FEATURES OF THE PROVISION OF SOCIAL SERVICES, INDIVIDUAL CATEGORIES OF CITIZENS: LEGAL ASPECT

Abstract

The article examines the legal status of persons suffering from mental disorders, analyzes the socio-legal issues of psychiatric care, and also makes proposals for the socio-legal protection of this category of citizens. The author considers the rights of persons suffering from mental disorders, including those in medical organizations providing psychiatric care in inpatient conditions.

Full Text

The Constitution of the Russian Federation proclaims social guarantees for age, sickness, disability, loss of breadwinner, for the upbringing of children and in other cases prescribed by law. At present, the State is emphasising medical care for the population, including persons with mental health problems. However, social support for such citizens is not yet at a sufficiently high level.
According to the World Health Organisation there is a wide range of psychiatric disorders, including depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, mental retardation and developmental disorders, including autism.
Persons with mental health problems require not only medical but also social assistance in accessing education programmes adapted to their needs, finding employment and accommodation, as well as other aspects of life necessary for the full inclusion of persons with mental health problems in mainstream society.
Mental disorders are characterised by the fact that they disrupt not only the individual but also the social functioning of the individual, and affect the relationship and interaction of the individual with other people and with society as a whole.
The Russian Federation Law on Psychiatric Care and Guarantees of the Rights of Citizens in the Provision of Psychiatric Care is the basic legal act that regulates the provision of psychiatric care in the Russian Federation.
It defines the rights of persons suffering from mental disorders (Art. 5, 37); the independence of the psychiatrist in the provision of psychiatric care (Art. 21); the requirement that an involuntary examination may only be carried out by decision of a judge or court (Art. 25, 32), the establishment of an independent service for the protection of the rights of patients in psychiatric hospitals (art. 38); the appeal to the procurator and to the courts against unlawful acts of health professionals providing psychiatric care (art. 47) and others.

It should be noted that relations in the sphere of psychiatric care are regulated by Federal Law No. 76-FZ dated 10 June 2008 "About public control over the provision of human rights in places of forced detention and about assistance to people in places of forced detention", Government Decree No. 522 dated 25 May 1994 "About measures to ensure psychiatric care and social protection of people with mental disorders".
Not always, persons suffering from mental illness, due to various specific circumstances, can not only exercise their rights, but also be aware of them, so the state must provide assistance in resolving social and legal issues as urgently as medical and psychiatric issues.
It is very difficult to protect the interests of citizens in psychiatric care, because society still has a negative attitude towards the mentally ill. In addition, the rights of people with mental disorders have always been limited, and this has been a basis for abuse in the field of psychiatric medicine. In order to live a full life, there is a need to rehabilitate people with mental disabilities, to reintegrate them into society, and to return them to work.
The increase in disability amongst people with mental health problems is often due to the fact that there are major barriers to their employment and rehabilitation in the labour market. Currently, people with mental health problems are often the first to be dismissed from their jobs, and face acute problems in securing employment, and making a living for themselves and their families.
The consequence of mental illness is generally an inability to adapt to present-day life situations, and an inability to look after oneself without the help of others. Persons with mental health problems are often unable to perform activities that a reasonably healthy person performs on a daily basis. Sometimes a person may need help with documents. This is mainly to obtain new documents or to restore documents that have been lost (passport, health insurance policy, pension certificate, documents that certify the right to housing, etc.).
There are grounds for placement in neuropsychiatric institutions for social care. The grounds, specified in Art. 41 of the Law of the Russian Federation from 02.07.1992 N 3185-1 "About psychiatric help and guarantees of the rights of citizens at its rendering", are personal statement of the person, suffering from a mental disorder, and the conclusion of the medical commission with the participation of psychiatrist, and for the minor at the age up to 18 years or person, recognised in the established order disabled to work - decision of trusteeship and guardianship authority, accepted on the basis of the conclusion of the medical commission with the participation of psychiatrist. According to Article 43 of the Law of the Russian Federation from 02.07.1992 N 3185-1 "About psychiatric help and the guarantees of the rights of citizens at its rendering", the administration of psycho-neurological establishments for social assistance is obliged at least once a year to examine the persons living in it, the medical commission with the participation of the psychiatrist to decide on their further maintenance in this establishment, and also on possibility of the review of decisions on their incapacity.
The basic rights of persons suffering from mental disorders are specified in the Law of the Russian Federation from 02.07.1992 № 3185-1 "About psychiatric assistance and guarantees of the rights of citizens at its rendering". Often such violations are so severe that they significantly deprive the sick person of the ability to make conscious decisions and lead to a loss of purposeful behaviour. In some cases, the behaviour of the person with a mental disorder even becomes dangerous, both for him or herself and for others. Society must be prepared to take measures to prevent the person from engaging in dangerous behaviours, which may involve restrictions on personal freedoms and the possibility of involuntary measures to protect the person and others.

In addition, the behavioural characteristics of a mental disorder require a certain degree of public protection and the interests of the person suffering from the mental disorder themselves. Above all, this concerns the protection of civil rights and legal interests, which a person suffering from a mental disorder cannot normally defend on his or her own. Understanding this, society has to ensure that certain benefits are granted to the mentally ill.
Article 5 of this law stipulates that persons suffering from mental disorders enjoy all the rights and freedoms of citizens provided for in the Constitution of the Russian Federation and federal laws, while restrictions on the rights and freedoms of persons suffering from mental disorders associated with this very disorder are permitted only in cases provided for by the laws of the Russian Federation.
Persons with mental disabiliƟes have the right to be treated with respect and humanity, in a way that does not undermine their dignity. They may receive information about their rights as well as about the treatment of their mental illness. Patients should receive such information in a form that is accessible to them, taking into account their mental state. Mental health care is provided in the least restrictive environment and wherever possible in the community. The stay in a medical organisation which provides psychiatric care on an inpatient basis to citizens is provided only for the period necessary for the provision of psychiatric care in such conditions.
Persons suffering from mental disorders receive all types of treatment, including sanatorium and spa treatment, only on medical grounds. Such psychiatric care is provided in an environment that meets sanitary and hygienic requirements.
Prior consent and refusal at any stage to use methods of prevention, diagnosis, treatment and medical rehabilitation, medicines for medical use, specialized therapeutic foods and medical devices, scientific research or training, or photography, video or film-making as a test object is required.
In the manner prescribed by law, patients are assisted by a lawyer, legal representative or other person, and any specialist involved in the provision of psychiatric care may be invited at their request, with their consent, to serve on a medical commission in matters regulated by the Act.
Article 37 of the same Act sets out separately the rights of patients in medical organisations providing inpatient psychiatric care.
They have the opportunity to address directly to the head doctor or head of the department about the treatment, examination, discharge from the medical organisation providing in-patient psychiatric care, and the observance of the rights granted by this Act; to submit without censorship complaints and applications to the representative and executive authorities, the prosecutor's office, the court, a lawyer, a public legal office (if any); to meet with a lawyer, an employee or an authorized representative of a public legal office; to meet with a lawyer, an employee or an authorized representative of a public legal office (if any); and to make complaints about the treatment, examination, discharge from a medical organisation providing in-patient psychiatric care and the rights granted by this Act.
Citizens who are in medical organisations and receive psychiatric care may perform religious rites, observe religious canons, including fasting, have religious paraphernalia and literature, if it does not violate the internal regulations of the medical organisation; subscribe to newspapers and magazines; receive general education, including an adapted educational programme.

In addition, such patients may receive equal remuneration with other citizens for work in accordance with its quantity and quality, if they participate in productive work.
Since the adoption of the Law on Psychiatric Assistance and Guarantees of Citizens' Rights in Providing It, many changes have been made to it (for example, the Federal Law of 08.03.2015 No. 23-FZ supplemented Article 34 of the Law on Psychiatric Assistance with Part 4). These innovations, while important, have not changed the concept of the Law or affected its fundamentals. Of particular importance, in our view, are the following changes:
- Removal of the psychiatric service from the municipal health care system;
- granting some "fully" incapacitated psychiatric patients the right to make independent decisions regarding consent or refusal of psychiatric care;
- the judicial procedure for psychiatric hospitalisation of mentally incapacitated people who have been declared incapable by a court under Article 29 of the Civil Code, in cases where hospitalisation is carried out at the request or with the consent of the legal representative of the incapacitated person (rather than the incapacitated person himself);
- the regulation of judicial procedures for involuntary psychiatric measures by the Code of Administrative Court Procedure, unprecedented for our country, instead of the previous regulation of this judicial activity by the norms of the CPC RF.
Thus, people with mental disorders need attention from the state and society, through the provision of social services and medical care. This category of the population needs help with socialisation, with access to adapted educational programmes, with finding accommodation and employment. The restoration of the patient's social status is also necessary. But this cannot be achieved without restoring the individual to his or her rights. We believe that in order to solve these problems, there is a need for a full-fledged regulatory framework capable of addressing the issues in the sphere of assistance to persons suffering from mental disorders.