When a person is in an inadequate state, family and friends call a doctor. Often, a visit from a specialist is not enough to return the patient to normal life, and hospitalization in a psychiatric department is required. This is where a very important question arises. How to put a person in a psychiatric hospital without his consent and whether this can be done.
A friend of mine faced a similar situation. His grandfather fell into an inadequate and dangerous state for others. An elderly man tried to set fire to the house, cursed and cried. A doctor was called, but he refused to hospitalize the man due to lack of consent on his part. It turned out that the doctor’s actions were unlawful, which I will discuss in this note.
On what basis can a citizen be placed in a mental hospital?
To commit a person to a psychiatric hospital without his consent, there must be compelling reasons. The procedure is regulated by the Law “On Psychiatric Care” in Articles 28-29. There are several reasons why such intervention may be required:
- Availability of a referral issued by a psychiatrist.
- A citizen approaches the emergency department of a mental hospital for help.
When it comes to placement in a hospital based on a personal request, the document is submitted in writing. When it is necessary to admit a child to a hospital, the consent of an official representative is required.
This person may be a parent or guardian. Sometimes the basis is a decision of the trustee body made on the basis of an appeal received from an interested person. If a person is hospitalized without his consent or without the permission of his legal representative, a number of documents will need to be submitted. The most important document is the decision of a psychiatrist, indicating that a person requires compulsory treatment.
How to forcibly hospitalize a mentally ill neighbor?
Friends! I’ll tell you a story from a recent legal practice of helping a tenant in an apartment building who lived above the apartment with a lonely, mentally ill tenant.
Why do I want to inform you about this? Almost every apartment building has a mentally ill neighbor who interferes with the normal living of citizens in his own apartment, simply screams, knocks, collects garbage from all over the area and stores it in the apartment, breeds a pack of dogs and cats, pigs, snakes, etc., creating all owners of other apartments have unsanitary living conditions.
I explain how to behave in these conditions, what correct measures to take, without wasting your time and money on absolutely ineffective decisions and actions.
There are two options for initial conditions:
-one , when a person is registered as a psychiatric patient, he is diagnosed with an acute form of mental illness.
- second , when there are all the signs of a mental illness, but a psychiatric examination has not been carried out on the person to determine whether the person being examined suffers from a mental disorder, whether he needs psychiatric help, as well as to decide on the type of such help.
In the case I am describing, the person is on a psychiatric register, he is 26 years old, his mother, approximately 45 years old, being the owner of the apartment and registered in it, for many years left her mentally ill son alone in the apartment and lives at a distance from him, as they say : "Out of sight, out of mind".
The neighbor's mother, being his guardian in accordance with Russian law, bears full responsibility for his actions, while receiving material support from the state for these needs. Leaving the mother alone in the apartment exposes both him and all the residents of the multi-storey building to danger, since a person who is not aware of his actions may well cause a flood, a fire, a household gas explosion, or attack girls or elderly women in the entrance or elevator for the purpose of physical violence and murder . As a result of such actions, this person will not incur criminal liability; there are no deterrent factors.
The patient behaved inappropriately, howled around the clock like a wild animal, shouted some kind of nonsense, a set of incoherent curses, often incomprehensible loud sounds, knocked with a metal object on the heating radiators, sometimes it was possible to understand fragments of phrases that he would kill all his neighbors, slaughter etc.
My client repeatedly called the local police officer or a police squad, he tried to attack the police officers, expressed threats of violence against the client, due to the fact that it was he who called the police.
The victim was also seen by a psychiatrist treating his neighbor with a request for his compulsory hospitalization in a hospital.
All the appeals of my principal did not have the effect of the indicated persons and did not lead to any result, then he turned to me for help.
What did I decide to advise my client after all his misadventures?
Being a lawyer, I drew up a statement with a full statement of this situation and a request to take measures to force the patient to be hospitalized in a hospital. Addressed and sent by mail three registered letters with notification of receipt and a list of investments in the envelope. The first letter with the application was sent to the guardianship and trusteeship authority of the relevant municipality, the second to the Prosecutor of the city or district, the third to the chief physician of the psychiatric service of the city-district.
a lawyer can protect the rights and legitimate interests of a citizen when providing him with psychiatric care At the same time, a lawyer can represent the interests of citizens who suffer from the proximity of mentally ill people left without proper care by close relatives-guardians.
To ensure the constitutional rights of citizens and the protection of life and health in the interests of an indefinite number of persons, including residents of an apartment building, the prosecutor is obliged, upon receiving information, to take measures established by law (file an administrative claim in court) for the forced hospitalization of a mentally ill person.
As a result of the measures I took, after the pressure exerted on her by the guardianship and trusteeship authority and the prosecutor, the mother moved the patient to another apartment under her direct care and control, and the apartment below was sold to other adequate persons with whom my client is now satisfied. The issue was resolved with little bloodshed, that is, without the prosecutor and other specified authorities going to court.
I will talk about all the necessary measures in a case where there are all the signs of a mental illness, but a psychiatric examination has not been carried out on a person and a final diagnosis of a specific mental disorder has not been established in the next review of my practice.
When defending the interests of the client, I was guided by Article 29 of the Law of the Russian Federation of July 2, 1992 N 3185-1 (as amended on July 19, 2018) “On psychiatric care and guarantees of the rights of citizens during its provision”
“Grounds for involuntary hospitalization in a medical organization providing psychiatric care in an inpatient setting”
A person suffering from a mental disorder may be hospitalized in a medical organization providing psychiatric care in an inpatient setting, without his consent or without the consent of one of the parents or other legal representative until a judge’s decision, if his psychiatric examination or treatment is possible only in an inpatient setting, and the mental disorder is severe and causes:
a) his immediate danger to himself or others, or
b) his helplessness, that is, his inability to independently satisfy the basic needs of life, or
c) significant harm to his health due to a deterioration in his mental state if the person is left without psychiatric help.
If you are interested in this topic, write to me personally or in the comments to this publication.
What if there is no specialist?
Only specialists of a certain profile can draw up a document that serves as the basis for referring a patient for treatment to a mental health clinic:
- a doctor working in a psychiatric department or a psychoneurological dispensary;
- psychiatrist of the emergency mental health team;
- private practitioner in psychiatry.
If you cannot find a doctor, and the actions of a citizen suffering from mental disorders pose a threat, then you need to call a specialist to your home or contact the police. Representatives of the security forces have the right to detain a citizen, and then call a specialist and send the citizen for examination. Based on the evidence, it will be possible to make a decision on the need for a compulsory decision or to refuse one.
Olga Timonina
How to admit a mentally ill relative to the hospital?
If a person is mentally ill and agrees to treatment:
Step 1. Contact an outpatient psychiatric service at your place of residence - a psychoneurological dispensary or a regional psychoneurologist who sees at the clinic.
It is possible to go to the hospital, bypassing the outpatient service, if the patient has an application with a request to be hospitalized and indicating the reasons for the application. In this case, the issue of placing a person for treatment is decided by the admissions department doctor and, if necessary, agreed with the hospital management.
Persons over 15 years of age independently consent to treatment and hospitalization.
Persons under 15 years of age are hospitalized voluntarily with the consent of their parents or other legal representatives.
If a person is mentally ill and does not agree to treatment:
In this case, it is possible to apply Article 29 of the Law of the Russian Federation of July 2, 1992 N 3185-I “On psychiatric care and guarantees of the rights of citizens during its provision.”
Article 29. Grounds for involuntary hospitalization in a medical organization providing psychiatric care in an inpatient setting.
A person suffering from a mental disorder may be hospitalized in a medical organization providing psychiatric care in an inpatient setting, without his consent or without the consent of one of the parents or other legal representative until a judge’s decision, if his psychiatric examination or treatment is possible only in an inpatient setting, and the mental disorder is severe and causes:
a) his immediate danger to himself or others, or
b) his helplessness, that is, his inability to independently satisfy the basic needs of life, or
c) significant harm to his health due to a deterioration in his mental state if the person is left without psychiatric help.
Step 1. Relatives write an application addressed to the psychiatrist of the outpatient service or the head. psychoneurological dispensary with a request to examine a sick relative: “I ask to examine ... (full name) on an involuntary basis to resolve the issue of hospitalization and treatment, because he ... (describe the danger to himself - suicidal threats, or to others).” Use only point “a”. If there are relatives, point “b” cannot serve as a basis for involuntary hospitalization of the patient. Point “c” is used only in the case of stereotypical exacerbations in chronically ill patients in the presence of initial symptoms.
Providing knowingly false information in an application for hospitalization may result in criminal liability!
It is better to write the application in two copies.
Step 2. Give one copy to a neuropsychiatrist (psychiatrist). On the second copy, obtain the signature of the person who accepted the document - doctor, receptionist, manager. dispensary. The doctor will explain next steps.
During an involuntary examination, if the patient has locked himself at home:
The door of an apartment/house can be opened on the basis of an appropriate written statement from relatives confirming the danger of the patient’s behavior to himself and others (threat of suicide, hostage-taking, etc.), in the presence of police officers. The door is opened by employees of the Ministry of Emergency Situations or the police.
If a relative is currently behaving inappropriately and aggressively towards others or is attempting suicide:
Step 1. In case of obvious aggression towards others, first call the police and inform the police that the person has a mental disorder. After the police arrive, the issue of calling a specialized emergency medical team is decided.
It may be necessary to call the Ministry of Emergency Situations, for example, if the patient has locked himself in a house/apartment or is on the edge of the balcony, threatening suicide. The door of an apartment/house can be opened on the basis of a written statement from relatives, in the presence of police officers. The door is opened by employees of the Ministry of Emergency Situations or the police.
Step 2. Call an emergency medical team.
Step 3. While the ambulance is driving, write a statement addressed to the head of the ambulance team with a request to hospitalize your relative for treatment: “I ask you to hospitalize... (full name), because he... (describe the danger to yourself - suicidal threats, or to others) "
Step 4. Submit the application to the ambulance staff. In case of refusal to hospitalize, obtain the signature of the head of the ambulance team and an indication of the reasons. You can complain to the management of the emergency medical service about the actions of ambulance employees.
It is advisable for relatives to accompany the patient to the hospital and give the doctor on duty an explanation of the circumstances of the hospitalization. Otherwise, the patient may mislead the doctor and return home on the same day with a desire to take revenge on you.
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What to do if a mentally ill person is a relative?
Dementia often begins in old age. Often people seek help when their elderly relatives begin to pose a danger to others precisely due to a mental disorder. Since a mental health center is a medical institution, it will be possible to hospitalize a relative there only if there is a mental disorder. The diagnosis must be made by a doctor.
An important nuance is that the disease must be curable during the period of stay in a medical institution. In addition, some conditions must be met:
- Relatives and friends do not have the opportunity to give injections at home, or relatives live in another area of the locality;
- visiting emergency doctors does not give any results;
- the patient does not receive the necessary treatment.
The fact that the applicant does not have the ability or desire to care for a sick relative cannot be considered as a basis. An important nuance is the presence of conscious consent from the patient for such hospitalization. It is unlikely that there will be people who would be willing to voluntarily go to a “psychiatric hospital.” A patient can be forcibly hospitalized only on the basis of a specialist’s referral. The doctor takes into account the severity of the disease and the degree of danger that the citizen poses to society.
Sharing a hospital stay with a child: conditions and opportunities
Sharing a hospital stay with a child often becomes a topic of discussion and conflict. On the one hand, a small patient needs care, which the hospital is sometimes unable to provide. And the child’s mood is much better when one of the parents is nearby, which affects the healing process. On the other hand, hospitals often cannot provide conditions for loved ones to stay with the baby. How to find a compromise and formalize it correctly.
Parents, other relatives and legal representatives have the right to be with the child when providing medical care anywhere - in a clinic, day or 24-hour hospital, in an ambulance. And although Article 51 of Federal Law No. 323 speaks only about cases when children are being treated in a hospital, the Family Code of the Russian Federation states that “a child in an extreme situation... has the right to communicate with his parents (persons replacing them) and other relatives." An extreme situation includes being in any medical organization (Article 55). The correctness of this approach is confirmed by judicial practice. For example, the refusal of an ambulance crew to transport a mother with a sick child in an intensive care vehicle was declared unlawful by the appeal ruling of the Kaliningrad Regional Court dated October 30, 2013.
Relatives may stay with the minor in the hospital during the entire period of treatment. This rule applies to any age of the child, any disease or condition. Note that the term “when providing medical care in an inpatient setting” cannot be interpreted as “only during the intervention.” As defined in Article 2 of Federal Law No. 323, medical care is a set of measures aimed at maintaining and (or) restoring health. This complex also includes medical monitoring of the child’s condition.
If the child is under four years old, the person accompanying him has another right - the medical organization must provide him with a bed and food free of charge. The same obligation arises for the hospital if there are medical indications for a child over four years of age. The costs of providing a bed and food are included in the cost of medical care provided to the child within the framework of the territorial compulsory medical insurance program (letter of the Ministry of Health of Russia dated December 21, 2015 N 11-9/10/2–7796).
Let us note that if the child’s condition improves to “moderate severity,” relatives will no longer be able to claim a free bed and food. But they will still have the right to stay with the child until he is discharged - in accordance with the internal regulations of the medical organization.
Rules of conduct in a medical organization must be publicly available. The best way out is to additionally introduce them to the child’s relatives against signature. This will allow you to avoid conflicts and complaints, as well as justify your actions during inspections.
Symptoms for which a person may be forcibly hospitalized
There are several characteristic signs that allow a citizen to be placed for compulsory treatment in a mental hospital. In particular, we are talking about the following points:
- aggressive behavior, when a person does not want to eat food, wants to commit suicide, fights and throws himself at others;
- a person cannot take care of himself, is poorly oriented in the situation and in space;
- public order disturbance. The state of health is constantly deteriorating.
The decision to place the patient in a hospital is made by a psychiatrist, but after a thorough examination of the patient and diagnosis.
What problems may arise with hospitalization?
There are several nuances that may become an obstacle to prescribing compulsory treatment to a sick person, namely:
- The person must give voluntary consent to the examination. If a citizen is already registered as a psychiatrist, then such consent is not required. In special cases, the specialist is obliged to request a court sanction.
- Elderly people may also have somatic diseases that can lead to temporary psychoexcitation. In this case, before visiting a psychiatrist, you will need to undergo a number of other specialists. Without the conclusions of these specialists, hospitalization may be refused.
- Patients over 65 years of age are not admitted to the hospital for treatment, although there are no such restrictions in the law and the actions of doctors are illegal.
Separately, it is worth mentioning the work of the ambulance. Psychiatrists only visit cases where a sick person poses a danger to others.
