The Ministry of Health regulates restrictions on the rights of patients in mental hospitals
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The Ministry of Health has developed rules for limiting the rights of patients in psychiatric institutions, including regulating the right to use a telephone. The document emphasizes that a psychiatric diagnosis and a patient’s stay in hospital cannot in themselves be a reason for banning communications. Officials point out that to limit rights, a specific reason is required, which must be indicated in the medical record. The psychiatrist with whom Kommersant spoke believes that this is an important step towards “creating an adequate legislative framework taking into account respect for the rights of patients.” However, lawyers call the document “very vague” and fear that it will not prevent abuse.
The Ministry of Health has published a draft “Procedure for limiting the rights of patients in psychiatric hospitals.” Its development was required by the new law on mental health care, which came into force in 2023. The law was actively discussed, including due to the exclusion of Art. 38, which provided for the state’s obligation to create independent services to protect the rights of people with mental disorders. In addition, the new law significantly expanded the powers of heads of departments and chief doctors of psychoneurological dispensaries and boarding schools. They were able to restrict some of the rights of patients, in particular to conduct uncensored correspondence; receiving and sending letters, parcels, parcels and money transfers; receiving visitors, as well as the right to purchase and use basic necessities, telephone, communications, and own clothing.
The Ministry of Health’s project establishes the boundaries of such actions by doctors. Thus, the rights of patients cannot be limited only on the basis of diagnosis and the fact that a person is under dispensary observation or in a hospital. The decision to restrict rights must be entered into the medical record. It must also indicate the specific circumstances that served as the basis for making such a decision; form of restriction of patient rights; justification for choosing such measures; the duration of the established restrictions.
The document emphasizes that patients’ rights cannot be limited for more than 15 days, although this period can be extended if necessary. The doctor is obliged to notify the patient, his relatives or legal representatives about the decision made within eight hours – by phone, via SMS, e-mail or registered mail.
The Ministry of Health emphasizes that the draft resolution was developed “to ensure compliance with the legitimate rights and interests of patients.” The document meets all the requirements of current legislation, the department’s press service said. They recalled that the law on psychiatric care and guarantees of the rights of citizens during its provision provides for the restriction of certain rights “in the interests of the health or safety of patients, as well as other persons.” “The project does not propose any changes in this part,” the department added.
“On the one hand, the law “On Psychiatric Care” has long had an article on the inadmissibility of restricting a patient’s rights only on the basis of a psychiatric diagnosis, as well as the fact of being under dispensary observation or staying in a medical organization,” comments a psychiatrist, head of a drug treatment and psychiatric clinic. Ruslan Isaev.—On the other hand, the law that currently exists is not entirely adequate to our reality. According to it, institutions are teetering on the brink of disruption. A significant number of psychiatric patients, due to the severity of their condition, really need restrictions on their rights for the sake of their own safety and the safety of those around them. The new regulation provides rules and procedures for dealing with such cases.”
Ruslan Isaev emphasizes that people with a psychiatric diagnosis are the most socially and legally unprotected members of society. After all, citizens believe that having a psychiatric diagnosis automatically limits their rights, although this is absolutely not the case. “We hope that this resolution is an important step by the Ministry of Health in the process of creating an adequate current legislative framework, taking into account respect for the rights of patients and the possibility of providing mental health care,” the psychiatrist concludes.
The head of the legal department of the Nizhny Novgorod ANO “Service for the Protection of the Rights of Persons Suffering from Mental Disorders, Orphans and Children Without Parental Care,” Alexander Gaganov, notes: now in psychiatric hospitals the rights of patients are limited “indiscriminately and unbalancedly”: “Everyone is deprived of the right to communicate and use personal phones. And we expected from this resolution that it would prevent excessive restrictions on people’s rights. However, the draft proposes insufficient measures to prevent unreasonable restrictions.”
In fact, the Ministry of Health offers “only two barriers” to abuse, says Mr. Gaganov. The first is the deadline for limiting the patient’s rights to 15 days. However, the number of decisions on extension may be unlimited, the lawyer points out, and the document does not contain a specific list of grounds for limiting the rights of patients. The second barrier is the obligation to inform the patient’s relatives or legal representatives. But this is done if the patient’s condition does not allow him to familiarize himself with the doctor’s decision, the lawyer emphasizes. In this case, the doctor himself assesses the patient’s condition and makes his own conclusion whether the patient can perceive information about the restriction of rights. “We believe that legal representatives should be informed in all cases of restriction of the rights of incompetent, partially capable, minors,” says Mr. Gaganov. “And at the request of an adult capable patient, other persons indicated by him during hospitalization. Moreover, most of the rights of patients that could potentially be limited during hospitalization are related to communication with the outside world. The draft resolution, for example, does not take into account the rights of incompetent minors at all. Their right to communicate with their family, if it existed before, is essentially limited.”
Lawyer of the “Need Help” Foundation Konstantin Vorobyov notes: as conceived by the project developers, any restriction of a patient’s rights should be an exception that is applied in emergency situations, indicating specific circumstances. “However, enforcement will be of key importance – how formally these rules will be accepted by chief doctors, heads of departments and inspection bodies. The procedure does not establish strict and detailed criteria for introducing restrictions and allows for the possibility of their extension an unlimited number of times,” says Mr. Vorobiev.
Lawyer of the Popular Front project “Region of Care” Evgenia Kravets agrees that the presented project is “very vague: a lot is left to local psychiatrists.” In her opinion, the document needs to be improved – in particular, it is necessary to specify the grounds for limiting the rights of patients. To do this, it is necessary to create a working group of psychiatrists and human rights lawyers, Ms. Kravets believes.
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