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English Language Page Any limitation of the rights and freedoms of citizens, including the limitation on the ground of a mental disorder, shall be allowed only in the cases provided for in the federal laws of the Russian Federation and only in so far as is necessary to protect the foundations of the constitutional order, morality, health, rights and legal interests of others, to ensure the defense of the country and security of the state. The legal status of citizens with mental disorders is regulated not only in the healthcare related legislation, but also by a wide array of branches of the Russian law: civil, civil procedure, family, housing, labor, pension, election, education, social protection and social care, military conscription and military service, as well as administrative, criminal, criminal procedure, criminal execution legislation, a host of separate statues and bylaws, and last but not the least by the international legal acts. The fundamental laws in the area of healthcare are the Foundations of Legislation of the Russian Federation on the Healthcare of the Citizens (hereafter Foundations) and Federal Law “On Psychiatric Assistance and the Guarantees of the Rights of Citizens in the course of its Provision.” In accordance with Article 17 of the Foundations, the state guarantees its citizens protection against any forms of discrimination related to their mental disorders. Article 5 of Federal Law “On Psychiatric Assistance” prohibits any limitation of the rights and freedoms of mentally disabled individuals based merely on the psychiatric diagnosis, the facts that they have been treated in clinics, psychiatric centers, or have been taken to a psycho-neurological facility for social care or special training. The Foundations set forth the rights of citizens in the area of healthcare, the rights of specific groups of people, including the rights of senior citizens and invalids, the rights of patients, the rights and obligations of medical workers, and professional medical associations. It is the Foundations that contain the oath to be taken by every doctor when he/she receives the diploma of higher education. The Foundations also define such notions as attending physician and physician-patient privilege, regulate the situations when the data containing privileged physician-patient information may be passed to third parties without consent of the citizen. In particular, the Foundations describe in detail the right of a citizen to access the information about his/her health, as well as the procedure for obtaining informed voluntary consent to a medical intervention. Federal Law “On Psychiatric Assistance” regulates the relationship between citizen and society through the prism of psychiatric health of the citizen. In order to observe the rights and freedoms of a citizen the Law makes it illegal to demand that a citizen should provide information about his mental health, as well as to force him to have a psychiatric examination except for the circumstances clearly defined by the RF laws. Thus the Law secures the universally accepted principle of voluntarism in seeking the psychiatric assistance. All the exceptions to this principle are strictly defined in Article 11 of Part 4 and Articles 23 and 29 of Parts 4 and 5 and are primarily dictated by the interests of the patient. The list of exceptions is exclusive. The Law ensures the execution of its requirements by setting up a comprehensive system of protection — at the state, society and representative levels — of the individual during psychiatric inspection, out of clinic observation and ward treatment. A statutory defined judicial procedure regulates the cases of involuntary provision of psychiatric assistance. The Law is thus capable of providing protection to every citizen against arbitrary and degrading treatment, but it is equally addressed to the officials, power bodies, prosecutors and judges. The civil and civil procedure laws regulates such issues as active capacity, invalidation of contracts made by mentally ill people, liability for the damage caused by a citizen incapable of understanding the meaning of his actions, invalidation of a will made by a legally incapable person, the right of a disabled ill person to an mandatory portion in the heritage, the issues of forensic and psychiatric enquiry, participation of mentally retarded people in court hearings, etc. The RF Family Code regulates such issues as permissibility of marriages involving mentally ill peoples and legitimacy of such marriages, the conditions and consequences of marriage invalidation, procedures for invalidating a marriage with a disqualified person, the right of a mentally ill person to raise children, alimony issues, etc. The main issues related to the rights of the mentally ill in the area of housing law are such issues as the recognition of the citizen’s entitlement to the improvement of his housing conditions, the right of some categories of mentally ill people to the preferential allotment of accommodation space, retention of accommodation space by an ill person who has been kept for treatment for a prolonged time in a psychiatric ward or psycho-neurological home, housing and utility service payment benefits, etc. In the area of labor law the main issues are the various occupational restrictions, procedures to determine disability, employment of invalids, etc. The criminal and criminal procedure legislation regulates such issues as insanity, criminal liability of individuals with mental disorders that do not preclude sanity, classification of the involvement of an individual with severe mental disorder into a criminal act as an aggravating circumstance, employment of compulsory psychiatric observation and treatment, redemption from penalty due to a mental disorder, liability for illegal placement into a psychiatric ward, handling of the cases of people with mental disorders, etc. However in practice the availability of a particular law does not guarantee its execution. People with mental disorders (or their representatives) often encounter insurmountable obstacles in the realization of their due rights. The root causes of this phenomenon are characteristic of the law enforcement system as a whole and reflect the current situation with the rule of law in general. The failure of rules and statutes in the area of human rights of mentally disabled people has also its own inherent raison d'être. The first reason is attributable to the mentality of many citizens and officials that is characterized by a wary and often hostile attitude towards people with a “psychiatric diagnosis.” As a result the legal norms granting to mentally disabled people equal rights with all other citizens are often being overlooked. This is vividly shown by a widespread practice of sending inquiries to psychiatric institutions asking whether a particular job or college applicant who has filed a complaint with an authority has been under psychiatric control, although the term “psychiatric control” has long been banned from official documents and is no longer used in the legislation. The officials sending such inquiries act thereby in gross violation of Article 8 of Federal Law “On Psychiatric Assistance.” By answering such inquiries the psycho-neurological clinics also often violate the Law. They do not realize that by given a reply “not under psychiatric control” they strengthen and exacerbate the public prejudices against the mentally ill, placating them as potentially very dangerous people. Such inquiries are often filed by employers about individuals whose place of work or position do not require a preemptive psychiatric examination. According to the rule set forth in Article 214 of the RF Labor Code, a compulsory preemptive (before getting on the payroll of an organization) or recurrent (while on the job) medical check up (examination) is applicable only to those workers who are engaged in a specific group of occupations, including hazardous occupations (due to the impact of hazardous agents and unfavorable working environment), as well as those working under the conditions of excessive danger. A special List of medical psychiatric contraindications for the performance of specific professional activities and activities involving an increase level of hazard has been introduced by a Resolution of the RF Government. The ways and procedures for taking such an examination have been set forth by another resolution of the government. A worker is subjected to an examination in response to a written request of the employer that shall specify the type of professional activity and the working conditions. Following the examination the psychiatrist shall give his opinion on the fitness (unfitness) of the worker to the type of activity that was specified in the request of the employer. Moreover, there is no mention of any certificates about whether or not a particular citizen has or has not received any treatment in an outpatient psychiatric facility. There is an ongoing unlawful practice of checking military IDs for notes about relief from military service, including special codes of mental disorders. These notes that relay exclusively to specific military affairs are being then used as a basis for taking decision about the probable employment of applicants, or their enrollment into educational institutions, etc. in the totally different civilian circumstances. Psycho-neurological facilities also receive letters from law-enforcement agencies inquiring whether a particular individual has been their patient. Such letters make reference to “an urgent necessity,” which, however, remains undefined. That is a gross violation of paragraph 3, section 3 of Article 61 of the Foundations under which the information covered by the physician-patient privilege can be provided only in response to an official request from investigation bodies, prosecutor’s office or court in relation to an ongoing investigation or trial. The regulation refers to a situation in which the patient is involved in a civil or criminal action. It is important to note that any such information cannot be requested prior to bringing up charges. A request for the information covered by the physician-patient privilege shall contain reference to a particular criminal case or a criminal/civil trial. The “urgent necessity” referred to by law-enforcement bodies for obtaining this kind of information is not related as a rule to any criminal investigation. For example, one of the policemen frankly told the officials in a psycho-neurological facility that the information about whether or not the person in question had been on their record was necessary “to close the case about the battery of that person” although by that time the fact of injury had been recorded by a forensic medical office and the petition filed by the victim identified the offender. Some of the law-enforcement officers in reply to the question about similar violations of the human rights of citizens with mental disorders often justify themselves by saying that by the time they have to decide on opening a criminal investigation in response to a petition filed by an individual they need to know “everything” about that petitioner. They have to make sure that the facts brought up in the petition (for example, about numerous thefts from an apartment, or destruction of property) are not the result of the petitioner’s lunacy and thus they believe they are entitled to inquire just in case whether or not the petitioner has been a patient of a psycho-neurological facility. Otherwise, if the criminal facts mentioned in the statement prove to be wrong and merely a result of the illness of the petitioner, they would have to close the criminal investigation and face, mildly speaking, the dissatisfaction of the leadership of the law-enforcement agencies. Although this line of argument might be logical to a certain extent, the resulting practice is definitely at odds with the current law. Citizens with mental disorders often encounter other difficulties when they turn to the law-enforcement bodies with petitions, complains and suits in order to reclaim their rights. This group of problems might be the result of internal agency statutes, instructions and rules that are prejudiced against this category of petitioners. For example, the Procedural Rules for the Consideration of Petitions and Claims of the Citizens in the prosecutor’s offices and organizations of the Russian Federation put into force by Order #4 of the Prosecutor General of January 15, 2003 mentions certain conditions under which the petitions of the citizens can be left without consideration and without sending an official notification to the petitioner. In particular, that should be possible, if “the petition’s content makes no sense, while the materials of previous investigations conducted on the petitions filled by the same person contain a document showing that the petitioner is mentally ill and is not capable of adequate evaluation of the current events.” It should definitely be impossible to consider a petition that has no sense. However, it is not quite clear why such a petition should not be ignored in the first place, but only with regard to previously received petitions. The reference to a document allegedly received during the checks on previous petitions and giving evidence about the mental illness of the petitioner that deprives him of the ability to adequately evaluate the current events, raises the following questions: What kind of document do they refer to (certificate, opinion, court decision, evidence of a witness)? Who has the right to issue such documents? What examinations, facts or data and for what time period were used as the basis for the conclusions made? What “current events” does it refer to? What criteria were used to determine the adequate perception of the events by the person in question? Does the chosen measure have the same legal validity as for example legal incapacity? What legal grounds were used by the prosecutor’s office to request such a document? And finally, isn’t it possible that the conclusion was made merely by an outside professional based only on the analysis of the text of the petition? Besides, even when the petition is rejected, it would probably be advisable to notify the petitioner that his petition would not be acted upon and give him the necessary justification. In that case the petitioner would get a second chance to clearly explain his problem and thus still retain the option of petitioning the prosecutor’s office. The only significant “document” under such circumstances would be a court decision ruling the petitioner incapable, which would only mean that he must be represented in court by a guardian. However, in a great number of cases an incapable person would be deprived of guardianship care (either the guardian would not be appointed or once appointed would pursue his own, oftentimes mercantile interests), while the custody and guardianship bodies would fail to exercise their responsibilities. It was not incidental that under Article 45 of the RF Civil Procedure Code the prosecutor was given the authority to go to court to defend the rights, freedoms and legal interests of a citizen, should the latter be incapable of taking legal action due to health, age or incapacity reasons. Thus, legal incapability of an individual shall not, in our opinion, prevent him from turning to the prosecutor’s office to defend his rights. All other so-called “documents” to the effect that the person in question is incapable of adequate perception of the reality and thus all subsequent petitions from that person to the prosecutor’s office shall be ignored without notification are of dubious legal value. Firstly, the physician, and later on the prosecutor, acting on the ground that the person is mentally ill, deprive that person of the protection of his legitimate interests, which contradicts the norms set forth in Article 5, Part 3 of Federal Law “On Psychiatric Assistance.” Moreover, the acceptable format of such right-abridging document has never been approved. Secondly, in accordance with Articles 37 and 39 of Federal Law “On Psychiatric Assistance,” all patients of a psychiatric ward have the right to file uncensored claims and petitions with the prosecutor’s office, while the administration of the psychiatric ward in its turn bears the responsibility for creating the necessary conditions for delivering these claims and petitions to the prosecutor’s office. Following these lines, the physician on the one hand has to meet the requirements of Federal Law “On Psychiatric Assistance,” while on the other can prevents the patient form getting his petition to be acted upon and even from being notified that his petition would be left without resolution. Thirdly, the aforementioned “document” reports on how the person in question evaluates and perceives the reality and not whether or not that person can understand his actions and is in control of them. Fourthly, it is common knowledge that a person with a mental disorder may be capable of making adequate judgments about some events, but not about others. It also goes without saying that certain past events that were judged inadequately by the patient at the time when they occurred, may be judged correctly by the same person now as a result of, for example, the remission. Fifthly, one should not forget that under these circumstances a prosecutor’s office may request the information covered by the physician-patient privilege only with consent of the petitioner or his rightful representative. In the absence of any justification under the Law on psychiatrist assistance any unofficial (i.e. unauthorized by the citizen) examination of the petitioner by a psychiatrist is absolutely impermissible. There is not doubt that handling of petitions arriving from petitioners with mental disorders is a hard task for anybody, including the prosecutor’s office. A good solution in this case would be a closer cooperation between the prosecutor’ office and various professional human rights associations, for example, the NHA of Russia. Other rights of citizens with mental disorders, including those guaranteed in the RF Constitution, are also being ignored. In a number of regions there is an bad practice when citizens undergoing treatment in psychiatrist wards would not be allowed to take part in the elections in spite of the fact that according to Article 32 of the RF Constitutions only those citizens who have been found incapable by a court of law or imprisoned under a decision of a court of law have no right to vote or to be elected. For example, for the last several years the Kalinin district electoral commission of the city of St. Petersburg has been denying the right to take part in the elections to the patients of the St Petersburg republican specialized psychiatrist intensive care clinic. A similar oral ban with reference to alleged regulations and instructions has been imposed by the Soviet district electoral commission of the city of Kazan not only on over one thousand patients who undergo compulsory treatment in the Kazan republican specialized psychiatrist intensive care clinic (although only five per cent of them are legally incapable), but also on the patients of a regular psychiatrist ward of another psychiatrist republican clinic, located in the city of Kazan. Some of the officials have apparently got used to treating citizens with mental disorders as legally incapable even in the absence of any court decision to that effect. Unfortunately, the chief physicians of those clinics failed from the very beginning to contest those decisions of the electoral commissions and did not insist on getting those decisions in writing. It seems to be very unlikely that any such decision would ever be put on paper due to its absolute illegality. The second explanation for failing to meet and even for breaking the legal requirements can be derived from the disrespectful attitude towards law and from the legal nihilism on the side of the officials of various bodies and agencies, who do not want to accept and observe Federal Law “On Psychiatrist Assistance,” as well as a number of other legal acts. Such attitudes can sometimes result in unwarranted placements of orphanage pupils into psychiatrist wards or psycho-neurological facilities, compulsory and unjustifiable placement of school children into correction classes of general education or subcollegiate schools, unlawful denial in the provision of social and medical assistance at home to senior citizens and invalids with mental disorders in the remission stages, etc. Citizens with mental disorders are often denied the right to get direct access to medical documents reflecting the condition of their health. This right has been provided for in Article 31 of the Foundations. However, medical facilities as a rule do not issue copies of medical documents to their patients even in the absence of any restrictions for that from the point of view of the patient’s health. Genuine battles can unfold in psychiatrist organizations when a citizen demands to be given a copy of his medical documents reflecting his health conditions. The rights of citizens with mental disorders are also infringed upon both in the criminal and civil process. Most frequently this happens in the course of forensic and psychiatric inquiries. In an attempt to monopolize expert services, the top management of some of the psychiatrist facilities conducting forensic and psychiatric inquiries does not execute court decisions, that call for inquiries with the participation of independent experts, in particular, representatives of the NHA of Russia, actively barring the participation of outside experts in the inquiry commission. The arguments brought up in such cases are often cooked-up and legally pointless. There are some known examples when these organizations attempted to contest the rightfulness of the position taken by the court, which assigned the conduct of outpatient inspections directly to the NHA psychiatrists and ruled to put the names of those specialists onto the commission membership list. Such actions run contrary to the provisions of Article 79 of the RF Procedure Code, under which an inquiry can be entrusted to a forensic expert organization, a specific expert or a group of experts. Other parties to the case are entitled not only to ask the court to appoint an inquiry to be conducted in a particular forensic expert organization, but even to assign this task to a particular expert. In the case of a criminal forensic inquiry, the right to file a request to appoint specific individuals as experts or to conduct the forensic inquiry in a particular expert organization is also given under Article 198 of the RF Criminal Procedure Code to the suspect, defendant, and victim. The rights of citizens with mental disorders are often violated even by the courts. Such individuals are rarely made familiar with the court ruling about the appointment of an inquiry and the relevant expert opinion. Thus they are deprived of the opportunity to ask the court to appoint an additional, follow-up or a comprehensive inquiry. This is primarily applicable to those individuals who have been requested to be ruled incapable. As a rule, they are not invited to attend the court hearings, although their inability to personally defend their rights and lawful interest in a trial and to be present in the courtroom would not have been examined and established by any experts. For that reason, such citizens are not even aware that they have been ruled insane. The same treatment is also given to those individuals who have been called insane with respect to their deeds. The rights of citizens with mental disorders are also violated during the military call-up. Some of the conscripts turn out to be citizens totally or partially unfit for military service due to their health, including those with mental disorders. According to the central military commissariat of the Ministry of Defense of Russia, around 40 per cent of the personnel discharged from the military service as people not suitable for conscription due to their health are people with mental disorders. This is the largest group among the wrongly called up conscripts with health problems. Military conscription commissions do not conduct a psychological-psychiatric examination of the draftees all the time; they do not always prepare written reports to accompany the conscripts to their place of service. There’ve been instances when the conscription commission operated without a psychiatrist and unqualified individuals performed the examination of the mental health of the recruits. An inspection conducted in one particular region uncovered cases when absent professionals on the commission, including a psychiatrist, were replaced by paramedics. In this particular instance the party to blame was the local self-government body that failed to provide necessary specialists to the medical commissions. Similar facts have been revealed as a result of the prosecutor’s office inspections in Moscow, Ivanovo, Sverdlovsk regions and the republic of Tatarstan. According to the data provided by the Pskov regional prosecutor’s office 17 out of 20 revoked decisions of the regional conscription commission were attributable to an improper medical opinion. All conscripts were discharged from the regional conscription center because of their unfitness for military services and recommendations were made for their medical examination and treatment. In Kostroma region the military conscription in a number of cases was conducted not by conscription commissions, but by employees of the military commissariats who would make their own decisions about the fitness of individual citizens for military service and later file fabricated protocols of the conscription commissions to back up those decisions. There is still evidence of an ill practice when every effort is being made to reach a conscription target that is often exaggerated. This is the reason why people with obvious mental disorders are being sent time and again to the armed forces although the personal files of these conscripts contain the data about their mental problems. Logging an appeal against a decision of a conscription commission is normally fraught with considerable difficulties, created by the military commissariats. In violation of paragraph 6, Article 28 of Federal Law “On Military Duty and Military Service,” chair persons of the conscription commissions do not make public the decision of the conscription commissions and refuse to hand out copies of such decisions. The court then would refuse to accept a complaint against unlawful actions of the conscription commission without the copy of that decision attached. Citizens are often deprived of the opportunity to contest the decision of a conscription commission because they are considered called up the day after the decision was taken. There have been registered cases when conscripts would be sent to their places of duty right after the medical examination. As it has already been noted, the numerous instances of the abuse of the physician-patient privilege may be attributable to a wide range of reasons. Some of them are related to the legal nihilism of those who are responsible for the collection and dissemination of such data. In particular this is related to the mass media outlets, which would thoughtlessly demonstrate their knowledge about the mental health conditions of various people without being aware that such actions are liable to disciplinary, civil, administrative and criminal proceedings. Following every such newspaper article, containing personal information about an individual and mentioning his psychiatric diagnosis, we feel obliged to contact the authors and the managers of the publication to explain to them the wrongfulness and harmfulness of this kind of journalistic work. The only convincing argument that seemed to impress the editors of the section “Accidents and events” of the Moscovsky Komsomolets newspaper when we raised this issue with them was our mentioning of the criminal liability for divulging a secret protected by law. One of the most notorious articles in this respect was an article in the newspaper Metro that is freely distributed in Moscow to thousands of passengers. In that article the journalist gave a record of her visit to a detoxification center where she put on a white robe and with permission of the physician listened to the complaints of the patients while looking through the stack of medical case histories to ease their tension. She said that above all she got interested in the medical terminology that was later explained to her with regard to each patient. The very title of the article “Do not be afraid of detoxification doctors and psychiatrists” sounds like a mockery of the law. The third reason is related to the shortcomings of the legislation as such. The problems with the observation of the rights of mentally ill people arise firstly due to the conflict of laws. For example, some of the provisions of the Law on Psychiatric Assistance contradict the Foundations of the RF Legislation on the Health Protection of Citizens and Federal Law “On the Provision of Social Services to Senior Citizens and Invalids,” etc. For example, under Federal Law “On Psychiatric Assistance” the cause for putting an incapable individual into a psycho-neurological facility for social care shall be the decision of the guardianship body, passed on the basis of the opinion of a medical commission with the participation of a psychiatrist. However, Federal Law “On the Provision of Social Services to Senior Citizens and Invalids” gives as the cause for such placement only a written request filed by the guardian. This rule is undoubtedly less desirable as it creates in fact a loophole for dishonest actions on the side of the guardian. There are also contradictions between the RF Civil Code and the RF Civil Procedure Code. Article 40 of the Civil Code says that only a court can rule to call a person legally capable following a request by the guardian of the incapable person or his guardianship body. At the same time according to the provisions of Article 286 and 45 of the Civil Procedure Code the right of filing such a request is given beside the guardian and the guardianship body also to a family member of the incapable person, psychiatric or psycho-neurological facility and the prosecutor’s office. By making an incursion into the procedural issues the Civil Code has narrowed the circle of probable petitioners, thus effectively reducing their opportunities to protect the rights of the people with mental disorders. Under the old RSFSR Civil Procedure Code of the right to file such petitions with the court also belonged to public organizations. Elimination of the latter from the list of persons and entities authorized to actively defend the rights of the incapable individuals seems to be a poorly justified novelty in the new Civil Procedure Code. Inconsistencies can be found even in the RF Civil Code. For example, Article 37 of the Civil Code authorizes the guardian to donate the property of the individual under his protection with prior permission of the custody and guardianship bodies. At the same time, Article 575 of the Civil Code completely bans any donations on behalf of the incapable individual by his guardian, except for ordinary gifts worth not more than 5 minimum wages. It often happens that the adopted by-laws are not in line with the corresponding law. For example, under paragraph 11 of the Rules of Military-Medical Inspection, adopted by the government’s Resolution #123 of February 25, 2003, medical organizations must report the information about the citizens kept on their record (under observation) for mental disorder, drug addiction, alcoholism, toxicomania, abuse of narcotic drugs and other toxic substances, or individuals undergoing follow-up treatment for other diseases, note the diagnosis and also make available medical files and other medical documents that characterize the health conditions of the citizens eligible for military registration, military conscription, citizens, who applied for enrollment into military academies, as well as reservists within two weeks following the receipt of the request not only from military and medical commissions, but also from military commissariats and HR departments of the federal executive bodies that have regular military formations within their organization. Surprisingly none of those responsible for the maintenance of law and order in this country is in any way concerned that this requirement is at odds with Article 61 of the Foundations of Legislation of the Russian Federation on the Healthcare of the Citizens that disallows the provision of information involving physician-patient privilege without express consent of the citizens. In this particular case it is necessary either to amend the Foundations, or to bring the text of the Rules in line with the Foundations. Secondly, the realization of the rights of individuals with mental disorders is hampered due to various gaps in the legislation. For example, there is not legal regulation of the issues related to the psychosomatic treatment, detoxification assistance, and in-patient psychiatric examination of citizens (including compulsory examinations) eligible for military registration or military conscription. Although Article 53 of the Foundations proclaims the right of the citizens to independent medical examination, it doesn’t list independent military examination as an available option. The long-awaited introduction into RF Civil Procedure Code of Article 35 regulating the proceedings for the consideration of the cases of involuntary hospitalization of citizens into psychiatric facilities and involuntary psychiatric examination under the Law on Psychiatric Assistance has finally closed (ten years after the enactment of the Law) the gap concerning the decision making process on this issue and removed the inconsistencies in the application of this law. However the developers of the new CPC overlooked the fact that Federal Law “On the Provision of Social Services to Senior Citizens and Invalids” of August 2, 1995 made the courts responsible also for taking a decision on involuntary placement of individuals with mental disorders into psycho-neurological homes. The procedural rules for the consideration of such cases remained undefined by RF Civil Procedure Code. Thirdly, the impact of a number of legal innovations has been brought to naught due to their conceptual faults. This pertains in full, for example, to the attempt to introduce into the criminal law the notion of partial insanity. The legal norm of criminal liability of the individuals with mental disorders that do not rule out sanity (Article 22 of the RF Criminal Code) was the reply to the growth of crimes committed by individuals with mental disorders. It was meant to lay down the legal foundation for taking into account the psychic and psychological characteristics of the offender’s personality, and the way they affect the offender’s choice of behavioral patterns and their subsequent implementation. It was meant to become the basis for taking the behavioral correction and social rehabilitation of this type of individuals to a qualitatively new level. However, that did not happen. A number of key issues, including the criteria for keeping tabs on partial insanity, the rules for sentencing those who have committed their offence in the state of partial insanity, as well as service of the term and amnesty issues in relation to such individuals were left without regulation. The introduction of the institute of compulsory psychiatric outpatient observation and treatment has not received either legal or organizational backing. There is also a lesser incompatibility between part 1 and part 2 of Article 22 of the Criminal Code related to the responsibility of the court to take into account the psychic disorder of the defendant. The lack of readiness both on the side of psychiatric experts and judges for the implementation of this norm caused a lot of controversy in the expert and judicial practice. The total number of people recognized by forensic and psychiatric inquiries as eligible under the requirements of Article 22 of the Criminal Code is from 3.7 to 3.9 thousand a year. In 75% of the cases the experts recommend a compulsory medical treatment in addition to the punishment. However, the number of convicts actually receiving such a treatment under a court’s order is normally 2.6-3.3 times less. This discrepancy cannot be explained by the balanced position taken by the courts towards the application of this measure. The courts often simply ignore the expert opinion in their rulings, experience great difficulties in reaching their own decision on the issue, and order additional or follow-up inquiries without sufficient cause. When they choose to follow the recommendations of the experts, they do it a perfunctory way without providing sufficient justification. The experts in their turn fail to tie up in a sufficient way the mental disorders of an individual with the circumstances of his crime. In some regions of Russia the partial insanity norm is either totally ignored or applied too frequently. In other regions all individuals recognized as partially insane are recommended for a compulsory treatment. There are also regions where compulsory treatment is not recommended to this category of individuals at all. The fourth reason for the failure of the laws related to the individuals with mental disorders is the absence of the mechanisms for their implementation, as well as the lack of sufficient funding. It is this reason that is given by the bodies of social protection to explain the implementation failure of Federal Law “On Social Protection of Invalids in the Russian Federation” (enacted as far back as 1995) with regard to the development of individual rehabilitation programs for invalids that have to be initiated by the State Medical and Social Inspection Service. The lack of funding also brought to a halt the Federal Special Program called “Urgent Measures for the Improvement of Psychiatric Assistance (1995-1997)” that created the necessary environment for the implementation of Federal Law “On Psychiatric Assistance.” About half of the Russian Federation constituent territories have not adopted such programs at all, while the rest have implemented them only partially. The plans to create a special service provided for in Federal Law “On Psychiatric Assistance” that would be responsible for the protection of the rights of patients, kept in psychiatric wards, also failed to materialize. Not attempts have been made to study the foreign experience in this area. The failure of the laws, related to the protection of the rights of citizens, including the most socially vulnerable groups, like individuals with mental disorders, who are in need of special care and attention, is also explained by the lack of appropriate environment. Especially noteworthy in this respect is the extremely low overall level of legal awareness and legal culture in Russia. The majority of the citizens are ill informed even of those rights and the ways of their protection that have been proclaimed in the Basic Law of the country. Some citizens don’t even try to raise their awareness of these issues and thus to take a proactive position in defending their rights. Moreover, Russia unfortunately doesn’t possess the tradition of respecting and protecting the human rights and freedoms. |
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