A person who has been assigned a compulsory measure of a medical nature. Compulsory medical measures

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- these are measures of medical (psychiatric and organizational-preventive) assistance and protection provided for by law, forcibly applied in accordance with the ruling (decision) of the court to persons who have committed criminally punishable socially dangerous acts or crimes, who suffer from mental disorders and, as a result, pose a social danger for the purpose of healing or improving their mental state, as well as preventing them from committing new socially dangerous acts. The legislator classifies such measures as “other measures of a criminal legal nature.”

The use of compulsory medical measures is provided for in Art. 21,22,81 CC. In the norms of Ch. 15 of the Criminal Code, which defines the grounds, goals, types and procedure for applying these measures (Articles 97-104 of the Criminal Code), the provisions of these articles are specified.

The main provisions governing the use of compulsory medical measures and guarantees of the rights of citizens in respect of whom they are applied are also defined in the Criminal Procedure Code, Penal Code, other legislative and other regulatory legal acts, and international treaties to which Russia participates. The Plenum of the Supreme Court of the Russian Federation, in its resolution of April 7, 2011 No. 6 “On the practice of using compulsory measures of a medical nature by courts,” indicated that courts, when resolving issues related to the use of compulsory measures of a medical nature, should strictly comply with the Constitution of the Russian Federation and the norms of current legislation , take into account the practice of the European Court of Human Rights.

The specificity of this criminal law institution lies in its legal nature: in essence, compulsory medical measures are a kind of criminal law security measures applied to persons who have committed a socially dangerous act prohibited by criminal law, who suffer from a mental disorder and pose a danger to themselves or others persons who therefore need appropriate psychiatric treatment and various rehabilitation measures. The purposes of applying such measures are to cure or improve the mental state of these persons, as well as to prevent them from committing new socially dangerous acts.

Compulsory medical measures are not related to the state’s response to a crime in any form of criminal law or with the implementation of criminal liability, they are not a type of criminal punishment or another measure of a criminal law nature, which, according to Art. 2.6 and 7 of the Criminal Code should be applied “for the commission of a crime.” In contrast to such measures, which have a punitive nature and are applied to persons who have committed a crime, for its commission, in accordance with the nature and degree of its public danger and in order to restore social justice (Article 43), compulsory measures of a medical nature do not have any of these signs.

These measures are complex; they combine medical and legal components. They are applied to persons who suffer from mental disorders and need appropriate psychiatric treatment and various rehabilitation measures (medical component), who have committed a socially dangerous act prohibited by criminal law, pose a danger to themselves or other persons and therefore need the minimum necessary coercion and certain , sometimes significant, restriction of rights and freedoms (legal component). It would be more correct to call compulsory measures of a medical nature: “medical security measures in criminal law” or “medical measures of a criminal law nature.”

Such measures are applied strictly in the presence of legal grounds within the framework of criminal proceedings by a court decision in the presence of the conclusion of an independent commission of psychiatrists. These measures are ensured by state coercion and are applied to persons who have committed a socially dangerous act instead of criminal liability and (or) punishment or along with them.

The originality of the measures under consideration is also manifested in their content, the characteristic features of which are the following:

their use involves creating conditions that ensure the safety of the patient for others and himself during the treatment period;
they are carried out by way of legal coercion, i.e. on the basis of a legal and reasoned court decision and regardless of the wishes of the persons to whom they apply and their legal representatives;
their application (selection, continuation, change, termination) is based on an assessment of the severity and depth of the mental disorder and the presence of a social danger of the person, as well as the prognosis of their development;
the compulsory nature of these measures determines the exclusive competence of the court to prescribe, continue, change, terminate them; in this case, psychological and psychiatric expert opinions are not binding for the court and are assessed according to the general rules for assessing evidence in conjunction with other evidence characterizing the personality and behavior of a person precisely from the point of view of his danger to other persons and himself;
the most important principle of applying the measures under consideration is the minimum necessary sufficiency of coercion in relation to the patient to whom they are applied, and perhaps a more tactful and careful attitude towards his person.

Thus, we are talking about an independent and unique complex medico-legal institution, built around the forced application, in necessary cases, of measures of a medical and rehabilitation nature, the grounds and limits of application of which are provided for by criminal law, the procedure for application is criminal procedural, and the procedure for execution is criminal law. executive legislation of the Russian Federation and other federal laws.

Grounds and purposes of using compulsory medical measures

Grounds for the use of compulsory medical measures. In Part 1 of Art. 97 indicated three categories of persons, to whom the court may impose compulsory medical measures.

Firstly, these are persons who have committed a socially dangerous act prohibited by criminal law in a state of insanity. Such persons, due to a mental disorder, are not able to realize the actual nature and social danger of their actions (inaction) or to manage them, therefore they are not subject to criminal liability (Article 21 of the Criminal Code). Bringing criminal responsibility and applying punishment to such persons is senseless, inappropriate and unfair. Moreover, this is unacceptable, since it would mean prosecution without guilt.

Secondly, these are persons who, after committing a crime (before the trial, during the trial or during the execution of the sentence), have a mental disorder that deprives them of the opportunity to realize the actual nature and social danger of their actions (inaction) or to manage them and makes it impossible to assign or execute they are punished. Such persons are released by the court from punishment or from further serving it (Part I of Article 81 of the Criminal Code); in case of recovery, they may be subject to criminal liability and punishment if the statute of limitations provided for in Art. 78 and 83 of the Criminal Code.

Third, these are persons who have committed a crime and suffer from mental disorders that do not exclude sanity. We are talking about relatively shallow mental disorders that limit the ability of the subject of a crime to understand the nature and meaning of his actions or to control them (Article 22 of the Criminal Code). Compulsory treatment in the form of outpatient compulsory observation and treatment by a psychiatrist (Part 2 of Article 99 of the Criminal Code) is applied to such persons along with criminal punishment.

All of these persons are united by the fact that they: a) suffer from a mental disorder, b) have committed a socially dangerous act prohibited by law, and c) are recognized as in need of psychiatric treatment. However, the presence of these signs does not mean that these categories of persons are subject to mandatory compulsory treatment. Compulsory medical measures are prescribed to these categories of persons only in cases where their mental disorders are associated with the possibility of these persons causing other significant harm or danger to themselves or other persons (Part 2 of Article 97 of the Criminal Code).

In each specific case, the basis for the use of compulsory medical measures consists of a set of conditions specified in the law:

the person belongs to one of those specified in Part 1 of Art. 97 of the Criminal Code categories (he suffers from a mental disorder, has committed a socially dangerous act prohibited by law and is recognized as in need of psychiatric treatment);
this person represents a social danger (to himself or to other persons).

The purpose of applying compulsory medical measures is to cure the persons specified in Part 1 of Art. 97 of the Criminal Code, or such an improvement in their mental state that they cease to pose a public danger, as well as preventing such persons from committing new acts provided for in the articles of the Special Part of the Criminal Code (Article 98 of the Criminal Code).

The above was confirmed by the LVS of the Russian Federation in resolution No. 6 of April 7, 2011: “compulsory measures of a medical nature are measures of a criminal law nature and are applied only to persons who have committed a socially dangerous act provided for by criminal law in a state of insanity or who, after committing a crime, have suffered a mental disorder that makes it impossible to impose a punishment or its execution, as well as to persons who have committed a crime and suffer from mental disorders that do not exclude sanity, and only if the mental disorder is associated with the possibility of these persons causing other significant harm or with a danger to themselves or other persons (parts 1 and 2 of Article 97 of the Criminal Code of the Russian Federation). At the same time, the purposes of applying compulsory measures of a medical nature differ from the purposes of applying punishment and, by virtue of Article 98 of the Criminal Code of the Russian Federation, are to cure or improve the mental state of these persons, as well as to prevent them from committing new socially dangerous acts provided for by criminal law.”

Purpose of treatment involves the complete recovery of a person as a result of the application of correctly prescribed compulsory medical measures to him (for example, placement in a hospital with a certain type of regime, the use of drug therapy, psycho- and occupational therapy, as well as other measures aimed at restoring his mental health and social rehabilitation). In those frequent cases when a complete cure of the mentioned persons is impossible, achieving at least the goal of a stable “improvement of the mental state” of these persons, at least making them safe for themselves and other persons, is considered sufficient.

Purpose of warning new socially dangerous acts by the persons specified in Part 1 of Art. 97 of the Criminal Code means the achievement, as a result of the use of compulsory measures of a medical nature, of such a state of the patient in which he ceases to be socially dangerous both for himself and for other persons. The means of achieving this goal are various organizational, preventive, treatment and rehabilitation measures in relation to such persons in the form of isolating them from society, establishing regime restrictions, and using the necessary medical means and methods.

In cases where there is objective evidence indicating that the goal in question has been achieved, the application of these compulsory medical measures to him should be stopped. If necessary, general measures of psychiatric care may be applied to the person in accordance with health legislation.

Types of compulsory medical measures

The persons specified in Art. 97 of the Criminal Code, the court may impose compulsory medical measures in the form of outpatient compulsory observation and treatment by a psychiatrist or in the form of compulsory treatment in a psychiatric hospital of a general type, a specialized type or a specialized type with intensive supervision (Part 1 of Article 99 of the Criminal Code).

The law provides an exhaustive list of types of compulsory medical measures and types of medical institutions providing psychiatric care to these persons. The list is based on the views of specialists (a commission of psychiatrists and the court) about the nature and intensity of treatment of a person suffering from a mental disorder, and the degree of restrictions necessary to ensure the implementation of the goals provided for in Art. 98 of the Criminal Code. Types of compulsory measures differ in the regime of detention of patients and the intensity of supervision over them.

When choosing a compulsory measure of a medical nature to be applied, the court is guided by the medical (mental state of the patient) and social (degree of social danger) criteria specified in the law: the worse the first and the higher the second, the higher the degree of necessary restrictions and the intensity of treatment and rehabilitation measures . The basis of the court decision is reliable data indicating the nature and degree of social danger of the person (in particular, the characteristics of the socially dangerous act committed, the methods, motives, consequences of its commission, the person’s behavior before, during and after its commission), as well as an assessment of the mental disorder and the prognosis of its development, expressed in the conclusion of a commission of psychiatrists.

The type of compulsory measure of a medical nature is selected by the court, taking into account the provisions of Part 2 of Art. 99, art. 100 and 101 of the Criminal Code. When determining the type of such measure in relation to the persons specified in paragraphs. “a”, “b” part 1 art. 97 of the Criminal Code, courts should take into account the nature and degree of mental disorder, the person’s danger to himself and others, or the possibility of causing them other significant harm.

The court must justify the decision made on the basis of an assessment of the opinion of the expert (experts) on the mental state of the person against whom proceedings are being conducted to apply a compulsory measure of a medical nature, and other evidence collected in the case (clause 4 of the Resolution of the RF PVS dated April 7, 2011 No. 6).

Outpatient compulsory observation and treatment by a psychiatrist may be prescribed if there are grounds provided for in Art. 97 of the Criminal Code, if a person, due to his mental state, does not need to be placed in a psychiatric hospital (Article 100 of the Criminal Code). When deciding whether to assign this particular measure to a specific person, the court must proceed from the fact that this type of compulsory medical measures is used in cases where the person does not need special conditions for treatment, constant care and inpatient detention, and poses minimal danger for yourself or others.

The use of this measure involves systematic monitoring of the patient’s mental state through regular examinations by a psychiatrist; carrying out the necessary treatment, rehabilitation measures and providing social assistance at the patient’s place of residence or at the place of serving the sentence. The essence of this measure and its main advantage compared to compulsory hospital treatment is the possibility of maintaining the patient’s usual lifestyle, continuing to work if there are no contraindications for this, fulfilling civil, family and other responsibilities, and maintaining contacts with loved ones.

Outpatient compulsory observation and treatment by a psychiatrist may also be prescribed by the court to persons convicted of crimes committed in a state of sanity, but in need of treatment for mental disorders that do not exclude sanity. In this case, treatment is prescribed to the convicted person along with the punishment and is applied during its execution (Part 2 of Article 99 of the Criminal Code). Placing a patient in a psychiatric hospital excludes the possibility of carrying out the punishment assigned to him, therefore their joint application is not provided for by law.

Compulsory treatment in a psychiatric hospital may be appointed if there are grounds provided for in Art. 97 of the Criminal Code, if the nature of a person’s mental disorder requires such conditions of treatment, care, maintenance and observation that can only be carried out in a psychiatric hospital (Part 1 of Article 101 of the Criminal Code). The law provides for three options for compulsory treatment in psychiatric hospitals: general, specialized and specialized with intensive supervision. When choosing the type of hospital, the court must be guided by the principle of the necessity and sufficiency of the prescribed measure for the implementation of the treatment and rehabilitation measures indicated for the patient and the prevention of new dangerous actions on the part of the patient while respecting his rights and legitimate interests.

Compulsory treatment in a general psychiatric hospital can be prescribed to a person who, due to his mental state, needs inpatient treatment and observation, but does not require intensive supervision (Part 2 of Article 101 of the Criminal Code). These include, in particular: persons who retain the likelihood of repeating a socially dangerous act with a generally favorable therapeutic prognosis and the absence of a tendency to commit new socially dangerous acts and violations of hospital regulations; as well as persons with mental disorders transferred from outpatient compulsory treatment or from specialized psychiatric hospitals. The condition of such a patient allows for the possibility of his being kept without special safety measures, in a free inpatient setting.

A general psychiatric hospital is a department of a psychiatric hospital or other similar institution providing inpatient psychiatric care, for which the provision of compulsory treatment is not the main function.

Compulsory treatment in a specialized psychiatric hospital may be assigned to a person whose mental state requires constant monitoring (Part 3 of Article 101 of the Criminal Code). In specialized psychiatric hospitals (hospitals, departments provided for in Parts 3 and 4 of Article 101 of the Criminal Code), unlike general hospitals, only patients are kept who are sent for compulsory treatment and, therefore, pose a significant public danger. In this regard, in relation to such patients, there is a need for constant (continuous) monitoring, which is provided by additional medical personnel and a special security organization.

In accordance with parts 3 and 4 of Art. 101 of the Criminal Code, only persons whose mental state, accordingly, requires constant observation or who pose a particular danger to themselves or other persons and require constant and intensive observation (clause 4 of the resolution of the PVS of the Russian Federation from April 7, 2011 No. 6).

Compulsory treatment in a specialized psychiatric hospital with intensive supervision may be assigned to a person whose mental state poses a particular danger to himself or other persons and requires constant and intensive monitoring (Part 4 of Article 101 of the Criminal Code). This compulsory measure of a medical nature is recommended to be applied primarily to persons with chronic mental disorders or dementia, who show a tendency to commit repeated grave or especially grave socially dangerous acts and gross violations of hospital regulations, including attacks on staff, repeated attempts to escape, etc., and also transferred from general or specialized psychiatric hospitals.

Minors under 16 years of age are not sent to specialized psychiatric hospitals with intensive supervision.

The procedure for extending, changing and terminating compulsory medical measures

As well as the appointment of compulsory medical measures, issues of their extension, modification and termination are carried out only by the court upon the proposal of the administration of the institution providing compulsory treatment, on the basis of the conclusion of a commission of psychiatrists (Part 1 of Article 102 of the Criminal Code).

When prescribing compulsory measures, the court does not determine their duration, since it is impossible to determine in advance the period necessary to cure or improve the patient’s health condition. Only the type of compulsory measure is indicated. A person who has been assigned a compulsory measure of a medical nature is subject to examination by a commission of psychiatrists at least once every six months to determine his mental state and decide whether there are grounds for making a submission to the court to terminate the application or change such a measure.

An examination of such a person is carried out at the initiative of the attending physician if, during the treatment process, he came to the conclusion that it is necessary to change the compulsory medical measure or terminate its application. An examination can also be carried out at the request of the person himself, his legal representative and (or) a close relative, which is submitted through the administration of the institution providing compulsory treatment, regardless of the time of the last examination.

After six months have passed and there are no grounds to terminate or change the compulsory medical measure, the administration of the institution providing compulsory treatment submits a conclusion to the court to extend compulsory treatment. The first extension of treatment can be made after six months from the date of its start, and subsequently annually (Part 2 of Article 102 of the Criminal Code). Such a special procedure is provided for by law in connection with significant restrictions on the rights and freedoms of citizens during the application of compulsory medical measures and the need to guarantee their justified application and reasonable sufficiency.

The change or termination of the application of a compulsory medical measure is carried out by the court in the event of such a change in the mental state of a person in which there is no need to apply a previously prescribed measure or there is a need to prescribe another compulsory measure of a medical nature (Part 3 of Article 102 of the Criminal Code).

For example, if a person in respect of whom a compulsory measure of a medical nature has been prescribed in the form of outpatient compulsory observation and treatment by a psychiatrist, changes have occurred related to the need to place such a person in a psychiatric hospital for compulsory treatment (he has become an increased danger to himself or other persons ), the court has the right to change the type of compulsory medical measure in accordance with Part 1 of Art. 99 of the Criminal Code, when there is evidence that the nature of a person’s mental disorder requires such conditions of treatment, care, maintenance and observation that can only be carried out in a psychiatric hospital (clause 29 of the Resolution of the PVS of the Russian Federation of April 7, 2011 No. 6).

Grounds for stopping forced treatment there is no need for its use, meaning the absence of the general basis specified in Art. 97 of the Criminal Code, and achieving the goals provided for in Art. 98 of the Criminal Code: recovery of the patient or such a change in his mental state that there is no need for compulsory treatment.

In cases where, due to a change in the mental state of a person, there is no longer a need to apply a previously prescribed measure or there is a need to prescribe another compulsory measure of a medical nature, there is a basis for changing the previously prescribed measure and replacing it with another, more stringent or softer one, with a different “set” of compulsory -preventive, therapeutic and rehabilitation means and measures. Replacement of a previously prescribed compulsory measure of a medical nature is carried out on the basis of the signs specified in Art. 100 and 101 of the Criminal Code.

Conclusion of the commission of psychiatrists, as well as the presentation of the administration of the treating institution, are not binding for the court and are subject to verification and evaluation in court. The court has the right to disagree with the conclusions of the medical commission and the administration of the medical institution and make a decision contrary to their recommendations.

In the event of termination of the use of compulsory treatment in a psychiatric hospital, the court may transfer the necessary materials in relation to the person who was subject to compulsory treatment to the health authorities to resolve the issue of his treatment or referral to a psychoneurological social security institution in the manner prescribed by the legislation of the Russian Federation on healthcare (Part 4 Article 102 of the Criminal Code).

A patient in respect of whom the use of compulsory medical measures has been terminated by a court ruling, if there are medical indications, may, in accordance with the Law on Psychiatric Care, be left to continue treatment on a general basis in the same or another psychiatric hospital (except for specialized hospitals and specialized hospitals with intensive observation) or placed under the supervision of a psychoneurological dispensary (dispensary department, office).

Counting the time of application of compulsory medical measures. In case of recovery of a person whose mental disorder occurred after committing a crime (parts 1 and 4 of Article 81 of the Criminal Code), when imposing a sentence or resuming its execution, the time during which the person was subjected to compulsory treatment in a psychiatric hospital is counted towards the term of punishment at the rate of one day of stay in a psychiatric hospital for one day of imprisonment (Article 103 of the Criminal Code).

Compulsory medical measures combined with the execution of punishment

For persons convicted of crimes committed in a state of sanity, but in need of treatment for mental disorders that do not exclude sanity, the court, along with punishment, may impose a compulsory medical measure in the form of outpatient compulsory observation and treatment by a psychiatrist (Part 2 of Article 99 of the Criminal Code). This measure must be implemented at the place of serving imprisonment, and in relation to those sentenced to other types of punishment - in healthcare institutions providing outpatient psychiatric care (Part 1 of Article 104 of the Criminal Code).

If the mental state of the convicted person changes in the direction of deterioration so much that there is a need for his inpatient treatment (Part 1 of Article 101 of the Criminal Code), his placement in a psychiatric hospital or other medical institution is carried out in the manner and on the grounds that are provided for by the legislation on health care, i.e. .e. in the usual manner (Part 2 of Article 104 of the Criminal Code). Despite the similarity of the conditions underlying this measure and the basis of other compulsory measures provided for in Art. 101 of the Criminal Code, here we are talking about inpatient treatment, which is not in the nature of a compulsory measure; the basis, goals and content of its application do not entail the need to release the person from punishment, the serving of the sentence is not interrupted, the time of stay in the hospital is counted towards his term from the calculation provided for in Art. 103 of the Criminal Code. Those sentenced to punishment in the form of imprisonment are placed in inpatient medical institutions of places of deprivation of liberty, those sentenced to penalties not related to imprisonment are placed in psychiatric hospitals of health care authorities.

The time spent in these institutions is counted towards the term of serving the sentence. If there is no longer a need for further treatment of the convicted person in these institutions, discharge is carried out in the manner prescribed by the legislation of the Russian Federation on healthcare (Part 3 of Article 104 of the Criminal Code).

In cases of recovery of a convicted person who was prescribed compulsory treatment combined with the execution of a sentence, or such improvement in his mental state that there is no need for further compulsory treatment, the court terminates the application of compulsory medical measures on the proposal of the body executing the punishment, based on the conclusion of the commission psychiatrists (Part 4 of Article 104 of the Criminal Code). A change or extension of the application of such a compulsory measure, provided for in relation to other compulsory measures of a medical nature (Article 102 of the Criminal Code), is not provided for by law in relation to this measure.

To terminate compulsory treatment prescribed in accordance with Art. 104 of the Criminal Code, the basis on which it was assigned must be eliminated (Part 4 of Article 104 of the Criminal Code); the very end of the execution of a sentence that is accompanied by compulsory treatment (including in connection with an amnesty or pardon) does not entail its automatic termination.

Section VI. Other measures of a criminal legal nature

Chapter 15. Compulsory medical measures

Article 97. Grounds for applying compulsory medical measures
1. Compulsory medical measures may be imposed by a court on the following persons:
a) who committed acts provided for in the articles of the Special Part of this Code in a state of insanity;
b) who, after committing a crime, have developed a mental disorder that makes it impossible to impose or carry out punishment;
c) who have committed a crime and suffer from mental disorders that do not exclude sanity;
d) has become invalid;
e) who, at the age of over eighteen, have committed a crime against the sexual integrity of a minor under fourteen years of age, and who suffer from a disorder of sexual preference (pedophilia), which does not exclude sanity.
2. Persons specified in part one of this article are prescribed compulsory medical measures only in cases where mental disorders are associated with the possibility of these persons causing other significant harm or danger to themselves or other persons.
3. The procedure for the execution of compulsory medical measures is determined by the criminal executive legislation of the Russian Federation and other federal laws.
4. In relation to the persons specified in paragraphs “a” - “c” of part one of this article and who do not pose a danger due to their mental state, the court may transfer the necessary materials to the federal executive body in the field of healthcare or the executive body of the constituent entity of the Russian Federation in in the healthcare sector to resolve the issue of treating these persons in a medical organization providing psychiatric care, or sending these persons to inpatient social service institutions for persons suffering from mental disorders, in the manner established by legislation in the field of health care.

Article 98. Purposes of applying compulsory medical measures
The purposes of applying compulsory medical measures are to cure the persons specified in part one of Article 97 of this Code, or improve their mental state, as well as to prevent them from committing new acts provided for in the articles of the Special Part of this Code.

Article 99. Types of compulsory medical measures
1. The court may order the following types of compulsory medical measures:
a) compulsory observation and treatment by a psychiatrist on an outpatient basis;
b) compulsory treatment in a medical organization providing psychiatric care in an inpatient setting, of a general type;
c) compulsory treatment in a specialized medical organization providing psychiatric care in inpatient settings;
d) compulsory treatment in a medical organization providing psychiatric care in an inpatient setting, a specialized type with intensive supervision.
2. For persons convicted of crimes committed in a state of sanity, but in need of treatment for mental disorders that do not exclude sanity, including persons specified in paragraph "e" of part one of Article 97 of this Code, the court, along with punishment, may impose a compulsory measure of a medical nature in the form of compulsory observation and treatment by a psychiatrist on an outpatient basis.

Article 100. Compulsory observation and treatment by a psychiatrist on an outpatient basis
Compulsory observation and treatment by a psychiatrist on an outpatient basis may be prescribed if there are grounds provided for in Article 97 of this Code, if the person’s mental state does not require placement in a medical organization providing psychiatric care in an inpatient setting.

Article 101. Compulsory treatment in a medical organization providing psychiatric care in inpatient conditions
1. Compulsory treatment in a medical organization providing psychiatric care in inpatient conditions may be prescribed if there are grounds provided for in Article 97 of this Code, if the nature of the person’s mental disorder requires such conditions of treatment, care, maintenance and observation that can only be carried out in a medical organization providing psychiatric care in inpatient settings.
2. Compulsory treatment in a medical organization providing psychiatric care in an inpatient setting, of a general type, may be prescribed to a person whose mental state requires treatment and observation in an inpatient setting, but does not require intensive supervision.
3. Compulsory treatment in a specialized medical organization providing psychiatric care in an inpatient setting may be prescribed to a person whose mental state requires constant monitoring.
4. Compulsory treatment in a medical organization providing psychiatric care in an inpatient setting, of a specialized type with intensive supervision, may be prescribed to a person whose mental state poses a particular danger to himself or others and requires constant and intensive supervision.

Article 102. Extension, modification and termination of the application of compulsory medical measures
1. Extension, modification and termination of the application of compulsory medical measures are carried out by the court upon the proposal of the administration of the medical organization providing compulsory treatment, or the criminal-executive inspection that controls the application of compulsory medical measures, based on the conclusion of a commission of psychiatrists.
2. A person who has been assigned a compulsory measure of a medical nature is subject to examination by a commission of psychiatrists at least once every six months to decide whether there are grounds for making a submission to the court to terminate the application or to change such a measure. An examination of such a person is carried out at the initiative of the attending physician, if during the course of treatment he came to the conclusion that it is necessary to change the compulsory measure of a medical nature or terminate its application, as well as at the request of the person himself, his legal representative and (or) a close relative. The petition is submitted through the administration of the medical organization providing compulsory treatment, or the criminal executive inspection, which monitors the use of compulsory medical measures, regardless of the time of the last examination. In the absence of grounds for terminating the application or changing a compulsory medical measure, the administration of the medical organization providing compulsory treatment, or the criminal-executive inspection that monitors the use of compulsory medical measures, submits a conclusion to the court to extend compulsory treatment. The first extension of compulsory treatment can be made after six months from the date of commencement of treatment; thereafter, extension of compulsory treatment is carried out annually.
2.1. Regardless of the time of the last examination and the decision made to terminate the use of compulsory medical measures, the court, on the basis of a petition submitted no later than six months before the expiration of the sentence by the administration of the institution executing the punishment, appoints a forensic psychiatric examination in relation to the person specified in the sentence. paragraph "d" of part one of Article 97 of this Code, in order to resolve the issue of the need to apply compulsory medical measures to him during the period of parole or while serving a more lenient sentence, as well as after serving the sentence. The court, on the basis of the conclusion of a forensic psychiatric examination, may impose a compulsory medical measure provided for in paragraph “a” of part one of Article 99 of this Code, or terminate its application.
3. The change or termination of the application of a compulsory measure of a medical nature is carried out by the court in the event of such a change in the mental state of a person in which there is no need to apply a previously prescribed measure or there is a need to prescribe another compulsory measure of a medical nature.
4. In the event of termination of the use of compulsory treatment in a medical organization providing psychiatric care in inpatient conditions, the court may transfer the necessary materials in relation to the person who was subject to compulsory treatment to the federal executive body in the field of healthcare or the executive body of the constituent entity of the Russian Federation in the field health care to resolve the issue of treating this person in a medical organization providing psychiatric care, or sending this person to an inpatient social service institution for persons suffering from mental disorders, in the manner established by legislation in the field of health care.

Article 103. Counting the time of application of compulsory medical measures
In case of recovery of a person whose mental disorder occurred after committing a crime, when imposing a sentence or resuming its execution, the time during which the person was subjected to compulsory treatment in a medical organization providing psychiatric care in an inpatient setting is counted towards the sentence at the rate of one day stay in a medical organization providing psychiatric care in an inpatient setting for one day of imprisonment.

Article 104. Compulsory medical measures combined with the execution of punishment
1. In the cases provided for by part two of Article 99 of this Code, compulsory measures of a medical nature are carried out at the place of serving imprisonment, and in relation to those sentenced to other types of punishment - in medical organizations of the state health care system that provide psychiatric care on an outpatient basis.
2. If there is a change in the mental state of a convicted person requiring treatment in an inpatient setting, the placement of the convicted person in a medical organization providing psychiatric care in an inpatient setting or another medical organization is carried out in the manner and on the grounds that are provided for by legislation in the field of health care.
3. The time spent in the medical organizations specified in parts one and two of this article is counted towards the term of serving the sentence. If there is no longer a need for further treatment of the convicted person in the medical organizations specified in parts one and two of this article, discharge is carried out in the manner prescribed by legislation in the field of health protection.
4. Termination of the application of a compulsory medical measure combined with the execution of a sentence is carried out by the court upon the proposal of the body executing the punishment, based on the conclusion of a commission of psychiatrists.

In modern society, a huge number of crimes are committed every day. They can have different causes, severity, and consequences. Some of them are committed by criminals intentionally, with a certain intent. But there are also offenses that are committed unconsciously, due to a mental disorder. Standard measures cannot be applied to such people. In this case, compulsory medical measures are considered relevant.

General concept

So, this is a special form of state coercion, which contains legal and medical aspects. It lies in the fact that for persons who have committed a serious crime in a state of insanity or sanity under the influence of a mental disorder, forced confinement to a medical institution can be used. At the same time, specialists carry out all the necessary medical manipulations to restore the psyche and social connections of the offender.

Only the court has the right to establish compulsory medical measures after consultation with a group of specialists. Such relations are also regulated by executive legislation.

Compulsory medical measures are applied to mentally ill people who cannot be imprisoned for their actions. The impact is in the nature of therapeutic treatment in closed institutions.

What reasons exist for choosing such measures?

This question is very important when choosing a punishment for a crime. Compulsory medical measures may be established by the court if the following grounds are present:

the act that the person committed is provided for by the Special Section of the Criminal Code and was committed in a state of insanity;
as a result of the crime, a person has developed a mental disorder for which imprisonment cannot be imposed;
public danger of a person;
the need for treatment of substance abuse, drug addiction, alcoholism or other pathology associated with such addictions.

If there is no serious threat from the violator of the law, then compulsory medical measures are not prescribed.

Goals of PMMH

Now we need to understand why the court makes such a decision. The following goals of compulsory medical measures can be distinguished:

Protective. It must protect society from the unlawful behavior of a mentally ill person that poses a danger to others. It should be noted that the attacker’s actions are caused by pathological changes in the psyche.
Socializing. Since the offender acts against the foundations of society not of his own free will, but as a result of illness, it is necessary to help him return to normal life. He cannot do this on his own.
Preventive. The court, by its decision, tries to prevent this person from committing repeated crimes.

In addition, compulsory medical measures are mainly needed to cure the disorder and stabilize the mental state.

Who might such coercion be intended for?

There are several categories of people to whom such punishment can be applied. Proceedings for the application of compulsory medical measures are fair to the following violators:

1. Insanity. At the time of carrying out the action that violated the law, they were in an altered mental state due to a chronic, temporary, stationary disorder. As a result of the disease, the person could not exercise control over what he was doing or be aware of the consequences and nature of his own actions. It should be noted that the grounds for using compulsory medical measures are present here, and they are more than sufficient. Criminal liability and punishment in this case are meaningless. The fact is that both during the implementation of illegal actions and after that, such a person cannot adequately evaluate his actions, or really understand the consequences of his actions.

2. Limited sanity. That is, such offenders have mental illnesses and disorders that could affect behavior and make the individual socially dangerous. However, they do not rule out sanity. Awareness of one's actions is present, but it is limited. There are grounds for compulsory medical measures for such persons; supervision by specialists is prescribed along with criminal punishment.

3. Persons whose mental function disorder occurred after the commission of a crime or at the stage of pre-trial investigation (court hearing), imprisonment. In this case, the offender may be released from serving the sentence. At the same time, he must be under the constant supervision of specialists.

Signs of PMMH

The use of coercive measures differs from other types of punishment in several ways:

The conditions in which the offender will stay must be such that he cannot harm himself or others during the period of treatment.
Such measures are imposed compulsorily. In this case, the opinion of the person himself or his legal representatives (guardians) is not taken into account.
Their appointment is based on an assessment of the depth of mental damage, the severity of the act committed, as well as the prognosis of the subsequent development of the disorder. It also takes into account how dangerous the offender may be to society.
Only a court can prescribe, modify or terminate such measures. At the same time, the conclusion of a psychiatric examination is not fundamental in making a decision. The judge may accept or reject this information at his own discretion.
The use of compulsory medical measures must be tied to the principle of a tactful and careful attitude towards the person of the offender. Only the necessary sufficiency of coercion is allowed so that the person can be helped to socialize and prevent the repetition of negative actions.

Features of PMMH

So, according to the instructions of the Criminal Code, compulsory measures of a medical nature are a form of state coercion that does not significantly, but limits the rights of the patient. Naturally, the use of such treatment has its own specifics:

There is no way to determine the period for which the patient will need psychiatrist help. The fact is that even the most experienced doctor will not be able to predict the time and effectiveness of treatment.
The state of the patient’s mental health can change significantly throughout the entire period of therapy, both for the better and for the worse.
Legal regulation of such decisions is quite problematic. A lot depends on the penitentiary service, the opinion and integrity of doctors.
There is no single document that accurately records all the conditions for the movement and detention of persons with mental problems. In some cases, this may lead to a violation of the patient’s rights.

The implementation of the presented measures is carried out after a court ruling in the specified institution. The ruling (coercive medical measures cannot be applied forever) changes frequently. Periodically, the forensic medical commission may re-examine the offender. This is necessary in order to constantly monitor changes in the patient’s health status and promptly change or cancel the presented measure.

Control over the implementation of compulsory treatment also falls on the shoulders of the judiciary. It is recorded in several documents. The first of these is to decide the validity of MH's coercive measures. The second fixes the timing of repeated examinations of the person, and also prescribes the timeliness of further actions to terminate, change or extend such measures.

Types of PMMH

Now we need to figure out where and how the treatment occurs. First of all, keep in mind that seats are chosen only by the court. In this case, the mental state of the offender, as well as his level, is of great importance. The judge can motivate the production of compulsory measures of a medical nature with an expert opinion on the health of the accused. Although he may not rely on the opinion of doctors.

There are the following types of compulsory medical measures:

Providing assistance and observation on an outpatient basis. It is carried out in an ordinary psychiatric hospital or department of another health care institution. There are no special conditions or additional security measures required here, and the person does not stay here permanently. Such treatment is prescribed to a person who, due to his mental state, does not need inpatient observation. The fact is that he does not pose a serious danger to the environment. In turn, he is obliged to regularly undergo examinations by a psychiatrist and take prescribed treatment. Such assistance is provided at the place of residence or without interruption from serving the sentence. If the patient is not sentenced to imprisonment, then a psychiatrist can visit him at home.
Compulsory treatment in a regular psychiatric hospital. This place accommodates those offenders who are unable to receive outpatient therapy but do not require intensive supervision. Such people at large remain likely to commit atrocities, even if the overall prognosis for their condition is positive. However, during observation there is no need for special conditions. That is, a person can move freely in a hospital. Treatment is carried out in those institutions whose main function is not the implementation of compulsory measures.
Providing assistance in a specialized psychiatric hospital. Those persons who are sent for correction by the court end up in such an institution. They require constant monitoring as they can be very dangerous to the environment. This institution requires not only additional medical personnel, but also its own security.
Treatment in a secure institution with special supervision. Violators who pose an extreme danger to society and themselves are held here. They require intensive monitoring. Such individuals may suffer from dementia or chronic disorders. They are capable of repeatedly committing especially serious atrocities, violating hospital regulations and attacking staff.

In some countries there is a special type of compulsory treatment - castration. This applies to persons who have committed sexual violence with particular cruelty against minors or young children. This castration is carried out using special medications that help suppress sexual desire.

These types of coercive medical measures are often used against virtually all offenders with mental health problems. However, the latter type of assistance cannot be prescribed to children under 16 years of age.

MPH extension procedure

Proceedings regarding the application of medical measures may be returned to court more than once. The fact is that when making a decision, the exact date for completing treatment is not indicated. The court cannot know exactly when the patient will experience improvement or complete recovery. The first examination after the appointment of the presented measures is carried out six months later. It can be initiated either by the attending physician or by the patient himself or his relative (legal representative). The conclusion of the commission may become the basis for canceling or extending previously established measures.

If the patient’s condition has not improved by the time of examination, then most likely a decision will be made to extend the treatment provided. It should be noted that subsequent revisions and identity examinations are carried out every year.

There are cases when cases of application of compulsory medical measures are reviewed on an extraordinary basis. For example, if a person has experienced significant improvements in his mental state.

Procedure for termination of PMMH

Cases involving the use of compulsory medical measures may be reviewed until a decision is made to cancel them. If the person who committed the crime has a significant improvement in his mental state, then treatment can be completed. That is, the grounds for its use disappear.

It should be noted that changes in health status may lead to a mitigation of the judge's decision or the imposition of a more severe punishment. In this case, the conclusion of forensic psychiatrists is not significant. The court may or may not take it into account at its own discretion.

If the decision by the competent authorities was made in the direction of canceling the PMMH, then the corresponding decision should be transferred to the local health authorities. Here the decision is already made to send the offender to a regular medical institution.

There are cases when a person who has committed an atrocity, despite a court decision, may believe that he still requires medical attention. In this case, the patient may voluntarily remain to continue therapy. At the same time, he has the opportunity to choose. The patient can undergo treatment where he did before, or choose another institution.

After treatment is cancelled, the offender may serve a more severe sentence, which involves restriction or imprisonment.

Peculiarities of undergoing treatment in conjunction with serving a criminal sentence

There are cases that the disorder occurred after the commission of the act or it does not exclude the sanity of the person. In this case, criminal punishment may be imposed along with compulsory treatment. Most often, such sentences are imposed on partially sane patients, alcoholics and drug addicts who need relief from addiction.

After completion of mental rehabilitation, the person continues to serve the assigned prison term. However, if the offender continued therapy at the end of his stay in prison, then compulsory treatment does not automatically end. To cancel it, a medical examination and a court decision are required.

Therapy can be carried out in the institution where the offender is serving his sentence, or in a special institution. There is one peculiarity. The time that the offender spends on treatment is counted towards the criminal term when it is assigned or reinstated. The calculation is as follows: a day of compulsory treatment is a day of imprisonment.

That's all the features of this theme. Be law abiding. Good luck!

These measures are a type of measures that carry criminal legal nature. The meaning of such measures is that in relation to a person suffering from mental illness and who has violated the law, forced hospitalization, the use of various medical procedures and outpatient observation are provided.

Such persons are required to undergo the necessary psychiatric or drug treatment procedures.

Many scientists do not recognize these coercive measures as the implementation of such a concept as criminal liability. In other words, they cannot fully be a type of punishment. Their main goal is to improve the general condition of the patient, eliminating his danger, both for himself and for other people.

“Compulsory medical measures” and “involuntary psychiatric measures” are two completely different concepts, from a legal point of view. Psychiatric treatment is provided to people who commit crimes.

Types and characteristics

Four types of compulsory medical measures should be considered:

All the types of measures described above differ in their regime and may depend on the conditions of detention and the thoroughness of supervision.

Goals

Article 98 of the Criminal Code provides for the following purposes of applying compulsory medical measures:

absolute cure of patients, or taking all necessary measures to improve their health;
preventing the likelihood of persons committing dangerous public acts.

These measures can also be used to ensure the safety of both others and the patient himself.

The implementation of social rehabilitation measures should not be ruled out.

To whom can they be appointed?

This happens exclusively through the court (Article 97 of the Criminal Code):

Citizens who have crossed the line of the law under the articles provided for by the Special Part of the Criminal Code, while in a state of insanity.
Persons whose mental disorder manifested itself after the crime was committed. This mental disorder makes it impossible to carry out punishment, as well as to impose it.

Citizens who have committed a crime and suffer from mental illnesses that do not exclude absolute sanity.
Persons over 18 years of age have committed dangerous acts directed against the sexual integrity of a person under 14 years of age. Such persons suffer from a dangerous mental disorder such as pedophilia, but their sanity cannot be ruled out.

Compulsory measures can be imposed on the above-mentioned persons only in situations where their mental disorders can cause harm or pose a danger to society.

The application of measures against these persons is provided for by the current legislation of Russia.

Information about citizens who have committed crimes in a state of insanity and do not pose a great danger to their mental health can be transferred by the court to the federal executive bodies in the field of healthcare.

Who can nominate?

In this aspect of the problems of compulsory medical measures, decisions can only be made by court.

At the same time, it is necessary to take into account that:

The grounds and limits for the use of these measures are established by the Criminal Code, the procedure for their application is established code of Criminal Procedure, and the order of execution of measures is established Criminal Executive Code.

Reasons for use

As mentioned above, these grounds are established Criminal Code, namely Article 97. Measures are prescribed by the court only in situations where a person is dangerous to others and to himself, and can also cause other dangerous harm.

That is, these measures may not be prescribed at all if a person has any mental disorder. What is required from the court is not so much an appointment as a forecast of the likelihood of a mentally ill person committing any dangerous actions for society.

If a person cannot be dangerous to society, the court is obliged to send all information about him to psychoneurological institutions at the place of residence. These medical institutions have the right to decide on his treatment within their own walls.

Assessing a person’s danger to society and to oneself is quite difficult. It is generally accepted that such a manifestation of such danger consists in the likelihood of the specified person committing any dangerous act recorded in the relevant documents.

Coercive measures may be applied to:

Persons who committed criminal acts when they were absolutely insane.
Persons whose mental disorder occurred after the crime had already been committed.
Persons who suffer from mental illness have committed a crime, but are sane.
Persons who committed a criminal act against the sexual integrity of a citizen under 14 years of age.

Application of this type of measures

Compulsory treatment can only be applied to a citizen who has committed an action that falls under the criteria of the Criminal Code (Special Part).

Such measures constitute the provision of medical care to a mentally ill person. They are used only to cure a person from an illness and prevent further dangerous actions.

In situations where there are any doubts about whether the person who committed the crime is mentally ill, it is necessary to order an examination, which is called forensic psychiatric.

When the examination recognizes the person, the court stops the case, immediately, if necessary, by imposing a compulsory measure of a medical nature. The type of measure is also selected after an examination, based on its results.

However, this procedure (examination) may not always be mandatory. The court will assess the social danger of the act and its consequences, the number of victims, and the method of committing the act.

Deadlines

The time that may be required for treatment is impossible to predict. Because of this, these measures cannot be associated with any specific deadline. To respect the rights of a person who is subjected to compulsory treatment, from time to time it is being examined.

In situations where the person recovers, the use of coercive measures ceases.

The case is sent for subsequent renewal and preliminary investigation. This is done in cases where the statute of limitations has not expired and there were no other grounds for termination of the case.

The time spent on applying coercive measures will be counted towards serving the sentence. One day in a psychoneurological institution is equal to one day of serving a sentence.

However, it should be taken into account that the time of application of coercive measures is not associated with punishment.

It is determined solely by the health of the person undergoing treatment.

In what cases can application be extended?

The mental state of a person may change during treatment. The issue of extending measures can only be decided by the court. The initiative to extend the measures is submitted by the attending physician of the medical institution where the patient is being treated.

The conclusion of psychiatrists is presented to the court. If there are no grounds for terminating or changing the use of compulsory measures, then the court decides to extend them. Most often, extension of compulsory measures is required when there is no improvement in the patient’s condition.

When can termination occur?

The process of deciding whether to stop the use of coercive measures can be resolved similarly to the issue of their extension. The chief physician of a medical institution is obliged to write an application to the court for a decision to terminate the relevant measures.

There are the following reasons for this:

change in the patient’s condition when the public danger disappears;
absolute recovery.

These grounds must be completely stable for the court to make a decision to terminate treatment in psychiatric institutions.

Application problems

There are a number of problems associated with the use of coercive measures.

It is almost impossible to predict the healing time.
The mental state of citizens who are subject to such measures may change.
Today, many problems arise in the legal regulation of this type of action.
The possibility of using coercive measures is established in various documents, but nowhere is there a strictly prescribed procedure for transporting and maintaining patients, and some nuances of document flow in such cases are not taken into account.

So, compulsory medical measures are usually prescribed to persons who have committed acts dangerous to themselves and society.

Their purpose does not depend in any way on the wishes of the patient and his relatives. All questions and renewals. Termination and modification of these measures shall be made solely by the court.

Section VI. OTHER MEASURES OF A CRIMINAL LEGAL NATURE

Chapter 15. COMPULSIVE MEASURES OF A MEDICAL NATURE

Article 97. Grounds for applying compulsory medical measures

Commentary on Article 97

1. Compulsory medical measures are a specific type of medical measures applied to a person suffering from mental disorders, without his consent or the consent of his legal representatives in the event of his committing a socially dangerous act provided for by criminal law and requiring compulsory treatment due to his mental state and rehabilitation.

2. Issues related to the grounds and procedure for applying medical measures are regulated by international conventions and agreements, federal legislation of the Russian Federation, and departmental regulations. This is, first of all: “International Classification of Diseases (ICD-10)” (approved by Order of the Ministry of Health of the Russian Federation dated May 27, 1997 N 170) (Part I); Criminal Code of the Russian Federation (chapter 15), Criminal Procedure Code of the Russian Federation (chapter 51); Penal Code of the Russian Federation (Article 18); Law of the Russian Federation of July 2, 1992 N 3185-1 “On psychiatric care and guarantees of the rights of citizens during its provision” (as amended on November 21, 2011); Resolution of the Plenum of the Supreme Court of the Russian Federation dated 04/07/2011 N 6 “On the practice of using compulsory measures of a medical nature by courts.”

3. Compulsory measures of a medical nature have legal and medical components. These measures are considered legal for the reason that the grounds, types, goals, procedures and procedure for application are determined by criminal and criminal procedural legislation. In addition, compulsory medical measures are prescribed only by the court, which subsequently reviews and makes decisions on the extension, modification and termination of the application of compulsory medical measures. At the same time, compulsory measures of a medical nature are also medical, since the same grounds, goals, types, order of application and termination of these measures depend on purely medical factors, such as, for example, the diagnosis of the disease, the mental state of the patient, etc.

4. Compulsory medical measures are not punishment, although they have a number of common features with it. In particular, both punishment and compulsory measures of a medical nature are measures of state coercion and are ensured by the coercive power of the state. In addition, punishment and compulsory medical measures are imposed by the court only if a citizen commits socially dangerous acts provided for by criminal law. The most important thing that unites punishment and compulsory measures of a medical nature is that in both cases certain rights and freedoms of citizens who committed these acts are limited to varying degrees.

5. The differences between compulsory medical measures and punishment are manifested in the peculiarities of the content of these legal categories, as well as in the specifics of the goals and grounds and procedure for their application. So, in accordance with Art. 43 of the Criminal Code of the Russian Federation, punishment as a measure of state coercion is imposed by a court verdict and applied to a person found guilty of committing a crime in order to restore social justice, correct the convicted person and prevent the commission of new crimes. As for compulsory measures of a medical nature, the main thing in their content is the treatment of a patient who has committed an act provided for by the Criminal Code of the Russian Federation.

6. Compulsory medical measures, unlike punishment, are not punishment. Their content and forms of execution are determined only by the characteristics of the disease. The same applies to the procedure for determining the timing of treatment. If the term of serving the sentence is precisely defined in the sentence, then in the court decision on the application of medical measures there are no such instructions, and everything here depends on the mental state of the patient.

An important difference between punishment and compulsory measures of a medical nature is also manifested in the procedure for implementing compulsory measures of a medical nature. To avoid possible abuses, this procedure is thoroughly regulated in federal Russian legislation (Chapter 51 of the Code of Criminal Procedure of the Russian Federation). On this matter, the court makes a decision (and not a sentence that determines the punishment). In a decision made by the court in the deliberation room (an additional guarantee of ensuring the rights and freedoms of a citizen), the court must answer the following questions: whether an act prohibited by criminal law took place; whether this act was committed by a person in a state of insanity; whether, after committing a crime, this person developed a mental disorder that makes it impossible to impose a punishment or carry it out; whether the person’s mental disorder poses a danger to him or others or whether the person is likely to cause other significant harm; whether a compulsory measure of a medical nature can be applied and which one (Article 442 of the Code of Criminal Procedure of the Russian Federation). Only after assessing the answers to these questions, the court makes an appropriate decision: a) on release from criminal liability and the application of medical measures in relation to a person who has committed an act prohibited by criminal law in a state of insanity; b) on release from punishment and the application of a compulsory medical measure in relation to a person who, after committing a crime, developed a mental disorder that makes it impossible to impose a punishment or carry it out; c) on the termination of the case and on the refusal to apply a compulsory measure of a medical nature in cases where the person does not pose a public danger due to his mental state or has committed an act of minor gravity, as well as when one of the grounds provided for in Art. Art. 24 – 28 of the Code of Criminal Procedure of the Russian Federation, regardless of the presence and nature of the person’s disease.

A decision on the application of medical measures is made by the court if there are sufficient grounds for it. These grounds are strictly defined by criminal law (Part 1 of Article 97 of the Criminal Code of the Russian Federation).

If a person who has committed a crime is declared sane, but has a mental disorder that does not exclude sanity, then, along with the assigned punishment, he is given the necessary compulsory medical measures in the form of outpatient compulsory observation and treatment by a psychiatrist. The same procedure applies to the persons specified in paragraph “d” of part one of Article 97 of this Code.

Common to all groups of persons named in paragraphs “a” - “e” of Part 1 of Art. 97 of the Criminal Code of the Russian Federation, the signs are: the presence of a mental disorder that makes it difficult to choose one or another form of behavior in a criminal situation; commission by a person of an act provided for by the Criminal Code of the Russian Federation; the threat of committing a new social act under the influence of a mental disorder. At the same time, it can be noted that the legislator identifies the most unprotected category of victims - minors under 14 years of age, against whom crimes can be committed against their sexual integrity. The perpetrators of these crimes, recognized as sane, pose a high danger, and therefore specific medical measures must be applied to them.

7. The most common basis for the use of compulsory medical measures is the commission of an act provided for by the Criminal Code of the Russian Federation in a state of insanity (over 80%).

Quite rare in practice are cases of application of paragraph “b” of Part 1 of Art. 97 of the Criminal Code of the Russian Federation, which provides for the imposition of compulsory medical measures on persons who, after committing a crime, develop a mental disorder that makes it impossible to assign or carry out punishment. This mental disorder can be permanent or temporary. In case of persistent mental disorder, compulsory treatment is prescribed in the same manner as in relation to a person who has committed a socially dangerous act in a state of insanity.

In case of temporary mental disorder (alcoholic psychosis, reactive state in connection with the initiation of a criminal case, threat of punishment, etc.), the criminal case is suspended and only in cases of a protracted nature of the disease the court prescribes compulsory medical measures.

8. In paragraph “c” of Part 1 of Art. 97 provides for the application of compulsory medical measures to persons who have committed a crime and suffer from mental disorders that do not exclude sanity. This category of persons, defined by Art. 22 of the Criminal Code of the Russian Federation, belongs to those with limited sanity due to the presence of mental abnormalities, both hereditary and acquired (drug addicts, alcoholics). A person suffering from a mental disorder that does not exclude sanity is subject to criminal liability along with sane persons. However, this circumstance is taken into account by the court and can serve as a basis for imposing a punishment of compulsory medical measures.

In clause “e”, part 1, art. 97 provides for the application of compulsory medical measures to persons who have committed crimes against the sexual integrity of minors under 14 years of age and who suffer from a disorder of sexual preference (pedophilia), which does not exclude sanity. Crimes of this type include the crimes specified in the note to Art. 73 of the Criminal Code.

9. The decision on the use of compulsory medical measures is associated with the possibility of persons suffering from mental disorders causing other social harm (after previously caused or with danger to themselves and other persons). In other situations, in relation to the persons specified in part one of Art. 97 of the Criminal Code of the Russian Federation and who do not pose a danger due to their mental state, the court may transfer the necessary materials to the health authorities to resolve the issue of treating these persons or sending them to psychoneurological institutions of the Ministry of Health and Social Development. Accordingly, this type of treatment is not compulsory, but its goals are the same as when applying compulsory measures of a medical nature, namely the cure of persons suffering from mental disorders or improvement of their mental state, as well as preventing them from committing new acts provided for in the articles of the Special Part of the Criminal Code RF.

Article 98. Purposes of applying compulsory medical measures

Commentary on Article 98

1. Compulsory measures of a medical nature are classified by criminal law as other measures of a criminal law nature. Consequently, the goals of applying compulsory measures of a medical nature in their general orientation correspond to the tasks defined by Art. 2 CC.

2. The specificity of the purposes of applying compulsory measures of a medical nature is that, on the one hand, these purposes in their content are purely medical in nature and are aimed at curing the persons specified in Part 1 of Art. 97 of the Criminal Code, or improvement of their mental state. On the other hand, the purposes of applying compulsory measures of a medical nature have a legal orientation - preventing these persons from committing new dangerous acts.

3. In the system of goals for applying compulsory measures of a medical nature, priority is given to medical goals (healing or improving the mental state of persons specified in Part 1 of Article 97 of the Criminal Code), since their achievement makes it possible to cure a person and at the same time significantly increase the effectiveness of various general and special measures to prevent these persons from committing new acts provided for in the articles of the Special Part of the Criminal Code of the Russian Federation.

4. Under cure in the sense of Art. 98 of the Criminal Code is understood as the complete disappearance of painful manifestations of a mental disorder that could lead to the commission of an act provided for by the Criminal Code of the Russian Federation. The difficulty in resolving the issue of cure in this case is that mental disorders often tend to systematically worsen, the disease often has a paroxysmal or periodic course. Medical practice shows that the disappearance of painful mental manifestations, after the next attack, phase or exacerbation has passed, does not at all mean that a cure has occurred in the sense of Art. 98 of the Criminal Code. As a rule, after remission or the onset of the so-called bright period, mental illness can henceforth manifest itself in conjunction with the consequences of a past illness, which served as the basis for the appointment of compulsory medical measures. These circumstances must be taken into account in both medical and law enforcement activities.

5. The current state of medical science and practice allows us to assert that in many cases of providing psychiatric care, including in the form of compulsory medical measures, there is not a cure, but an improvement in the mental state of the persons to whom these measures are prescribed. Improving the mental state of persons specified in Part 1 of Art. 97 of the Criminal Code, which have, accordingly, criminal law consequences provided for in Ch. 15 of the Criminal Code, their mental state is considered to be such that not all of them disappear, but only the most severe, persistent or systematically worsening painful manifestations that have or may have a socially dangerous nature.

6. Achieving such a legally defined goal of applying compulsory measures of a medical nature as preventing the commission of persons specified in Part 1 of Art. 97 of the Criminal Code, new acts provided for by the articles of the Special Part of the Criminal Code of the Russian Federation, are achieved through the implementation of a complex of medical, organizational, economic, managerial and legal measures to influence these persons. These measures are strictly regulated by federal legislation and corresponding departmental regulations and instructions (Law of the Russian Federation “On Psychiatric Care and Guarantees of the Rights of Citizens in its Provision”; Temporary Instructions on the Procedure for Application of Compulsory Medical Measures in Respect to Persons with Mental Disorders who have Committed Socially Dangerous Acts ; Instructions for organizing compulsory outpatient treatment for alcoholism or drug addiction for convicts serving sentences in institutions of the penal system of the Ministry of Justice of Russia, approved by Order of the Ministry of Justice of Russia dated August 3, 2001 N 229, etc.).

Article 99. Types of compulsory medical measures

Commentary on Article 99

1. Depending on the nature of the mental disorder and the degree of public danger of the committed act, the court may appoint one of the four named in Part 1 of Art. 99 of the Criminal Code of the Russian Federation of types of compulsory measures of a medical nature. The specifics of each of them are determined by the content of treatment, its intensity, and the features of ensuring the safety of patients and the citizens around them.

2. List of types of compulsory medical measures specified in Art. 99 of the Criminal Code of the Russian Federation is exhaustive and is not subject to broad interpretation.

3. In order to ensure greater guarantees of respect for the rights and legitimate interests of citizens and to avoid possible abuses, the grounds for prescribing certain types of compulsory medical measures are determined in special norms (Articles 100, 101 of the Criminal Code of the Russian Federation).

4. Persons recognized as of limited sanity (see commentary to Article 22 of the Criminal Code), who have been sentenced, as well as those convicted of committing a crime against the sexual integrity of a minor under fourteen years of age over the age of eighteen, and suffering from sexual dysfunction (...) sexual preference (pedophilia), which does not preclude sanity, along with punishment, outpatient compulsory observation and treatment by a psychiatrist may be prescribed.

Article 100. Outpatient compulsory observation and treatment by a psychiatrist

Commentary on Article 100

1. Outpatient compulsory observation and treatment by a psychiatrist belongs to the category of the least stringent types of compulsory medical measures. This type of compulsory treatment is prescribed in cases where a person, due to his mental state, does not need to be placed in a psychiatric hospital (Article 100 of the Criminal Code). Basically, outpatient compulsory observation and treatment by a psychiatrist is applied to persons who have committed a crime and suffer from mental disorders that do not exclude sanity. In this case, the court takes into account: the nature and degree of the person’s mental disorder, the social danger of the act, the real opportunity in a particular region to provide outpatient observation and treatment by a psychiatrist.

2. Outpatient psychiatric care provides for periodic health examination of persons in need of medical measures, diagnosis of mental disorders, their treatment, psychoprophylaxis and rehabilitation assistance, special care for persons suffering from mental disorders.

3. Outpatient observation and treatment by a psychiatrist, as a rule, is prescribed for those individuals who can realistically assess their mental state, voluntarily comply with the treatment regimen and means, have stable and predictable behavior, do not require constant medical supervision and have the ability to independently solve social problems. and everyday issues.

4. One of the most important components of outpatient compulsory observation and treatment by a psychiatrist is dispensary observation, which includes regular examinations by a psychiatrist. Moreover, such examinations do not necessarily require the consent of the patient or his relatives. Dispensary observation also involves the use of psychopharmacological, psychotherapeutic and social rehabilitation agents. At present, when the process of overcoming health crises is just beginning, it is difficult to count on the high effectiveness of outpatient compulsory observation and treatment by a psychiatrist. Nevertheless, there are incomparably more positive aspects here. Treatment of mental disorders in a familiar environment for the patient, and even more so the completion of treatment carried out in a hospital, is almost always more effective in an outpatient setting.

5. The implementation of outpatient compulsory observation and treatment by a psychiatrist for persons convicted of crimes committed in a state of sanity, but in need of treatment for mental disorders (Part 2 of Article 99 of the Criminal Code) is unique. This uniqueness is determined mainly by the place of compulsory observation and treatment (correctional institution). In accordance with Art. 18 of the Criminal Code and Part 1 of Art. 104 of the Criminal Code, depending on the nature of the diseases and their course, compulsory medical measures for those sentenced to imprisonment are applied either in the medical-sanitary part of the correctional institution or in the correctional institution. As for those sentenced to other types of punishment (not related to imprisonment), compulsory medical measures are carried out in relation to them in health care institutions that provide outpatient psychiatric care.

Article 101. Compulsory treatment in a psychiatric hospital

Commentary on Article 101

1. Compulsory treatment in a psychiatric hospital is a more stringent type of compulsory medical measures compared to outpatient compulsory observation and treatment by a psychiatrist. The law provides for compulsory treatment in a psychiatric hospital: general type; specialized type; specialized type with intensive supervision.

2. Compulsory treatment in a general psychiatric hospital can be prescribed to a person whose mental state requires inpatient treatment and observation, but does not require intensive observation (Part 2 of Article 101 of the Criminal Code).

A feature of a general psychiatric hospital is that this hospital is not specifically designed for the use of compulsory medical measures. This is usually an ordinary psychiatric hospital. There are no special security measures; the inpatient regime corresponds to standard psychiatric treatment institutions. In these institutions, persons assigned to compulsory medical treatment are in the same conditions as other patients admitted to a general hospital on a general basis.

Compulsory treatment in a general psychiatric hospital is prescribed by the court, taking into account the results of a forensic psychiatric examination. This takes into account the fact that the patient who has committed a socially dangerous act, at the time of making a decision on the type of compulsory medical measures, does not have any obvious tendencies towards gross violations of the hospital regime. At the same time, the likelihood of a recurrence of psychosis remains.

3. Compulsory treatment in a specialized psychiatric hospital has a special specificity. In accordance with the law (Part 3 of Article 101 of the Criminal Code), compulsory treatment in a specialized hospital can be prescribed to a person whose mental state requires constant monitoring. The need for constant monitoring is primarily due to the fact that patients who are subject to this type of compulsory medical measures show (can show) active aggressiveness towards others. The medical and legal characteristics of such patients do not allow them to be left unattended. They are characterized by a tendency to repeatedly commit a socially dangerous act. In addition, the patient’s behavior often turns out to be dangerous for himself (auto-aggressive behavior), and here it is impossible to do without outside help.

Constant observation concerns almost the entire process of a patient’s stay in a specialized psychiatric hospital. This includes the stage of drug treatment, occupational therapy, and social adaptation in the stage of communication with others, etc.

4. Persons who have committed grave and especially grave acts provided for by the Criminal Code of the Russian Federation and continue to pose a particular danger to themselves and others (refuse treatment, show aggression in attitude towards medical personnel and other patients, preparing to escape, making attempts to sa(…)sus, etc.). In this medical institution, the regime is provided by properly trained personnel. The use of physical restraint measures (restraining the patient using special clothing) is also acceptable here. To avoid cases of abuse of this kind of means of deterring aggression, a written record must be made in the relevant medical documents about the forms and time of application of measures of physical restraint.

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