointment, the doctor is obliged to find out the reasons for the absence (exacerbation of psychosis, somatic illness, departure, etc.) and take measures to examine him. The district psychiatrist, who is the main figure in the neuropsychiatric dispensary or office, distributes all patients in his area into 5-7 groups of dynamic observation, depending on the mental state and the method of treatment chosen. The dynamic observation group determines the interval between the meeting of the patient and the doctor from once a week to once a year. Observation is called dynamic, because depending on the mental state of the patient, he moves from one group to another. A stable remission for 5 years with a complete reduction of psychotic manifestations and social adaptation give grounds for deregistration in a neuropsychiatric dispensary or office.

Institutions of out-of-hospital care for the mentally ill

Modern trends in the organization of psychiatric care Emphasis on Great attention to the rehabilitation of patients (return to society) "Psychoeducation" out-of-hospital forms (teaching care (dispensaries, day and night hospitals, recognizing the hostel, symptoms of a sanatorium, mental health and labor disorders) workshops, etc. )

Research methods in psychiatry Clinical method (anamnesis of life and illness, conversation and observation of the patient) Psychological method (psychological tests) Paraclinical methods (laboratory tests, CT, MRI, EEG, etc.)

Ethical aspects of psychiatry (tasks of psychiatric ethics) 1. Increasing society's tolerance for persons with mental disabilities. 2. Limiting the scope of coercion in the provision of psychiatric care to the limits determined by medical necessity (which serves as a guarantee of human rights). 3. Establishment of optimal relationships between a medical professional and a patient, contributing to the realization of the interests of the patient, taking into account the specific clinical situation. 4. Achieving a balance of interests of the patient and society based on the value of health, life, safety and well-being of citizens.

On April 19, 1994, at the Plenum of the Board of the Russian Society of Psychiatrists, the Code of Professional Ethics of a Psychiatrist was adopted.

Basic ethical principles: n n the principle of autonomy - respect for the patient's personality, recognition of the right to independence and freedom of choice; the principle of non-harm - involves not harming the patient not only directly, intentionally, but also indirectly; the principle of beneficence - consists in the obligation of medical personnel to act in the interests of the patient; the principle of justice - concerns, first of all, the distribution of health care resources.

Ethical norms: n n truthfulness - implies the duty of both the doctor and the patient to tell the truth; privacy - implies the inadmissibility of intrusion into the sphere of personal (private) life without the consent of the patient, the preservation of the patient's right to privacy even in conditions that restrict his freedom; confidentiality - assumes that the information received by the medical worker as a result of the examination cannot be transferred to other persons without the permission of the patient; competence - implies the obligation of a medical worker to fully master special knowledge.

Legal aspects of psychiatry. In 1992, the Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens in its provision” was adopted

The law establishes the basic legal principles and procedures for the provision of psychiatric care in Russia: n n n the voluntariness of seeking psychiatric care (Art. 4), the rights of persons suffering from mental disorders (Art. 5, 11, 12, 37), the grounds for conducting a psychiatric examination (Art. 23, 24), grounds for dispensary observation (Art. 27), grounds for hospitalization in a psychiatric hospital (Art. 28, 29, 33), application of coercive medical measures (Art. 30).

The rights of persons suffering from mental disorders: n n to respectful and humane treatment, excluding the humiliation of human dignity; to receive 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 their mental disorders and the methods of treatment used; to psychiatric care in the least restrictive conditions, if possible - at the place of residence; to be kept in a psychiatric hospital only for the period necessary for examination and treatment;

n n n for all types of treatment (including sanatorium-and-spa treatment) according to medical indications in the absence of contraindications; to provide psychiatric care in conditions that meet sanitary and hygienic requirements; for prior consent and refusal at any stage to use medical devices and methods, scientific research or the educational process as an object of testing, from photo-video or filming; to invite, at their request, any specialist involved in the provision of psychiatric care, with the consent of the latter, to work in a medical commission on issues regulated by this Law; for the assistance of a lawyer, legal representative or other person in the manner prescribed by the legislation of the Kyrgyz Republic.

Rights and obligations of patients in psychiatric hospitals: n n n apply directly to the head physician or head of the department for treatment, examination, discharge from a psychiatric hospital and compliance with the rights granted by this Law; file uncensored complaints and applications to representative and executive authorities, prosecutors, courts and lawyers; meet with a lawyer and a clergyman in private; in the absence of medical contraindications, perform religious rites, observe religious canons, including fasting, in agreement with the administration, have religious paraphernalia and literature; subscribe to newspapers and magazines;

n n n n Receive a comprehensive school education or a special school for children with intellectual disabilities if the patient is under 18 years of age; receive, on an equal footing with other citizens, remuneration for labor in accordance with its quantity and quality, if the patient participates in productive labor. conduct correspondence without censorship; receive and send parcels, parcels and money orders; use the phone; receive visitors; to have and acquire essentials, to use their own clothes.

Involuntary initial examination. n n n The decision on a psychiatric examination of a citizen without his consent is made by a psychiatrist upon the application of the interested person, which must contain information about the existence of grounds for such an examination. Having established the validity of the statement about the need for a psychiatric examination without the consent of the citizen, the doctor sends to the court his reasoned opinion on this need. The judge decides on the issue of giving a sanction and a three-day period from the date of receipt of the materials. If, based on the materials of the application, the signs of paragraph "a" are established, the psychiatrist may decide to examine such a patient without the sanction of a judge.

Involuntary hospitalization. n n In case of involuntary hospitalization for the indications set forth above, the patient must be examined by a commission of hospital psychiatrists within 48 hours, regardless of weekends and holidays. If hospitalization is recognized as unreasonable and the hospitalized does not want to stay in the hospital, he is subject to immediate discharge. Otherwise, the conclusion of the commission is sent to the court within 24 hours. The judge, within 5 days, considers the application of the hospital for involuntary hospitalization and, in the presence of the inpatient, gives or does not give a sanction for the further detention of the person in a psychiatric hospital. Subsequently, an involuntary hospitalized person is subject to a monthly examination by doctors, and after 6 months, the conclusion of the commission, if the need to continue treatment, is sent by the hospital administration to the court at the location of the psychiatric hospital to obtain permission to prolong treatment.

Forensic psychiatric examination. n n Expertise in a criminal case may be appointed by an investigator of an investigative committee or by a court, based on its own considerations or at the request of a person interested in the process. An examination is carried out on a person under investigation, a defendant or a witness, if the investigating authorities or the court have doubts about the mental health of these persons.

Circumstances that are the reason for the appointment of a forensic psychiatric examination (FPE): n n n a person has applied for psychiatric help in the past, if the person has committed a particularly serious offense, if mental disorders appeared during the investigation or trial, if the person has suicidal statements and actions, if the offense was committed under the influence of alcohol.

n n n n In all territories of the Russian Federation, SPE centers are organized, consisting of outpatient and inpatient services. Work in them should be carried out by EPE psychiatrists with appropriate certificates. Experts have the right to get acquainted with all the materials of the court case, request medical documents or other data that are missing for expert evaluation. Experts also act in court as witnesses, have the appropriate rights and obligations, give a signature on criminal liability for knowingly false testimony (there is a corresponding section in the act of forensic psychiatric examination). Within 30 days, the subject must be examined with the involvement, if necessary, of specialists other than psychiatrists, an examination report is drawn up and sent to the address of the person who sent him for examination. The SPE commission includes at least three psychiatrists, the act is signed by all members of the commission, including invited experts. If one of the experts does not agree with the conclusions, he writes a dissenting opinion, and in such cases a second examination is appointed with a different composition of experts.

The concept of insanity. Article 21 disorder, dementia, or other mental illness. A person who has committed a dangerous act in a state of insanity, as provided for by the Criminal Code, may be imposed by a court of compulsory medical measures provided for by this Code.

The medical (biological) criterion of insanity is the establishment of the very fact that a person has mental disorders and the time of their development - before the commission of any act, at the time of commission or after it.

The legal (psychological) criterion of insanity provides a forensic psychiatric assessment that determines how and to what extent a mental illness could affect the adequacy of a person’s actions and deeds (a person’s inability to realize the actual nature and social danger of their actions (inaction) is an intellectual sign; lack the ability to lead them is a strong-willed sign).

CIVIL CODE OF THE RUSSIAN FEDERATION. A capable citizen after coming of age can properly dispose of his property, donate it, sell it, enter into inheritance rights.

The concept of disability. Article 29. Recognition of a Citizen as Incapable n n n A citizen who, due to a mental disorder, cannot understand the meaning of his actions or control them, may be recognized by a court as incapable in the manner prescribed by civil procedural legislation. He is placed under guardianship. On behalf of a citizen recognized as incompetent, transactions are made by his guardian. If the grounds by virtue of which the citizen was declared incompetent have disappeared, the court recognizes him as capable. On the basis of a court decision, the guardianship established over him is cancelled.

Article 30. Restriction of a citizen's legal capacity 1. A citizen who, due to the abuse of alcohol or drugs, puts his family in a difficult financial situation, may be limited by the court in legal capacity in the manner prescribed by civil procedural legislation. Guardianship is established over him. 2. He can make other transactions, as well as receive earnings, pensions and other incomes and dispose of them only with the consent of the trustee. However, such a citizen independently bears property liability for transactions made by him and for the harm caused to him. 3. If the grounds by virtue of which the citizen was limited in legal capacity have disappeared, the court cancels the restriction of his legal capacity. On the basis of a court decision, the guardianship established over a citizen is cancelled.

Military medical expertise. n n n In the structure of the medical service of the Russian Army, full-time and non-staff military medical commissions (VVK) have been created, which, if necessary, include psychiatrists. Regular commissions are organized in hospitals and district military commissariats, non-staff - in civilian psychiatric hospitals by order of the head of the medical department of the district with the rights of hospital commissions. The work of the VVK is regulated by the "Regulations on the military medical examination", in the schedule of diseases of which 8 articles are assigned to mental disorders, including in general form almost all the headings of the ICD 10. The "Regulations" contains four columns: the first reflects the results of the examination of conscripts, the second - conscription servicemen, in the third - contract servicemen, in the fourth - military service on submarines.

The results of the examination in the form of five categories of fitness for military service: n n n A - fit for military service, B - fit for military service with minor restrictions, C - limited fit for military service, D - temporarily unfit for military service, E - unfit to military service.

Labor expertise. n n n Labor expertise is carried out according to the same rules as in the general medical network. Examination of temporary incapacity for work is carried out by attending physicians who single-handedly issue certificates of incapacity for work to citizens for a period of 30 days, and for a longer period - by a medical commission appointed by the head of the medical institution. The medical CEC (control and expert commission) in a psychoneurological dispensary or psychiatric hospital decides on the duration of temporary disability, which is reflected in the disability certificate provided to the patient. If the duration of treatment lasts more than four months, the question arises of transferring the patient to disability. In cases where there is reason to expect a favorable outcome of a mental disorder with a good remission, the sick leave can be extended up to 10 months.

n n n The diagnostic activity of CEC is also associated with the decision of the question of the suitability or unsuitability of the patient for a particular type of activity. For example, a patient with epilepsy is not allowed to drive a car and work with mechanisms, patients with schizophrenia are deprived of the opportunity to enter some universities. During the examination of temporary disability, the need and timing of the temporary or permanent transfer of the employee for health reasons to another job is determined, and a decision is made to send the citizen to the medical and social expert commission (MSEK), including if this citizen has signs of disability. Medical and social expertise establishes the cause and group of disability, the degree of disability of citizens, determines the types, volume and timing of their rehabilitation and measures of social protection, gives recommendations on the employment of citizens.

n n n The main criterion for determining the disability group is the residual degree of ability to work. In accordance with this, the 3rd and 2nd I have three gradations, and the 1st only one, since the disabled person of the 1st group is recognized as disabled. MSEC is produced by institutions of medical and social expertise of the system of social protection of the population The recommendations of MSEC on the employment of citizens are mandatory for the administration of enterprises, institutions and organizations, regardless of the form of ownership.

Psychiatric care in our country is provided by psychiatric and narcological services. The legislative framework in the field of psychiatry protects the interests of the mentally ill and creates conditions for the fulfillment of all requirements and tasks aimed at providing psychiatric and social assistance to patients.

Currently, in modern conditions, psychiatric and narcological services are presented as follows:

• medical institutions of the system of the Ministry of Health (psychiatric and narcological hospitals, psycho-neurological and narcological dispensaries, specialized psychosomatic departments in general somatic institutions, specialized adult and children's rooms in general somatic polyclinics and central district hospitals, mental health research institutes);
• private drug and psychiatric clinics and offices;
• institutions of the Ministry of Education (special schools, boarding schools, sanatoriums and sanatorium-forest schools, special preschool institutions);
• social security institutions (special homes for the disabled, medical and social expert commissions - MSEC); institutions of the Ministry of Justice (special hospitals).

In accordance with the tasks of psychiatric and narcological treatment and rehabilitation assistance, it is organized in the following forms:

• outpatient: neuropsychiatric dispensaries (adult and children's medical clinics, teenage reception, adult and children's day hospitals, "Home hospitals"), narcological dispensaries (outpatient reception rooms for adults and children, day hospitals for adults and children, department of narcological examinations, chemical toxicological laboratory, functional diagnostics room), children's neuropsychiatric dispensaries, psychiatrist's consultative offices at children's and adult polyclinics;
• inpatient: general psychiatric hospitals for adults and children, narcological hospitals for adults and children, psychosomatic departments in general hospitals, specialized hospitals for inpatient compulsory treatment by court order; in some cases, specialized type hospitals for mental patients suffering from tuberculosis;
• emergency psychiatric and narcological care: specialized ambulance teams, intensive care units for psychiatric and narcological profiles;
• rehabilitation and social support: medical and labor workshops, working groups under social security agencies for home care, hostels and specialized homes for the disabled for the mentally ill left without care;
• education and training of the disabled: specialized schools; vocational schools (vocational schools).

Outpatient care is provided in the form of consultative and medical care or dispensary observation.

For psychiatric care, adult patients are allocated the rate of a local psychiatrist per 25,000 adults. Each psychiatric district has a position of a district nurse, a social worker, a medical psychologist and a social work specialist per 75,000 people, and a psychotherapist per 100,000 people. Such a polyprofessional team is headed by a district psychiatrist. In the work of these teams, regular group discussions of treatment and rehabilitation plans and their subsequent implementation are mandatory.

A local psychiatrist or narcologist receives patients and visits them at home. In addition to medical diagnostic and advisory assistance, dispensary employees (doctors, nurses, social workers) provide social support, carry out rehabilitation of patients, consult relatives of patients, if necessary, and advocate for the legal interests of mentally ill patients. Outpatient forensic psychiatric examinations (by medical experts), as well as military and labor examinations are carried out on an outpatient basis.

For persons suffering from chronic, often exacerbated mental illness, the dispensary establishes observation. A patient under dispensary observation, depending on the type of observation, the doctor should systematically examine. If the patient is not at the next appointment, he is visited at home (by a doctor or district nurse). Particular attention should be paid to patients with disabilities, who are under guardianship, who are lonely, referred to a day hospital, who need better living conditions, who have attempted suicide or committed an offense, and who are prone to sexual perversions (perversions). If such patients change their place of residence, information about them is sent to the appropriate neuropsychiatric or narcological dispensary. Dispensary supervision assumes some lack of freedom of patients. Staying at a dispensary observation may result in the denial of a driver's license or a permit to carry a weapon. Therefore, the Law indicates that such monitoring can be established only for the time when it remains necessary. With recovery or a significant and persistent (lasting for 4-5 years) improvement, dispensary observation may be terminated. The decision on registration and deregistration is made by the medical commission (MC) appointed by the administration of the medical institution. If the patient does not agree to be monitored, he can go to court. The court, having considered the arguments of doctors, lawyers and experts, may consider dispensary observation unnecessary and cancel it.

Doctors of the psycho-neurological dispensary, in addition to dispensary observation, also carry out medical consultations, which are carried out exclusively on a voluntary basis. The patient comes to the doctor only when he himself feels the need. Although an outpatient card (medical history) is also created for the patient in this case, his rights cannot be limited in any way. For example, to obtain a driver's license, such a patient can apply to the registry of psycho-neurological and narcological dispensaries, and he will be issued a certificate stating that he is not under dispensary observation. Unfortunately, the population retains a biased, distrustful attitude towards psychiatric and narcological services, and patients with mild disorders who are under advisory supervision make up no more than 20% of all those observed in dispensaries, although their number significantly exceeds this figure. In recent years, specialized offices of a psychoneurologist and psychotherapist have been created at general clinics, which makes it possible to treat mild mental and psychosomatic disorders in confidentiality, as well as to more successfully identify certain mental disorders in the population.

Outpatient psychiatric or narcological care for children under the age of 14 is provided by a psychiatrist or narcologist in a children's psycho-neurological dispensary or narcological dispensary, from 14 to 18 years of age, adolescents receive assistance in a teen cabinet. Consent to the examination of a minor (under the age of 15) is given by his legal representative (parents, guardian).

Due to the insufficient definition of the concepts of "mental illness", "mentally ill", these terms and their derivatives are not used in the Law. As a generic collective concept covering all people in need of psychiatric competence, the Law uses the formula: “persons suffering from mental disorders”, since it includes both the mentally ill themselves, and persons with borderline neuropsychiatric disorders, and patients with so-called psychosomatic diseases or symptomatic mental disorders in general somatic diseases. The differentiation of this vast contingent in order to determine indications for certain types of psychiatric care, including those provided involuntarily, is carried out using additional criteria that take into account the degree and depth of disorders, the level of social adaptation, etc., which makes it possible to accept individual decisions Commentary on the legislation of the Russian Federation in the field of psychiatry / Coll. authors. Under total ed. T. B. Dmitrieva. - M.: Spark Publishing House, 1997. P.7..

Psychiatric care includes: consultative and diagnostic, therapeutic, psychoprophylactic, rehabilitation care in out-of-hospital and inpatient settings; all types of psychiatric examination; social assistance in the employment of persons suffering from mental disorders, as well as in caring for them; teaching disabled people and minors suffering from mental disorders Maleina MN Man and medicine in modern law. Educational and practical guide. - M .: BEK Publishing House, 1995. P. 104 ..

Psychiatric care is guaranteed by the state and is carried out on the basis of the principles of legality, humanity and observance of human and civil rights.

The diagnosis of a mental disorder is made in accordance with generally recognized 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 related to the state of his mental health Law of the Russian Federation of July 2, 1992 No. 3185-1 "On psychiatric care and guarantees of the rights of citizens in its provision" // VSND and the RF Armed Forces. 1992. No. 33. Art.1913. .

Psychiatric care is provided by licensed state, non-state psychiatric and neuropsychiatric institutions and private psychiatrists. Psychiatric care without a state license is prohibited.

To obtain a license, an application is submitted to the licensing commission under the state administration body indicating the types of medical activities for the provision of psychiatric care and the established documents (charter, memorandum of association, documents confirming the qualifications of employees, a conclusion on the technical condition of the building, etc.). The Licensing Commission considers the application within two months. In case of refusal to issue a license, the commission informs the applicant in writing of the reason for the refusal, which may be appealed in court.

Institutions and privately practicing psychiatrists who have received a license are entered in the corresponding unified state register. The license shall indicate the full name of the institution or the surname, name, patronymic of a privately practicing psychiatrist, their legal address and the types of medical activities for the provision of psychiatric care, for which permission is given. Suspension and annulment of a license is carried out by a court decision.

A psychiatrist who has received a higher medical education and confirmed his qualifications in accordance with the procedure established by law has the right to practice medicine in the provision of psychiatric care. Other specialists and medical personnel involved in the provision of mental health care must undergo special training and confirm their qualifications for admission to work with people suffering from mental disorders.

When providing psychiatric care, the psychiatrist is independent in his decisions and is guided only by medical indicators, medical duty and the law. A psychiatrist, whose opinion does not coincide with the decision of the medical commission, has the right to give his opinion, which is attached to the medical documentation Maleina MN Man and medicine in modern law. Educational and practical guide. - M .: BEK Publishing House, 1995. P. 105 ..

The provision of psychiatric care in Russia is regulated by the Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens in its provision." The psychiatric service in the Russian Federation has a number of organizational forms of hospital and out-of-hospital care for the population.

Psychiatric hospitals. Psychiatric hospitals are intended for the treatment of patients with mental disorders of the psychotic level. However, in modern conditions, not all patients with psychosis require mandatory hospitalization in a psychiatric hospital (PB), many of them can receive outpatient treatment. Hospitalization in the hospital is justified in the following cases:

• - refusal of the patient from treatment by a psychiatrist. In this case, subject to the conditions described in Art. 29 of the Law on Psychiatric Care, involuntary hospitalization and treatment can be ordered by the court. Grounds for hospitalization in a psychiatric hospital on an involuntary basis, if the mental disorder is severe and causes for the patient:
  • a) his immediate danger to himself or others, or
  • b) his helplessness, that is, his inability to independently satisfy the basic needs of life, or
  • c) significant harm to his health due to the deterioration of his mental state, if the person is left without psychiatric care;
• - the presence of psychotic experiences in the patient, which can potentially lead to life-threatening actions for the patient and the people around him (for example, depression with delusions of guilt can push the patient to commit suicide, even if he consents to treatment, etc.);
• - the need for treatment that cannot be done on an outpatient basis (high doses of psychotropic drugs, electroconvulsive therapy);
• - appointment by the court of a stationary forensic psychiatric examination (for persons under arrest there are special "guard" departments of forensic psychiatric examination, for others - "non-guard");
• - appointment by the court of compulsory treatment of mentally ill persons who have committed offenses. Patients who have committed especially serious crimes may be placed by the court in specialized hospitals with enhanced supervision;
• - helplessness of the patient in the absence of relatives capable of caring for him. In this case, the registration of the patient in a psychoneurological boarding school is shown, but before receiving a place in it, patients are forced to stay in a regular psychiatric hospital. Forensic psychiatry: Textbook for universities / Ed. B.V. Shostokovich. - M.: Zertsalo, 1997.

The structure of psychiatric hospitals corresponds to that of multidisciplinary hospitals, it includes an emergency room, medical departments, a pharmacy, functional diagnostics rooms, etc.

Since in the treatment departments of a psychiatric hospital patients are being treated involuntarily, there are patients in compulsory treatment and patients with auto-aggressive and aggressive tendencies, all departments provide for special conditions for the stay of patients: all department doors are closed for patients, there are bars and nets on the windows, there are no doors in the wards, nursing posts are organized, where staff is around the clock, supervising the patients. The closed mode of departments, however, does not violate the provisions of the law on psychiatric care, since. patients who are in the hospital voluntarily may refuse treatment at any time and will be examined by a commission of doctors, which will either agree with the decision of the patient and give an opinion on his discharge or refuse the patient to be discharged and send an appropriate conclusion to the court on the need to recognize hospitalization as involuntary.

Patients unable to live independently, in need of constant care, in the absence of relatives capable of providing this care, are transferred for further residence and treatment to psycho-neurological boarding schools (PNI) of the social security system.

In addition to ordinary psychiatric patients, there are specialized psychiatric hospitals that treat non-psychotic mental disorders:

• Narcological hospitals - they treat and rehabilitate patients with addictions to various psychoactive substances (PSA). The main therapeutic measures in these hospitals are aimed at stopping the use of surfactants, stopping the withdrawal syndrome, establishing remission (abstinence from the use of surfactants). These hospitals do not have conditions for the treatment of psychosis, therefore, with the development of psychosis due to the use of psychoactive substances or its withdrawal (for example, delirium tremens), patients must be transferred to a regular psychiatric hospital
• Hospitals for the treatment of borderline mental disorders.

Psychoneurological dispensaries. Psychoneurological dispensaries (PND) are organized in those cities where the population size allows to allocate five or more medical positions. In other cases, the functions of a psycho-neurological dispensary are performed by a psychiatrist's office, which is part of the district polyclinic.

The functions of the dispensary or office include:

• mental hygiene and prevention of mental disorders,
• timely detection of patients with mental disorders,
• the treatment of mental illness,
• medical examination of patients,
• provision of social, including legal assistance, to patients,
• Carrying out activities of a rehabilitation nature.

Identification of mentally ill is carried out in accordance with the "Law on Psychiatric Care": when a citizen himself applies for psychiatric help or when people around him, law enforcement agencies, district administrations, social security organizations apply for a psychiatric examination, as well as during preventive examinations (call for military service, obtaining rights, weapons licenses, when applying for a job in certain professions, etc.), consulting a psychiatrist in multidisciplinary hospitals, during examinations, etc. Forensic psychiatry: A textbook for universities / Ed. B.V. Shostokovich. - M.: Zertsalo, 1997.

Advisory and dynamic accounting in IPA. Clinical examination provides for two types of monitoring of patients: a) advisory, b) dynamic.

advisory observation is established over patients with a non-psychotic level of disorders, in which a critical attitude towards the disease remains. In this regard, the time of the next visit to the doctor is determined by the patient himself, just as patients in the district clinic go to the doctors when they have any complaints. Advisory supervision does not imply "registration" of the patient in the IPA, therefore, persons who are registered with the advisory service most often do not have any restrictions "in the performance of certain types of professional activities and activities associated with a source of increased danger" and can obtain the right to drive a car , a license for a weapon, work in dangerous jobs, in medicine, etc., make transactions without any restrictions.

dynamic dispensary observation is established for patients with a psychotic level of disorders, in which there is no critical attitude towards the disease. Therefore, it can be carried out regardless of the consent of the patient or his legal representative.

With dynamic observation, the main initiative for the next examination comes from the district psychiatrist, who sets the date for the next meeting with the patient. If the patient did not appear for the next appointment, the doctor is obliged to find out the reasons for the absence (exacerbation of psychosis, somatic illness, departure, etc.) and take measures to examine him.

The dynamic observation group determines the interval between the meeting of the patient and the doctor from once a week to once a year. Observation is called dynamic, because depending on the mental state of the patient, he moves from one group to another. A stable remission for 5 years with a complete reduction of psychotic manifestations and social adaptation give grounds for deregistration in a neuropsychiatric dispensary or office.

Patients under dispensary observation are usually recognized as unfit due to a mental disorder to perform certain types of professional activities and activities associated with a source of increased danger. Such a decision is made by a medical commission, based on an assessment of the state of mental health of a citizen in accordance with the list of medical psychiatric contraindications, and can be appealed in court.

Outpatient care facilities for the mentally ill. In recent years, in connection with the achievements of psychopharmacotherapy, institutions of out-of-hospital care for the mentally ill and rehabilitation are becoming more widespread. In addition to neuropsychiatric dispensaries, they include day and night hospitals, medical and labor workshops, special stages or special workshops at industrial enterprises, hostels for patients with mental disorders. http://yurist-online.com/uslugi/yuristam/literatura/stati/psihiatriya/010.php.

Day and night hospitals are usually organized at neuropsychiatric dispensaries and psychiatric hospitals. Day hospitals are intended for relief of primary mental disorders or their exacerbations, if their severity does not correspond to those indicated, as conditions requiring mandatory hospitalization in a psychiatric hospital. These patients are examined daily by doctors, take prescribed drugs, undergo the necessary examinations, and return home in the evening. Night hospitals pursue the same goals as day hospitals in cases of possible evening deterioration or an unfavorable home situation.

Therapeutic labor workshops, which are part of the system of rehabilitation of patients, are designed to develop or restore labor skills for disabled people of the 2nd or 3rd group. They receive remuneration for their work, which, together with pensions, makes it possible to feel relatively independent financially.

Features of the organization of psychiatric care in the Russian Federation. Thus, the organization of psychiatric care in the Russian Federation is characterized by the following features:

• a variety of organizational forms, the ability to choose for the patient the organizational form of psychiatric care that best suits his condition,
• Continuity in treatment, provided with operational information about the condition of patients and ongoing treatment when it is transferred under the supervision of a psychiatrist of another institution in the system of organizing psychiatric care,
• · rehabilitation orientation of organizational structures.

Coordination in the work of psychiatric institutions, continuity in their work, methodological guidance is carried out by the organizational methodological cabinet for psychiatry, headed by the chief psychiatrist of a particular territory. Forensic psychiatry: A textbook for universities / Ed. B.V. Shostokovich. - M.: Zertsalo, 1997.

The correct solution of the issue of the further procedure for the proceedings and the need to apply coercive medical measures to a person in the presence of doubts about the mental state of the accused is impossible without the appointment and production of a forensic psychiatric examination (paragraph 2 of article 79 of the Code of Criminal Procedure).

Forensic psychiatric examination- this is a special study conducted by one or a group of forensic psychiatric experts in order to give an opinion on the mental state of the subject in criminal and civil proceedings.

The main tasks of forensic psychiatric examinations are:

definition of sanity - insanity;

determination of capacity - incapacity;

determination of procedural capacity in criminal proceedings;

determination of procedural capacity in civil proceedings;

The majority of forensic psychiatric examinations in Russia are carried out in state forensic psychiatric expert institutions. In forensic psychiatry, the functions of an expert institution are performed by forensic psychiatric expert commissions (SPEC) and forensic psychiatric expert departments organized at general psychiatric institutions - psychiatric hospitals and neuropsychiatric dispensaries. Main performance indicators of the forensic psychiatric expert service of the Russian Federation in 2009: Analytical review. M.: FGU "SSC SSP named after V.P. Serbsky" of the Ministry of Health and Social Development of Russia. 2010.Issue. 18. 188 p. Expert commissions and expert departments conduct forensic psychiatric examinations on a regular basis in accordance with the rules for conducting forensic examinations in an expert institution. The leader in the system of state forensic psychiatric expert institutions is the State Scientific Center for Social and Forensic Psychiatry. V.P. Serbsky (GNTSS and SP named after V.P. Serbsky). The procedure for organizing forensic psychiatric expert institutions is determined by departmental regulations of the Ministry of Health of Russia, which are coordinated, if necessary, with federal law enforcement agencies and legal departments - the Supreme Court of the Russian Federation, the General Prosecutor's Office of the Russian Federation, the Ministry of Internal Affairs of Russia, the Ministry of Justice of Russia (for example, Order of the Ministry of Health of Russia dated 12.08.2003 No. 401 and Federal Law No. 73-FZ of May 31, 2001 "On State Forensic Activities in the Russian Federation"). According to these regulatory documents, forensic psychiatric expert commissions are divided into outpatient and inpatient. Some of them are authorized to conduct both outpatient and inpatient examinations (mixed commissions).

Specialized forensic psychiatric inpatient departments are opened for the production of inpatient examinations at psychiatric institutions that have stationary forensic psychiatric expert commissions. One of them is intended for persons held in custody ("guard departments"), the other - for other subjects ("guardless departments") Forensic Psychiatry: A Textbook for High Schools / Ed. B.V. Shostokovich. - M.: Zertsalo, 1997 ..

The activities of forensic psychiatric expert institutions are organized according to the zonal (zonal-territorial) principle, i.e. the expert institution serves the bodies of preliminary investigation or courts located in a certain territory. Forensic psychiatry: Textbook for university students / E.B. Tsargyasov; Z.O. Georgadze, - M.: Law and Law, UNITY-DANA, 2003. - p. 55.

Based on the results of a forensic psychiatric examination (FPE), a conclusion in writing, signed by all the experts who conducted it and sealed with the seal of the institution in which it was held. The term for drawing up an expert opinion is no more than 10 days after the end of expert studies and the formulation of expert conclusions. Federal Law No. 73-FZ of May 31, 2001 "On State Forensic Activities in the Russian Federation" (adopted by the State Duma of the Federal Assembly of the Russian Federation on April 5, 2001).

The conclusion has three parts.: introductory, research (including an anamnestic section, a description of the somatic, neurological and mental state, with a comprehensive examination - the psychological, sexological state of the subject), conclusions. The conclusion of a forensic psychiatric examination is optional for the court and is evaluated by the court according to the rules established in Article 67 of this Code. The disagreement of the court with the conclusion must be motivated in the decision or ruling of the court. Civil Procedure Code of the Russian Federation" dated November 14, 2002 N 138-FZ (adopted by the State Duma of the Federal Assembly of the Russian Federation on October 23, 2002) art. 86.