be done to ensure self-defence. it also happens that the person is not given an opportunity to contact his representative (lawyer), who could defend his interests in court, or with relatives (confidential agents, acquaintances, human rights organizations) so that they find and get a defence attorney to court. or the defence attorney is not given an opportunity to meet with the hospitalized person; all possible obstacles are placed to prevent it. the hospitalized person is subjected to psychiatric treatment without his consent (and without the consent of the court) as soon as he finds himself in a psychiatric inpatient ward. psychotropic drugs with effects varying in intensity are compulsorily administered into his body. as a result of having been drugged, the patient sometimes appears before the court in such a state that his look and behavior, caused by the influence of these drugs, can convince the judge that he sees a really inadequate person who is in need of psychiatric care. the patient is often in such an intoxication-induced condition that he is unable to put two words together, not to mention any real defence of his rights. according to the statement made by the ipa executive director lyubov vinogradova in 2005, a court comes to a hospital where it must make a number of judgments as to whether rightly or wrongly the hospital applies for the involuntary treatment of a person. the court makes its judgments for 20 cases within 20 minutes. in practice it means that the judge automatically signs judgments offered to him ready-made by the staff to allow for the involuntary treatments to continue. according to doctor of legal sciences vladimir ovchinsky, regional differences in forensic psychiatric expert reports are striking. for example, in some regions of russia, 8 or 9 percent of all examinees are pronounced sane; in other regions up to 75 percent of all examinees are pronounced sane. in some regions less than 2 percent of examinees are declared schizophrenics; in other regions up to 80 percent of examinees are declared schizophrenics. the russian legislation did not implement principle 18 of the principles for the protection of persons with mental illness and the improvement of mental health care, approved by the un general assembly in 1991, with respect to a patient's right to an independent psychiatric report. according to a report by the european committee against torture, the law does not reflect a patient's right to obtain the judgment for involuntary hospitalization. in a hospital courtroom, the judge announces the judgment, but the patient does not obtain any motivated judgment. there are sometimes cases where the patient is not informed by the court at all and hears about the judgment from his or her treating doctor or head of the unit. since the judgment for involuntary hospitalization, as a rule, is not delivered to the hospitalized person, he cannot appeal against the judgment in appeal hearing. in other cases, the documents sent by him are censored and left in his medical record if not erased. the hospitalized person also does not have opportunities to attend the court to obtain a copy of the judgment or come to the post office to send a complaint against the judgment. exceptions of the use of law enforcement article 29 of the law concerning involuntary hospitalization in a mental hospital shall not apply to senior officials and the judiciary on the ground that they are vested with parliamentary or judicial immunity. a psychiatrist who violates this rule can be deprived of his or her diploma and sentenced to imprisonment. passport data of persons vested with parliamentary or judicial immunity shall be included in the computer database, which is available to every psychiatric institution and shall be used by every psychiatrist before addressing the issue of involuntary hospitalization of a person in a psychiatric hospital. psychiatrists commented on how to treat the judge vested with judicial immunity as follows: "while knowing that the person in twilight state is dangerous and may kill or maim people nearby, the psychiatrist should provide this information to the regional court so that three judges of the court within 10 days can send to the supreme court of the country a petition for the removal of immunity from the judge. it is only a possible victim who should be worried about the fact that aggressive actions are likely to happen now because twilight state is usually short-lived. the victim may suffer or die, but it would happen in strict accordance with the law on the status of judges!" according to the next item of the commentary, the psychiatrist has no right to subject the incumbent president of the russian federation to the procedure of involuntary psychiatric examination or involuntary hospitalization. amendments and changes amendments and changes were included in the law several times: on 21 july 1998, 25 july 2002, 10 january 2003, 29 june and 22 august 2004, 27 july 2010, 7 february, 6 april, 21 november 2011. over five years, from 1998 to 2003, the serbsky center made three attempts to submit for the duma readings of amendments and additions to the law, but the ipa and general public managed to successfully challenge these amendments, and they were finally tabled. according to the ipa, these amendments to the law, if adopted, would have impaired patients' rights. in 2004, for instance, proponents of mental health reform could hardly prevent the effort by the doctors of the serbsky center to roll back some reforms in the law. in november 2012, mikhail vinogradov, an expert of the serbsky center, said: "we must restore the legal act that was in the soviet union;" he noted that the request by a large group of petersburg and moscow psychiatrists to restore the old mental health act was submitted to the state duma. at the same time, vinogradov expressed the opinion that the soviet mental health act "has never been used for political persecution." human rights activists who claim it did, in vinogradov's words, "are not very mentally healthy." however, valeriya novodvorskaya is widely known to have been arrested "for insulting president" in september 1990 and kept in a psychiatric hospital until august 1991. in december 2012, mikhail vinogradov repeated his point, "my opinion: we should completely cancel the current mental health law. one cannot give patients the right to decide their fate." he added, "do you talk about human rights activists? most of them are just unhealthy people, i talked with them. as for the dissident general grigorenko, i too saw him, kept him under observation, and noted oddities of his thinking. but he was eventually allowed to go abroad, as you know… who? bukovsky? i talked with him, and he is a completely crazy character. but he too was allowed to go abroad! you see, human rights activists are people who, due to their mental pathology, are unable to restrain themselves within the standards of society, and the west encourages their inability to do so." on the other hand, leonid kitaev-smyk, a doctor and psychologist who specialized in extreme conditions, believes that unscrupulous people may use certain provisions of the soviet mental health act, if restored, as a tool to settle scores, as was in soviet times. he says, "in some particular cases, people will simply write complaints against a person, will subject him to involuntary psychiatric examination. and he can be declared crazy after some bribe money have been paid. creative, nonordinary, talented people have labile (as scientists say) nervous system, movable psychics. and they can be declared not quite normal mentally and, perhaps, even dangerous." sergei shishkov, the key lawyer of the serbsky center, also disagreed with vinogradov, "we are unlikely to return to the soviet mental health act. it would be contrary to the international norms, which russia has joined, as well as to the russian constitution. article 29 of the mental health law allows placing dangerous patients in a hospital. but when following necessary judicial procedures. if a patient is too socially dangerous, he is placed in a hospital, and a judgment is made through the court post factum. if a patient cannot be left without treatment, but he does not give his consent to the examination, there is such a concept as "deferred examination", or examination postscriptum." criticism problems with enforcement according to st petersburg psychiatrist vladimir pshizov, the current law is a boon and works out when having the informal human attitude to the patient. however, as pshizov notes, a disastrous factor for domestic psychiatry is that those involved in political abuse of psychiatry in the soviet union were allowed to stay on their positions until they decide to retire. those who retained their positions and influence turned domestic psychiatry from politically motivated one to criminally motivated one because the sphere of interests of this public has been reduced to making a business of psychopharmacologic drugs and taking possession of the homes of the ill. this view is repeated by alexander danilin, who says that the mental health law is certainly a progressive thing but, in reality, nothing changes because real change will only happen when specialists change their viewpoints and methods. according to russian psychiatrist emmanuil gushansky, the law "on psychiatric care and guarantees of citizens' rights during its provision" that has been in force since 1993 is declaratory in nature and does not guarantee any rights. not only the general and reference items of the law but also its articles of direct application, which apply to the procedure of involuntary psychiatric examination, involuntary hospitalization, to the procedure of interning and keeping the mentally ill in long-term psychiatric care institutions ("internats" in russian), are violated in the grossest way. legal control over observing the mental health law is not exercised. psychiatry is the only medical specialty in which the doctor is given the right to violence for the benefit of the patient. the application of violence must be based on the mental health law, must be as much as possible transparent and monitored by representatives of the interests of persons who are in need of involuntary examination and treatment. while being hospitalized in a psychiatric hospital for urgent indications, the patient should be accompanied by his relatives, witnesses, or other persons authorized to control the actions of doctors and law-enforcement agencies. otherwise, psychiatry becomes an obedient maid for administrative and governmental agencies and is deprived of its medical function. it is the police that must come to the aid of citizens and is responsible for their security. only later, after the appropriate legal measures for social protection have been taken, the psychiatrist must respond to the queries of law enforcement and judicial authorities by solving the issues of involuntary hospitalization, sanity, etc. in russia, the psychiatrist is vested with punitive functions, is involved in involuntary hospitalization and, according to gushansky, the state machine hides behind his back, actually manipulating the doctor. the police are reluctant to investigate offences committed by the mentally ill. after receiving the information about their disease, the bodies of inquiry very often stop the investigation and do not bring it to the level of investigative actions. thereby psychiatry becomes a cloak for the course of justice and, by doing so, serves as a source for the rightlessness and stigmatization of both psychiatrists and persons with mental disorders. the negative attitude to psychiatrists is thereby supported by the state machine and is accompanied by the aggression against the doctors, which increases during the periods of social unrest. problems with legislation according to psychiatrist sofia dorinskaya, the law is in conflict with the constitution of the russian federation. in judicial system, there is procedure for collecting evidence. if a person does not sign a transcript of interrogation or if he signed it, he in court can say that he was forced to sign, and the judge will investigate this. anyway, it is stipulated. in psychiatry, a person's opinion is not considered to be something more or less reasonable at all. psychotherapist elena romek, after making an analysis of the law, came to the same conclusion that provisions of the law are in conflict with civil rights guaranteed by the constitution of the russian federation, universally recognized norms of international law, professional and ethical norms of medicine, and presumption of innocence. if violence (involuntary examination, isolation,