$1. Outpatient compulsory observation and treatment by a psychiatrist

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 a person, due to his mental state, does not need to be placed in a medical organization providing psychiatric care in an inpatient setting.

Comments to Art. 100 of the Criminal Code of the Russian Federation

1. Outpatient compulsory observation and treatment by a psychiatrist is assigned to persons who have committed a crime and who suffer from mental disorders that do not exclude sanity, as well as to persons who have committed socially dangerous acts in a state of insanity. In both cases, this coercive medical measure is applied to persons who, due to their mental state, are able to comply with the regimen of treatment and observation. Their behavior is ordered, they are able to realize the significance of the medical measures applied to them.

2. When deciding on the issue of imposing this coercive measure, the court shall take into account: a) the nature and degree of the mental disorder; b) the possibility of achieving the goals of applying compulsory medical measures through outpatient compulsory observation and treatment; c) the impact of a mental disorder on the patient's behavior (whether it is aggressive, whether it poses a real threat to himself and others, whether it indicates the likelihood of a repetition of a socially dangerous act, etc.).

According to Art. 27 of the Law of the Russian Federation "On Psychiatric Care and Guarantees of the Rights of Citizens in its Provision", dispensary observation can be established for a person suffering from a chronic and protracted mental disorder with severe persistent or often exacerbated painful manifestations.

4. Persons sentenced to deprivation of liberty, arrest or restriction of liberty undergo outpatient treatment in institutions executing these types of punishments (Article 18 of the Penal Code of the Russian Federation).

Persons sentenced to punishments not related to deprivation or restriction of liberty undergo outpatient compulsory observation or treatment by a psychiatrist in a medical institution at the place of residence. A court ruling on the application of this measure is sent to the indicated institution; this is also reported to the internal affairs body, whose task is to control and ensure the appearance of a person to a psychiatrist with the frequency established by him.

Since 1997, Russia began to use outpatient compulsory observation and treatment by a psychiatrist, or APNL. Up to this point, only a stationary form of medical measures has been taken, although in countries such as Germany, Great Britain, Australia, the USA, the Netherlands, coercion is still used.

The first prerequisites for outpatient coercion were observed as early as 1988. In Ukraine, Uzbekistan, Kazakhstan, Azerbaijan, Georgia, the SSR in the Criminal Code considered the transfer of a patient to relatives or guardians under the supervision of a doctor as compulsory medical measures. But this was only a prerequisite, since the USSR Ministry of Health at that time believed that there was no need for outpatient practice.

Nikonov, Maltsev, Kotov, Abramov lawyers and psychiatrists theoretically substantiated the importance of compulsory outpatient treatment. They said that among the patients there are people who have committed socially dangerous acts, do not need inpatient treatment, but psychiatric control and various therapies are needed. The authors also emphasize that in some cases, after inpatient treatment, patients could not adapt to life, which led to an aggravation of their mental state and an increased risk of endangering the public, while it is impossible to resume compulsory treatment, since the court has already canceled. In this case, the replacement by the court of hospital for outpatient treatment is a trial discharge, in which the patient can be returned to compulsory inpatient care.

Specifics of APNL in different countries

The formation of the APNL in different countries has its own characteristics:

1. In Russia, this form is a norm of criminal law, which is applied to insane and less sane persons.
2. In the UK, the Mental Health Act, 1983, is used. It gives the court the right to send a patient to a hospital for up to 6 months. Patients can then be discharged under conditions of regular psychiatric and social monitoring. Also, outpatient monitoring is prescribed during a long vacation from the hospital.
3. In some US states, a conditional discharge is used in cases where the patient has been discharged from the hospital, and the term of punishment that could have been assigned to him in a sane state has not yet passed. The extension or cancellation of treatment is decided by the court.
4. In the Netherlands, APNL is received not only by hospital patients, but also by those who voluntarily agreed for the sake of a reduction and a suspended sentence. Such a proposal is put forward as an alternative for a less serious offence. Also, this measure is used in relation to complex and aggressive patients so that their condition does not worsen and there is no relapse.
5. In the provinces of Canada, patients are gradually being returned to the community. All are treated on an outpatient basis. They are observed under the jurisdiction of a special "observation commission", or Commission d "examen, Board of Review. Every year it checks the patient's status and sets the conditions under which the patient remains in society, and if they are not met, the subject returns to the hospital. The conditions include the following :
   • meetings with a psychiatrist;
   • taking medication;
   • life in a certain environment;
   • avoidance of alcohol and other harmful substances.

Essence of APNL in Russia

Article 100 of the Criminal Code of the Russian Federation and some by-laws describe the country's APNL: a person who has been released from criminal liability and punishment is sent to a dispensary or other psycho-neurological institutions, where either they are treated on an outpatient basis. The patient must:

• explain the meaning and significance of these actions;
• warn that in case of evasion from observation, he is transferred to a hospital.

The instructions of the Ministry of Health and the Ministry of Internal Affairs of the Russian Federation oblige a psychiatrist to visit a patient at least once a month. The police help

• in control of the patient's behavior;
• if necessary, determine the location;
• in hospitalization if there is a danger to society from this person.

Also, health and internal affairs authorities can exchange information about APNL patients. Benefits for facial outpatient treatment:

• contact with others;
• life with family;
• availability to go to work;
• leisure activities.

These advantages are characteristic only for persons who are in a stable mental state and follow the instructions of a psychiatrist.

APNL classification

All persons undergoing outpatient compulsory therapy are divided into two groups:

• patients with primary coercive measure;
• patients in the final stage of coercive measures after the hospital.

APNL can also be classified:

• adaptive-diagnostic stage;
• planned differentiated curation;
• final stage.

Let's consider each of them.

Characteristics of the adaptive-diagnostic phase

The first stage is recommended for people who have been diagnosed with a temporary mental disorder or mental exacerbation (attack, paroxysm) of a chronic mental disorder, provided that it ended by the time of examination and did not leave clinical manifestations that need only a doctor's control or preventive therapy. It is also necessary to take into account that the patient maintains social adaptation and the ability to comply with the regimen.

Sometimes APNL is prescribed for people with negative personality mechanisms of OOD. But it is applicable when the patient was provoked to act by the situation itself, which arose against his will and was resolved by the time of the examination. Also, such a measure is prescribed if the patient:

• does not have psychopathic manifestations;
• does not have a tendency to an alcoholic state;
• not prone to drug use;
• has little or no tendency to repeat the situation;
• has a predominance of persistent negative disorders with a decrease;
• maintains a relationship with the doctor.

The primary stage is not assigned to persons:

• capable of spontaneous frequent occurrence of mental relapses, which can be easily caused, for example, by alcohol, psychogenics, etc.
• with incomplete treatment of an attack;
• psychopathic disorders with irascibility, opposition, emotional coarseness, moral and ethical decline;
• with a recurrence of committing acts dangerous to society, for example, a crime, in a state of psychosis or remission.

In doing so, you need to take into account:

• degree of inability to social adaptation;
• social microenvironment;
• alcoholization;
• anesthesia.

An example of patient H., aged 40, who committed OOD in a state of temporary psychological disorder. He was accused of causing bodily harm to his relative.

Previous development was not observed. Electrician. While serving in the army, he received a head injury with loss of consciousness. After the patient complained of headaches, dizziness. Sometimes he drinks alcohol. In a state of intoxication, headaches intensify, the patient becomes irritable. A few days before the act, the wife of the patient was hospitalized in a somatic hospital. For 4 days he drank 150 grams of vodka. He experienced a deterioration in health, decreased appetite, poor sleep, and a sense of concern for his wife. Before committing an act at work, he drank 150 grams of vodka. After the evening shift came home. Communicated with the family and complained of feeling unwell, headache. For a long time he could not fall asleep, feelings of anxiety and anxiety did not leave him. According to the household members, he got up at 3 am and drank one tablet of diphenhydramine. At 6 o'clock in the morning the patient got up again and began to say something inarticulate. When the mother went to the neighbors, the patient caught up with her on the landing and pushed her hard. A relative who was trying to drag her mother home was hit, after which she fell down the stairs and received fractures. The patient then returned home, went to the kitchen, took a knife and stabbed himself in the chest, damaging his lung. Witnesses said that the patient behaved in silence, the view was terrifying, his eyes were bulging. The same condition was observed during the arrest of the man. In the police car, he did not contact anyone, did not pay attention to appeals, stared at one point with rounded eyes. After the operation, the patient regained consciousness, was able to adequately answer questions, referred to memory lapses, and could not believe what had happened.

During the examination, the experts made the following conclusion: at the time of the act against relatives, the patient had scattered residual neurological symptoms, signs of paroxysmal activity were detected on the EGG. Complaints are characteristic of a cerebrasthenic condition. The patient is depressed by the current situation, completely critical, intellectually preserved. There are no psychotic phenomena and paroxysmal disorders. This means that Kh., due to an organic brain lesion at the time of the offense, developed a twilight state of consciousness provoked by alcohol. The commission recommended sending him to compulsory outpatient observation and treatment by a psychiatrist.

The recommendation was made on the basis that X had no prior history of any mental disorder. This episode was the only one in her life, so there is no indication for inpatient treatment. However, the presence of a head injury does not allow to give a clear confidence that the disorder of consciousness may not recur. Therefore, the patient must be observed by a psychiatrist, periodically undergo examinations and EEG control, undergo appropriate absorbable and dehydration therapy.

During outpatient compulsory treatment at the first adaptive-diagnostic stage, the patient undergoes an additional examination to clarify the basic etiological factors that are the basis for the development of a psychotic state during OOD, paraclinical studies, or EEG, are also carried out. In addition, information is being collected on risk factors for relapse. After that, recommendations are given about the lack of contact with persons with whom experiences were associated during psychosis, and social problems that need a dispensary are established.

At the second stage, a complex of rehabilitation measures and therapy is determined for each patient, depending on the identified pathology. They do not need to be released from work, since at the time of the appeal they do not have grounds for this, but there are exceptions and they recommend light working conditions.

The patient must undergo drug therapy, psycho-corrective treatment, which explain the impact of adverse effects on the body and the importance of observing psycho-hygienic measures.

At the third stage, patients with organic brain damage are observed. For them, control studies are carried out by a neurologist, ophthalmologist, etc. in order to reveal the dynamics of pathological factors that are irritants for relapse. The following events take place here:

• discussion and compilation of favorable and pathogenic life situations;
• the process of learning, consolidating protection skills;
• auto-training;
• etc.

With the improvement of the EEG parameters and the overall state of the psyche, one can judge the positive dynamics and the achieved stable compensation of consciousness, which makes it possible for the court to note APNL. The continuation of APNL in this case is 6-12 months. With the manifestation of any form of pathology, the patient and relatives should immediately visit a psychiatrist on a regular basis due to the possibility of relapse.

For people with a negative-personal character at the first stage, the main tasks are:

• clarification of the structure of disorders;
• choice of biological therapy;
• the establishment of socio-psychological factors that promote or hinder adaptation in the conditions of APNL;
• diagnostics of structure and behavior;
• establishing functional links between cognitions (expectations, assessments, etc.) and features of the external manifestation of verbal and non-verbal behavior;
• assessment of the household environment to improve it in order to exclude relapse;
• undergoing psychotherapy.

The patient and relatives are explained the legal status of the patient, and they also talk about the importance of observing the regimen of observation and therapy. If there has been a decrease in working capacity, provided that there is no disability, then the person must undergo a medical and social examination. In addition, it is necessary to establish the forms of social assistance that the patient needs, for example:

• resolution of family conflicts;
• improvement of living conditions;
• etc.

At the first adaptive-diagnostic stage, with a stable state of mind, the patient can take part in cultural events and labor processes.

Definition of the second stage - planned differentiated curation

This phase contains a combination of biological therapy with therapeutic and corrective work on the psyche and the provision of social assistance.

Biological therapy is based on the principle of a differentiated approach, which should take into account:

• treatment of probable compensation of the condition;
• therapy of persistent psychopathological disorders;
• relapse prevention measures.

Behavioral therapy includes learning that:

• develops new coping skills;
• helps to improve communication skills;
• helps to overcome maladaptive stereotypes;
• helps to overcome destructive emotional conflicts.

The task of this stage is to smooth and replace as much as possible the features that led the patient to commit an offense, for this they improve the situation:

• in family;
• in a microsocial environment.

At the second and final stage, consultations and therapy are provided to the relatives of the patient.

If the treatment lasted more than 6 months, and the mental state was stable, and the patient constantly visited a psychiatrist and took the necessary medications, while there were no episodes of delinquency and bad deeds, and he was able to adapt, then withdrawal from APNL may be considered.

The nature of the final stage

This phase occurs after compulsory treatment, when the patient needs the help and control of a psychiatric service that promotes social adaptation. Treatment in a hospital and a psychiatrist is evidenced by the following signs:

• clinical picture of a chronic mental illness of delusional and / or psycho-like manifestation with a non-remission course or unstable remissions with frequent relapses;
• criticism of the disease and / or committed OOD, regardless of adequate long-term therapy;
• the need for continued treatment;
• collected information from the anamnesis, which indicates violations of social adaptation;
• in the past, there was a tendency to abuse drugs, alcohol, etc.;
• the presence of criminal experience;
• change in the microsocial environment at the place of residence.

All of the above signs are the basis for changing the type of compulsory medical measure.

At the first stage of APNL, patients undergo supportive therapy, during this period social and domestic problems are solved, neurotic layering is removed for those in need, and assistance is provided in adaptation.

The second stage is responsible for achieving mental stability and adaptation through the implementation of individual, differentiated treatment and rehabilitation measures. The frequency of meetings with a psychiatrist depends on:

• mental state of the patient;
• compliance with the constant intake of maintenance therapy from 1 time per week to a month, since during this time all the most significant social and domestic problems should be resolved.

At the second stage, in patients undergoing APNL treatment, deterioration is observed. For example, in schizophrenics, the manifestation of an attack is autochthonous, seasonal; in a patient with a brain injury, relapse is provoked by external stimuli. If a worsening of the mental state is detected early on, then a change in the APNL is not required, although in some cases it is still necessary.

Psychocorrective measures contribute to:

• the formation of communication skills, including cognitive, emotional and behavioral aspects;
• creating satisfactory self-control through social skills training.

The third stage is responsible for preparing the patient for the withdrawal of compulsory treatment. This stage is characterized by the following:

• achieving a stable state of mind;
• persistent reduction of residual psychopathological symptoms;
• maximum adaptation.

Before canceling the compulsory decision, conversations are held with the patient and relatives:

• about the possibility of recurrence:
• about the need to comply with the regime of dispensary observation.

Almost all patients after discharge from inpatient treatment have a disability of group II. Only 15% do not need it. Such people may return to their previous jobs. Usually, labor adaptation takes place in special medical and labor workshops.

The psychiatrist and the police are collaborating at this time to exchange information about the patient:

• about his whereabouts;
• about his place of residence;
• about labor status.

Also, the exchange of information provides for the assistance of the police at a time of increased threat to society.

The patient's positive attitude towards treatment, visits to a psychiatrist and various therapies, allow us to predict further cooperation with the patient after the withdrawal of APNL. Contact is also established with a relative who is critical of the state of health of the person. This contact gives:

• transfer of part of the responsibility;
• obtaining information about relapse.

All procedures are necessary in order to prevent a recurrence of a dangerous situation.

Termination of APNL does not guarantee a recurrence of mental state imbalance. Therefore, it is necessary to take into account the objective data that are obtained from:

• doctor;
• family members:
• neighbors;
• the police;
• social worker.

Achieving adaptation contributes to:

• loss of unfavorable microsocial environment;
• creating a satisfactory lifestyle;
• emergence of interests;
• emergence of worries.

But do not forget that the successful adaptation of patients in this group is often unstable, since minor difficulties, an asocial environment, alcohol consumption can lead to a breakdown. Data of successful adaptation are considered:

• total control;
• long-term follow-up (up to 2 years or more).

The essence of coercive measures with the execution of punishment

This type of punishment can be applied by the court if a person commits a crime and needs treatment for a mental disorder, not excluding sanity - part 2 article 22, part 2 article 99, article 104 of the Criminal Code of the Russian Federation.

Article 62 of the Criminal Code of the RSFSR, 1960 states: it is necessary to use compulsory treatment and the application of punishment measures against persons suffering from alcoholism and drug addiction. This law was applied only in cases where it was provable. However, in the late 80s, the norm began to be criticized, referring to the infringement of human rights. But still in 1996 the Criminal Code retained this punishment. This was reflected in articles 97, 99, 104. In 2003, an amendment was made - the abolition of punishment (point "d", part 1, article 97 of the Criminal Code). Now persons must undergo only compulsory treatment within the framework of the penitentiary system.

The above changes did not affect people who were in a state of mental disorder at the time of the commission of the crime (Article 22 of the Criminal Code). According to part 2 of article 97 of the Code, compulsory treatment is not used for all subjects, only for those whose mental disorder is capable of harming themselves and other people. For persons referred to in Art. 97 can only be used by a psychiatrist for APNL (according to part 2 of article 99). Two parts of article 104 of the Criminal Code state that when undergoing inpatient treatment or APNL, the patient's sentence is counted.

From all it follows that legal and medical relations consider this measure as:

• an independent type of compulsory treatment;
• responsibility for certain duties.

These aspects are specified in article 102 of the Criminal Code. Cancellation of punishment occurs after the conclusion of the commission of psychiatrists is presented to the court. It should be noted that this measure is quite fully described in part 3 of Article 97 of the Criminal Code.

But, despite this, the execution of the measure has many legally unclear and controversial issues, which indicates the problematic nature of its application. Compulsory treatment should take place for a long time even at the first stage, in case of avoiding relapse. Otherwise, the resulting effect will disappear, and it will be impossible to resume the APNL. And to apply these measures throughout the entire term of punishment, which can exceed 10-25 years, is clinically and organizationally unjustified.

It is also not clear who will implement the coercion, as the Psychiatric Care Act does not allow medical institutions to perform such actions on persons whose disorder is not severe.

In modern times, what has been said is doubtful, since coercive measures with the execution of punishment in all cases are executed properly and bring the desired effect.

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Grounds for outpatient compulsory treatment by a psychiatrist

The application of compulsory medical referral measures is possible only to those persons who have committed acts characterized by public danger and enshrined as signs of certain articles of the Criminal Code. Such measures are manifested in the form of medical care aimed at curing the subject of the crime, improving his mental indicators, which is necessary to prevent him from committing criminal acts in the future.

Persons who have become subjects of crimes, in respect of which there are doubts about the usefulness of their mental state, are subject to referral for a forensic psychiatric examination. The conclusion of the examination on the insanity of a person is the basis for terminating the case by proceedings. In this situation, the subject of the crime is subject to mandatory medical intervention of a coercive nature.

Legislators have identified an exhaustive range of grounds that may affect the need for compulsory medical actions:

• the presence of a state of insanity in a person who has committed an act of a socially dangerous nature;
• the presence of a mental disorder, which excludes the possibility of both determining the level of punishment and its execution upon conviction;
• the establishment of a mental disorder that does not exclude sanity;
• establishing the need for compulsory treatment for diseases associated with alcoholism or drug addiction.

The appointment of compulsory treatment measures can be carried out in cases where the presence of a mental disorder becomes the basis for the emergence of confidence in the public danger of a person and the possibility of harm, both to himself and to those around him. Thus, the purpose of medical influence is justified by the need to protect society not from a criminal act, but from the possibility of its commission.

At the time of the appointment of measures of compulsory treatment, the court is obliged to take into account the available medical indicators of the person and his public danger. The level of severity of the committed act is not taken into account. The act itself can be perceived only as a symptom of the disease.

The court does not have the right to establish measures of compulsory treatment in relation to persons who have become subjects of crimes, in the absence of one of the four above grounds.

Appointment and visitation of treatment by a psychiatrist

Considering the materials of each specific criminal case, and studying the characteristics of the person who committed the criminal act, the court is obliged to decide on the need to apply measures of compulsory treatment to the offender.

In cases where one of the grounds for imposing such measures exists, the court is obliged to refuse to establish a punishment and determine the medical measures that must be applied to the person forcibly in order to recover and prevent future commission.

When assessing the public danger of the subject himself, the court determines the measures of medical intervention that may be expressed in the appointment:

• outpatient compulsory observation by a psychiatrist or treatment by him;
• inpatient treatment in a psychiatric clinic;
• inpatient treatment in a medical institution of a specialized type;
• inpatient treatment in a psychiatric clinic of a specialized type, coupled with a high intensity of observation.

The court determines the type of treatment required based on recommendations that are substantiated by the result of the forensic psychiatric examination. According to its inner conviction, the court may go beyond the recommendations.

The appointment of outpatient compulsory observation and treatment is carried out by the court, regardless of his sanity or insanity. Compulsory observation and treatment by a psychiatrist on an outpatient basis is a measure that is necessary to create security for both the subject of the crime and the society surrounding him.

Persons in respect of whom a decision has been made on the recognition of their insanity may be transferred to custody. At the same time, the application of measures of compulsory psychiatric treatment to them may not be mandatory. In such cases, the court appoints mandatory medical observation, with the registration of a person with a medical institution that provides psychiatric treatment, in accordance with his place of residence.

The provision of psychiatric medical care is mandatory for medical institutions.

Persons who have not been declared insane and who have been sentenced to a non-custodial sentence may be required to undergo compulsory outpatient observation and treatment procedures. The fulfillment of this obligation must be carried out regardless of the wishes of the convicted person.

The terms required for the complete recovery of persons who have committed criminal acts cannot be established by a court decision. The reason for this is the impossibility of determining the specific period of time required for the complete cure of the criminal subject.

Such a period can be determined exclusively by a medical institution on the basis of indications that are noted in the process of his treatment.

From the side of the administration of the psychiatric clinic, a submission is sent to the court, indicating the cure of the offender. The completion of compulsory treatment, which has a positive result, is the basis for its termination on the basis of a procedural document issued by the judicial authority.

$1. Outpatient compulsory observation and treatment by a psychiatrist

Outpatient compulsory observation and treatment by a psychiatrist in accordance with the law (Article 100 of the Criminal Code) "may be prescribed if there are grounds provided for in Article 97 of this Code, if the person, due to his mental state, does not need to be placed in a psychiatric hospital."

The general basis for the appointment of coercive medical measures is "danger to oneself or other persons" or "the possibility of causing other significant harm" to insane, partially sane, alcoholics and drug addicts who have committed crimes, as well as persons whose mental disorder occurred after the commission of crimes. According to experts, outpatient compulsory observation and treatment by a psychiatrist can be prescribed to persons who, due to their mental state and taking into account the nature of the committed act, pose a low social danger or do not pose a danger to themselves and other people. The last statement clearly contradicts the prescription of the law (part 2 of article 97) that compulsory medical measures are prescribed only in cases where mentally ill persons can cause harm or are dangerous to themselves or others.

The legislator, as a circumstance allowing the court to prescribe compulsory outpatient treatment and treatment by a psychiatrist, provides for such a mental state in which a person who has committed a dangerous act does not need to be placed in a psychiatric hospital. The Criminal Code does not provide criteria for this mental state. Forensic psychiatrists believe that an outpatient form of compulsory treatment can be applied to persons who, due to their mental state, are able to independently satisfy their vital needs, have sufficiently organized and orderly behavior and can comply with the outpatient treatment regimen assigned to them. The presence of these signs allows us to conclude that a mentally ill person does not need inpatient compulsory treatment.

However, the legal criteria for a mental condition in which the patient does not require inpatient treatment are:

1. the ability to correctly understand the meaning and significance of the applied outpatient observation and treatment by a psychiatrist;

2. the ability to manage their behavior in the process of compulsory treatment.

The medical criteria for the mental state in question are:

1. temporary mental disorders that do not have a clear tendency to recur;

2. chronic mental disorders in remission due to compulsory treatment in a psychiatric hospital;

3. alcoholism, drug addiction, other mental disorders that do not exclude sanity.

In accordance with the law, to persons who have committed a crime in a state of sanity, but who suffer from alcoholism, drug addiction or another mental disorder within the framework of sanity, if there are grounds, the court may prescribe compulsory medical treatment only in the form of outpatient observation and treatment by a psychiatrist (part 2 of Art. 99 of the Criminal Code).

The place of compulsory outpatient treatment depends on the type of punishment imposed by the court:

o persons sentenced to deprivation of liberty undergo outpatient treatment at the place of serving their sentence, that is, in correctional institutions;

o Persons sentenced to non-custodial sentences receive compulsory treatment from a psychiatrist or narcologist at the place of residence.

In essence, compulsory outpatient observation and treatment by a psychiatrist is a special type of dispensary observation and, as such, consists in regular examinations by a psychiatrist (in a dispensary or other medical institution providing outpatient psychiatric care) and providing a mentally ill person with the necessary medical and social assistance (Part 3, Article 26 of the 1992 Law). Such observation and treatment by a psychiatrist is established regardless of the consent of the patient and is carried out on a compulsory basis (part 4 of article 19 of the 1992 Law). Unlike ordinary dispensary observation, compulsory observation and treatment is canceled only by a court decision, and, if necessary, can be changed by the court to another measure - compulsory treatment in a psychiatric hospital. The basis for replacing outpatient treatment with inpatient treatment is the submission of a commission of psychiatrists about the deterioration of the mental state of the person and the impossibility of carrying out compulsory treatment without placement in a hospital.

Outpatient compulsory observation and treatment by a psychiatrist in some cases can be used as a primary measure of compulsory treatment, in other cases this measure can act as the last stage of compulsory treatment following compulsory treatment in a psychiatric hospital.

As a primary measure, compulsory outpatient observation and treatment by a psychiatrist can be used against persons who have committed socially dangerous acts in a state of short-term mental disorder caused by pathological intoxication, alcohol, intoxication, exogenous or postpartum psychosis.

As the last stage of compulsory treatment, experts propose to apply outpatient observation and treatment by a psychiatrist in relation to persons who have committed socially dangerous acts in a state of chronic mental disorder or dementia, after undergoing compulsory treatment in a psychiatric hospital due to the fact that these persons need medical supervision and supportive care regimen.

The introduction in the Criminal Code of such a compulsory medical measure as outpatient observation and treatment by a psychiatrist is aimed at reducing the number of persons subjected to compulsory treatment in psychiatric hospitals and maintaining their social adaptation during outpatient treatment by a psychiatrist in the patient's habitual living conditions.