mental health in russia mental health in russia mental health in russia is covered by a law, known under its official name—the law of the russian federation "on psychiatric care and guarantees of citizens' rights during its provision" (russian: зако́н росси́йской федера́ции «о психиатри́ческой по́мощи и гара́нтиях прав гра́ждан при её оказа́нии», zakon possiyskoy federatsii "o psikhiatricheskoy pomoshchi i garantyakh prav grazhdan pri yeyo okazanii"), which is the basic legal act that regulates psychiatric care in the russian federation and applies not only to persons with mental disorders but all citizens. a notable exception of this rule is those vested with parliamentary or judicial immunity. providing psychiatric care is regulated by a special law regarding guarantees of citizens' rights. politics of russia law constitution russian criminal code tax code mental health law presidencypresidentvladimir putin (list) presidential administration security council state council 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forces civic chamber accounts chamber opposition human rights political abuse of psychiatry russia portal other countries psychiatry in russia and the ussr kgb (managing organ of psychiatry) mental health in russia political abuse in russia political abuse in the ussr campaign against psychiatric abuse working commission cases of political abuse struggle against political abuse serbsky center bekhterev psychoneurological institute independent psychiatric association sluggish schizophrenia sulfozinum psikhushka due to this fact, it is acknowledged that functions of psychiatry are not limited to identifying and removing biological anomalies that cause "mental illnesses", caring for patients and alleviating their sufferings, but they also apply to the scope of their civil rights. the passage of the law was one of the five conditions for the membership of the all-union society of psychiatrists and neuropathologists in the world psychiatric association. the law passed on 2 july 1992 and received the number 3185-1. history revolutionary period there was an increasingly decentralised approach to psychiatric care before 1917, with smaller hospitals (10 to 20 beds), more out-patient clinics, and some collaboration with private practice. psychiatrists were expected to deal with general medical issues and problems relating to epidemic and infectious diseases, witness corporal punishment, and to attend executions. after the 1905 russian revolution there was an influx of political prisoners into asylums. local zemstvos provided two-thirds of the funding for psychiatric services and the central government one third. the commissariat of public health established the psychiatry commission in october 1917. psychiatrists were given greater control over hospitals. psychiatric services were funded by central government. support services for mentally ill soldiers were provided by the russian red cross society until they were taken over by the commissariat of public health in 1919. they appointed a psychiatrist/neurologist consultant for the red army. soviet union during the period of the soviet union, it was not considered reasonable to pass special legislative acts protecting the material and legal part of the patients' mental health, thus leaving mental health services mainly inconsistent and unregulated. there were only guidelines of the legal and medical departments that stipulated certain rules of handling the mentally sick and imposing different sanctions on them. two guidelines on the management of mentally ill persons were published in 1961 and 1971, respectively. these were prepared by lawyer alexander rudyakov, who was the legal adviser to the chief psychiatrist of the moscow oblast, and read that the grounds for urgent hospitalization was when an ill person was of social danger. up until 1988, psychiatry in the ussr was not regulated by laws, there were only departmental guidelines, especially those of the ussr ministry of health, and one article in the fundamentals of health legislation of the ussr. vague wordings in the guidelines led to their wide and arbitrary application, which was fully in the hands of psychiatrists. in the absence of legal control over the actions of doctors, departmental regulation of mental health care has contributed to psychiatric abuse. only in the beginning of 1988, the ussr adopted the statute on conditions and procedures for the provision of psychiatric assistance, which has been the first legal act in this field and has certainly played a positive role for soviet psychiatry. however, the 1988 statute did not fully protect the rights of citizens falling into the field of activity of psychiatry, did not fully protect the mentally ill, did not contain developed mechanisms for legal control over the actions of psychiatrists and did not conform to the ussr constitution and international standards. 1992 in 1992, in russia, the enactment of the law took place under dramatic circumstances, even with the consideration that there was an 80-year delay for any mental health legislation and given the fact that political abuse of psychiatry was unprecedentedly widespread and denied for two decades from 1968 to 1988. when soviet rule was coming to an end, the decision to develop a law on mental health was made by senior officials and under the threat of economic sanctions from the united states. an initiator of creating a serious, detailed mental health law in the ussr was a deputy of the last convocation of the supreme soviet of the ussr, a young engineer from a uralian town. when asked why he as an engineer needs it, he replied to semyon gluzman, "all this democracy will soon run out, guys who will come to power, will start repression, and you, dr. gluzman, and i will have a hard time. so let's at least get these guys blocked from this possibility and adopt a civilized law eliminating the possibility of psychiatric repression!" the law was developed with the participation of psychiatrists involved in political abuse of psychiatry. at a meeting held by the health committee of the supreme soviet of the ussr in the autumn of 1991, the law was approved, particularly in the speeches by the four members of the commission of the world psychiatric association, but this event was followed by the dissolution of the soviet union. as its result, the work on the draft of the mental health law automatically ceased. in 1992, a new commission was created under the supreme soviet of the russian federation and used a new concept of developing the law; a quarter of the commission members were the representatives of the independent psychiatric association of russia (ipa). the main developer of the law was svetlana polubinskaya of the institute of state and law of the russian academy of sciences. polubinskaya was the sole lawyer in the commission of psychiatrists for developing the law and lodged a categorical protest against including other lawyers in the commission. the supreme soviet of russia passed the law on 2 july 1992. the law has been in force since 1 january 1993. for the first few years, the law was defied, seen by the doctors as an undue burden and was not let known to the patients. in 1993, when the ipa printed the law in 50 thousand copies for the general reader, quite a number of heads of the moscow psychoneurologic dispensaries refused to circulate the law. over time, these difficulties were overcome. it became obligatory to know the law to pass the certification exam. overview the law contains 6 sections and 50 articles. section i of the law describes general provisions of psychiatric care in russia, covering items such as the right of persons with mental disorders, the voluntariness of seeking care/refusal of treatment, diagnostic and treatment procedures and ensuring that medical confidentiality is maintained in dealing with mentally ill patients. section ii covers the state provision of psychiatric care, including financial provision. section iii describes the rights and duties of mental health workers in russia, as well as the authorised institutions that provide mental health services. section iv details further into the types of psychiatric care and procedure of care, including the 'internment' process. section v describes the role of law enforcement, while section vi covers appeals against psychiatric care. practical significance adoption of the law on psychiatric care and guarantees of citizens' rights during its provision is regarded as an epoch-making event in the history of domestic psychiatry, as establishing the legal basis for psychiatric care, and, first of all, mediating all involuntary measures through judicial procedure. that is a major post-soviet achievement of russian psychiatry and the foundation for a basically new attitude to the mentally ill as persons reserving all their civil and political rights and freedoms. the main new democratic innovations for russian psychiatry were the two ones of the law: the mandatory judicial procedure during all involuntary measures (examination, hospitalization, treatment). however, during many involuntary hospitalizations in recent years, the staff of psychiatric hospitals did not follow the mandatory judicial procedure provided for by the law. moreover, in 2012, the independent psychiatric association published a paper by its former legal consultant, who in the paper proposed amendments to the law on fundamentals of protection of public health in the russian federation to legalize involuntary dispensary supervision over persons with mental disorders without their informed consent and court judgment having been taken. establishing the dispensary supervision over persons specified in part 1 of article 27 of the law on psychiatric care always leads to legally meaningful consequences for them, such as restrictions on their right to performing specific types of professional occupation and that related to a source of an increased danger. the highly publicized claim of the full equality of rights and freedoms for the mentally disordered and those for all remaining citizens; the clear reference that it is impermissible to restrict the rights and freedoms on the basis alone of having a psychiatric diagnosis, being under dispensary supervision, in an inpatient psychiatric ward or in a psychoneurological institution. the claim does not correspond to the law enforcement practice, under which the rights to be in correspondence without censorship, send and receive parcels, printed matters and remittances, use the telephone, receive visitors can be restricted by the attending doctor, the head of the unit or the head doctor in the interests of health or safety of the patients and others. in addition, the ipa former legal consultant in his paper insisted that the right to daily walks should be added to the list of patients' rights that may be restricted on the recommendation of the attending doctor or the head doctor in the interests of health or safety of patients and others. according to the russian psychiatrists valery krasnov and isaac gurovisch, the law minimizes and prevents the institutionalization of the mentally ill if their behavior does not pose a danger to others. however, article 38, which was once included in the law as a guarantee of keeping the whole law for patients of psychiatric hospitals, is still not working, and, as a result, the service independent of health authorities to defend rights of patients in psychiatric hospitals is still not created. involuntary mental hospitalization in 1989, the world psychiatric association issued a statement that includes the following phrase: "involuntary intervention is a great infringement of the human rights and the fundamental freedom of a patient. therefore, specific and carefully defined criteria and safeguards are needed for such intervention." the law establishes substantive and procedural criteria for legitimacy of involuntary hospitalization. russia is among such countries and their parts as austria, belgium, germany, israel, the netherlands, northern ireland, taiwan, and the canadian province of ontario that emulated the united states in adopting hospitalization criteria based on the presumed danger of the mentally ill. the same was true of the soviet union where the two guidelines of 1961 and 1971 read that the ground for urgent hospitalization was social danger of an ill person. there is such a thing carefully cultivated by authorities as