Forensic psychiatry

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Forensic psychiatry is a subspeciality of psychiatry and is related to criminology. [1] It encompasses the interface between law and psychiatry. According to the American Academy of Psychiatry and the Law, it is defined as "a subspecialty of psychiatry in which scientific and clinical expertise is applied in legal contexts involving civil, criminal, correctional, regulatory, or legislative matters, and in specialized clinical consultations in areas such as risk assessment or employment. [2] " A forensic psychiatrist provides services – such as determination of competency to stand trial – to a court of law to facilitate the adjudicative process and provide treatment, such as medications and psychotherapy, to criminals.

Contents

Court work

Forensic psychiatrists work with courts in evaluating an individual's competency to stand trial, defenses based on mental disorders (e.g., the insanity defense), and sentencing recommendations. The two major areas of criminal evaluations in forensic psychiatry are competency to stand trial (CST) and mental state at the time of the offense (MSO).

Competency to stand trial

Competency to stand trial (CST) is the competency evaluation to determine that defendants have the mental capacity to understand the charges and assist their attorneys. In the United States, this is seated in the Fifth Amendment to the United States Constitution, which ensures the right to be present at one's trial, to face one's accusers, and to have help from an attorney. CST, sometimes referred to as adjudicative competency, serves three purposes: "preserving the dignity of the criminal process, reducing the risk of erroneous convictions, and protecting defendants' decision-making autonomy". [3]

In 1960, the Supreme Court of the United States in Dusky v. United States established the standard for federal courts, ruling that "the test must be whether the defendant has sufficient present ability to consult with his attorney with a reasonable degree of rational understanding and a rational as well as factual understanding of proceedings against him." The evaluations must assess a defendant's ability to assist their legal counsel, meaning that they understand the legal charges against them, the implications of being a defendant, and the adversarial nature of the proceedings, including the roles played by defense counsel, prosecutors, judges, and the jury. They must be able to communicate relevant information to their attorney, and understand information provided by their attorney. Finally, they must be competent to make important decisions, such as whether or not to accept a plea agreement. [3]

In England, Wales, Scotland, and Ireland, a similar legal concept is that of "fitness to plead".

As an expert witness

Forensic psychiatrists are often called to be expert witnesses in both criminal and civil proceedings. Expert witnesses give their opinions about a specific issue. Often, the psychiatrist will have prepared a detailed report before testifying. The primary duty of the expert witness is to provide an independent opinion to the court. An expert is allowed to testify in court with respect to matters of opinion only when the matters in question are not ordinarily understandable to the finders of fact, be they judge or jury. As such, prominent leaders in the field of forensic psychiatry, from Thomas Gutheil [4] to Robert Simon and Liza Gold [5] and others [6] have identified teaching as a critical dimension in the role of expert witness. The expert will be asked to form an opinion and to testify about that opinion, but in so doing will explain the basis for that opinion, which will include important concepts, approaches, and methods used in psychiatry.

Mental state opinion

Mental state opinion (MSO) gives the court an opinion, and only an opinion, as to whether a defendant was able to understand what he/she was doing at the time of the crime. This is worded differently in many states, and has been rejected altogether in some, but in every setting, the intent to do a criminal act and the understanding of the criminal nature of the act bear on the final disposition of the case. Much of forensic psychiatry is guided by significant court rulings or laws that bear on this area which include these three standards: [7]

"Not guilty by reason of insanity" (NGRI) is one potential outcome in this type of trial. Importantly, insanity is a legal and not a medical term. Often, psychiatrists may be testifying for both the defense and the prosecution.

Forensic psychiatrists are also involved in the care of prisoners, both in jails and prisons, and in the care of the mentally ill who have committed criminal acts (such as those who have been found not guilty by reason of insanity).

Forensic psychiatry vs psychology

Forensic psychiatry

Forensic psychiatrists focus on how biology applies to the legal system. They focus more on the scientific facts as well as diagnosing and treating mental disorders. They legally assess clients, provide a diagnosis, and can prescribe medication if necessary. They are licensed medical doctors (MD) that make roughly $190,000 annually.[ citation needed ]

Forensic psychology

Forensic psychologists examine how different disorders and conditions can apply in court. Their jobs typically entail working as research assistants and probation officers. They often determine trial competency, assess the risk of inmates, and aid in jury selection. Forensic psychologists can use information learned about mental health and criminal justice to advocate for those who are mentally ill. After earning a master's and a PhD in psychology or a Doctor of Psychology, PsyD, they can become forensic psychologists. While they are required to be licensed by the state, they are not required to be medical doctors. This means that they cannot prescribe medication. Forensic psychologists make roughly $67,000 annually. [11]

Risk management

Many past offenders against other people, and suspected or potential future offenders with mental health problems or an intellectual or developmental disability, are supervised in the community by forensic psychiatric teams made up of a variety of professionals, including psychiatrists, psychologists, nurses, and care workers. These teams have dual responsibilities: to promote both the welfare of their clients and the safety of the public. The aim is not so much to predict as to prevent violence, by means of risk management.

Risk assessment and management is a growth area in the forensic field, with much Canadian academic work being done in Ontario and British Columbia. This began with the attempt to predict the likelihood of a particular kind of offense being repeated, by combining "static" indicators from personal history and offense details in actuarial instruments such as the RRASOR and Static-99, [12] which were shown to be more accurate than unaided professional judgment. More recently, use is being made also of "dynamic" risk factors, such as attitudes, impulsivity, mental state, family and social circumstances, substance use, and the availability and acceptance of support, to make a "structured professional judgment." The aim of this is to move away from prediction to prevention, by identifying and then managing risk factors. This may entail monitoring, treatment, rehabilitation, supervision, and victim safety planning and depends on the availability of funding and legal powers.

Risk management in forensic psychiatry is often done using standardised tests called structured professional judgement tools. Two such tools include the HCR-20 [13] and the newer SAPROF developed in the late 2010s. [14] [15] These tools are used to measure the likelihood of recidivism and identify protective factors for offenders.

United Kingdom

In the UK, most forensic psychiatrists work for the National Health Service, in specialist secure units caring for mentally ill offenders (as well as people whose behaviour has made them impossible to manage in other hospitals). These can be either medium secure units (of which there are many throughout the country) or high secure hospitals (also known as special hospitals), of which three are in England and one in Scotland (the State Hospital, Carstairs), the best known of which is Broadmoor Hospital. The other 'specials' are Ashworth hospital in Maghull, Liverpool, and Rampton hospital in Nottinghamshire. Also, a number of private-sector medium secure units sell their beds exclusively to the NHS, as not enough secure beds are available in the NHS system.

Forensic psychiatrists often also do prison inreach work, in which they go into prisons and assess and treat people suspected of having mental disorders; much of the day-to-day work of these psychiatrists comprises care of very seriously mentally ill patients,[ citation needed ] especially those with schizophrenia. Some units also treat people with severe personality disorder or learning disabilities. The areas of assessment for courts are also somewhat different in Britain, because of differing mental health law. Fitness to plead and mental state at the time of the offence are indeed issues given consideration, but the mental state at the time of trial is also a major issue, and this assessment most commonly leads to the use of mental health legislation to detain people in hospitals, as opposed to their getting a prison sentence.[ citation needed ]

Learning-disabled offenders who are a continuing risk to others may be detained in learning-disability hospitals (or specialised community-based units with a similar regimen, as the hospitals have mostly been closed). This includes those who commit serious crimes of violence, including sexual violence, and fire-setting. They would be cared for by learning disability psychiatrists and registered learning disability nurses. Some psychiatrists doing this work have dual training in learning disability and forensic psychiatry or learning disability and adolescent psychiatry. Some nurses would have training in mental health, also.[ citation needed ]

Court work (medicolegal work) is generally undertaken as private work by psychiatrists (most often forensic psychiatrists), as well as forensic and clinical psychologists, who usually also work within the NHS. This work is generally funded by the Legal Services Commission (used to be called Legal Aid).[ citation needed ]

United States

Forensic psychiatrists typically work with attorneys and judges. Their purpose is to mediate psychiatric-legal issues that require a more professional perspective. Their scope of practice also includes helping their clients improve their mental status. A few duties that are typically expected of a forensic psychiatrist include determining readiness for parole, conducting assessments to determine any mental issues, evaluating injuries and their effects on the client, and determining competency. All of these tasks have one thing in common: their main focus is on evaluating capacity and competence.[ citation needed ]

These workers play an important role in combating the phenomenon of "double revolving doors" between hospitals and prisons. Many mentally ill patients will rotate between hospitals and prisons because they are not getting the help they need. Legal decisions affecting psychiatric patients are not made lightly and require an in-depth analysis of anyone involved. Forensic psychiatrists have a background in both the medical aspect of psychiatry as well as the legal aspects of a courtroom.[ citation needed ]

Canada

Criminal law framework

In Canada, certain credentialed medical practitioners may, at their discretion, make state-sanctioned investigations into and diagnosis of mental illness.[ citation needed ] Appropriate use of the DSM-IV-TR is discussed in its section entitled "Use of the DSM-IV-TR in Forensic Settings".

Concerns have been expressed [ citation needed ] that the Canadian criminal justice system discriminates based on DSM IV diagnosis within the context of Part XX of the Criminal Code. [16] This part sets out provisions for, among other things, court ordered attempts at "treatment" before individuals receive a trial as described in section 672.58 of the Criminal Code. Also provided for are court ordered "psychiatric assessments". Critics have also expressed concerns [ citation needed ] that use of the DSM-IV-TR may conflict with section 2(b) of the Canadian Charter of Rights and Freedoms, which guarantees the fundamental freedom of "thought, belief, opinion, and expression".

Confidentiality

The position of the Canadian Psychiatric Association holds, "in recent years, serious incursions have been made by governments, powerful commercial interests, law enforcement agencies, and the courts on the rights of persons to their privacy." It goes on to state, "breaches or potential breaches of confidentiality in the context of therapy seriously jeopardize the quality of the information communicated between patient and psychiatrist and also compromise the mutual trust and confidence necessary for effective therapy to occur." [17]

An outline of the forensic psychiatric process as it occurs in the province of Ontario is presented in the publication The Forensic Mental Health System In Ontario: An Information Guide [18] published by the Centre for Addiction and Mental Health in Toronto. The Guide states: "Whatever you tell a forensic psychiatrist and the other professionals assessing you is not confidential." The Guide further states: "The forensic psychiatrist will report to the court using any available information, such as: police and hospital records, information given by your friends, family or co-workers, observations of you in the hospital." Also according to the Guide: "You have the right to refuse to take part in some or all of the assessment. Sometimes your friends or family members will be asked for information about you. They have the right to refuse to answer questions, too." [19]

Of note, the emphasis in the guide is on the right to refuse participation. This may seem unusual given that a result of a verdict of "Not Criminally Responsible by reason of Mental Disorder" is often portrayed as desirable to the defence, similar to the insanity defense in the United States. A verdict of "Not Criminally Responsible" is referred to as a "defence" by the Criminal Code. [20] However, the issue of the accused's mental state can also be raised by the Crown or by the court itself, rather than solely by the defence counsel, differentiating it from many other legal defences. [21]

Treatment/assessment conflict

In Ontario, a court-ordered inpatient forensic assessment for criminal responsibility typically involves both treatment and assessment being performed with the accused in the custody of a single multidisciplinary team over a 30- or 60-day period.[ citation needed ] Concerns have been expressed that an accused may feel compelled on ethical, medical, or legal grounds to divulge information, medical, or otherwise, to assessors in an attempt to allow for and ensure safe and appropriate treatment during that period of custody.[ citation needed ]

Some Internet references address treatment/assessment conflict as it relates to various justice systems, particularly civil litigation in other jurisdictions. [22] [23] The American Academy Of Psychiatry and the Law states in its ethics guidelines, "when a treatment relationship exists, such as in correctional settings, the usual physician-patient duties apply", which may be seen as contradiction. [24]

South Africa

In South Africa, patients are referred for observation for a period of 30 days by the courts if questions exist as to CST and MSO. Serious crimes require a panel, which may include two or more psychiatrists. Should the courts find the defendant not criminally responsible, the defendant may become a state patient and be admitted in a forensic psychiatric hospital. [25] They are referred to receive treatment for an indefinite period, but most were back in the community after three years. [26]

Educational requirements

A psychiatrist is a medical doctor who has completed undergraduate school, medical school, and residency training. Forensic psychiatrists typically have additional training that is relevant to the job they hold (such as a focus in child/adolescent, geriatric, or addiction). Many forensic psychiatrists will complete a more specific training after their residency in a related area. This training typically lasts another one or two years. [27] Because they have earned a doctorate in medicine (MD), they are able to both diagnose and treat disorders related to their mental state. They are also able to prescribe medication.

Training standards

Some practitioners of forensic psychiatry have taken extra training in that specific area. In the United States, one-year fellowships are offered in this field to psychiatrists who have completed their general psychiatry training. Such psychiatrists may then be eligible to sit for a board certification examination in forensic psychiatry. In Britain, one is required to complete a three-year subspeciality training in forensic psychiatry, after completing one's general psychiatry training, before receiving a Certificate of Completion of Training as a forensic psychiatrist. In some countries, general psychiatrists can practice forensic psychiatry, as well. However, other countries, such as Japan, require a specific certification from the government to do this type of work.

PAKISTAN

Case of Khizer Hayat comes to court notice when an appeal is submitted by Dr Usman Amin Hotiana for a mentally ill prisoner. This case spirals over the years and in span of ten years crystallize to a landmark judgment of Safia Bano Case. [28]

KHIZER HAYAT CASE

The saga started with the  Case of a death row mentally ill prisoner Khizer Hayat, a convicted prisoner diagnosed with schizophrenia in 2008 after murdering a colleague. He spent his last six years in solitary confinement, experiencing severe hallucinations and delusions without any insight. His case became a pivotal example in the evolution of mental health laws in Pakistan.

In 2013, Dr Hotiana collaborated with the Justice Project Pakistan (JPP) to stop Hayat's execution, garnering significant support from the psychiatric community. Pakistan Psychiatric Society fully supported and large number of psychiatrists signed the appeal and expressed their continuous support over the years.  Despite repeated death sentences, their appeals were successful in delaying his execution multiple times until Hayat eventually died in a hospital.

This case highlighted the challenges in assessing mentally ill prisoners within the legal system and emphasized the need for better understanding and cooperation between the legal and psychiatric communities. The persistent efforts led to broader awareness and changes in legal perspectives on mental illness and capital punishment. The story culminates in the landmark Supreme Court judgment in Safia Bano vs Home Department, which banned the death penalty for prisoners with severe mental illnesses, recognizing the unjustness of such punishments when mental illness impairs rationality [29]

This case was significant as it advocated for all prisoners with mental illnesses who were on death row. The executions of these individuals were postponed through appeals filed by the local nonprofit organization, Justice Project Pakistan [30] Dr. Hotiana reviewed Khizer Hayat's medical records and filed an appeal, asserting that Hayat suffered from severe, treatment-resistant schizophrenia, as confirmed by multiple psychiatrists over the years. The court stayed the execution. Dr. Hotiana presented the facts to Justice Umer Ata Bandial, who supported the civil society movement but noted that psychiatric terminology often lacks clarity in courtroom settings. [31]

PAKISTAN PSYCHIATRIC SOCIETY

Awareness about forensic mental health issues were created all over the country. Through academic workshops at the universities, colleges, courts. It involved lawyers, judges and mental health professionals. Newspaper articles on the plight of Imdad ali and others were highlighted. Awareness through issues of forensic psychiatry were highlighted [32] as well as plights of mentally ill [33] This particular prisoner, failed to have representation till the Supreme court took notice [34] Along with media awareness, scientific research about the perceptions of schizophrenia were studied. [35]

Prof Mubasshar Hussain Malik

This movement incorporated Prof Mubasshar Hussain Malik as he met the team at the first forensic conference at University of Health Sciences. Later he became one of the central figures to promote the cause.

INSTITUTE OF PSYCHIATRY

Prof Fareed Minhas , Head of the Department, Institute of Psychiatry at Benazir Shaheed Hospital invited Dr Usman Amin Hotiana for a Forensic Workshop named ' Forensic Psychiatry & Law: A torrid Love affair". This created a long lasting partnership across the key departments. [36]

DEATH OF KHIZER HAYAT

Khizer Hayat died after remaining ill at the Kotlakpath Jail and was brought to Jinnah hospital. His death brought a new spark to the movement. Again with new zest the campaign was initiated. All pending cases were reviewed and public awareness and technical issues were reviewed [37]

SAFIA BANO CASE

This landmark judgement culminated in deeply reviewing all the relevant mental illness related issues surrounding the death sentences of mentally ill prisoners. So the key mentally ill prisoners cases collectively were presented and seriously reviewed by Judges of the Supreme Court. Eventually they came up with broad answers to common issues presented to the court. This begins the new era of Forensic Psychiatry in Pakistan. [38]

See also

Related Research Articles

The insanity defense, also known as the mental disorder defense, is an affirmative defense by excuse in a criminal case, arguing that the defendant is not responsible for their actions due to a psychiatric disease at the time of the criminal act. This is contrasted with an excuse of provocation, in which the defendant is responsible, but the responsibility is lessened due to a temporary mental state. It is also contrasted with the justification of self defense or with the mitigation of imperfect self-defense. The insanity defense is also contrasted with a finding that a defendant cannot stand trial in a criminal case because a mental disease prevents them from effectively assisting counsel, from a civil finding in trusts and estates where a will is nullified because it was made when a mental disorder prevented a testator from recognizing the natural objects of their bounty, and from involuntary civil commitment to a mental institution, when anyone is found to be gravely disabled or to be a danger to themself or to others.

A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians and evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly mental issues. Sometimes a psychiatrist works within a multi-disciplinary team, which may comprise clinical psychologists, social workers, occupational therapists, and nursing staff. Psychiatrists have broad training in a biopsychosocial approach to the assessment and management of mental illness.

<span class="mw-page-title-main">Insanity</span> Abnormal mental or behavioral patterns

Insanity, madness, lunacy, and craziness are behaviors caused by certain abnormal mental or behavioral patterns. Insanity can manifest as violations of societal norms, including a person or persons becoming a danger to themselves or to other people. Conceptually, mental insanity also is associated with the biological phenomenon of contagion as in the case of copycat suicides. In contemporary usage, the term insanity is an informal, un-scientific term denoting "mental instability"; thus, the term insanity defense is the legal definition of mental instability. In medicine, the general term psychosis is used to include the presence of delusions and/or hallucinations in a patient; and psychiatric illness is "psychopathology", not mental insanity.

Forensic psychology is the practice of psychology applied to the law. Forensic psychology is the application of scientific knowledge and methods to help answer legal questions arising in criminal, civil, contractual, or other judicial proceedings. Forensic psychology includes research on various psychology-law topics, such as jury selection, reducing systemic racism in criminal law, eyewitness testimony, evaluating competency to stand trial, or assessing military veterans for service-connected disability compensation. The American Psychological Association's Specialty Guidelines for Forensic Psychologists reference several psychology subdisciplines, such as social, clinical, experimental, counseling, and neuropsychology.

<span class="mw-page-title-main">Political abuse of psychiatry in the Soviet Union</span> Misuse of psychiatry for political purposes in the Soviet Union

There was systematic political abuse of psychiatry in the Soviet Union, based on the interpretation of political opposition or dissent as a psychiatric problem. It was called "psychopathological mechanisms" of dissent.

<span class="mw-page-title-main">Mental Health Act 1983</span> Law in England and Wales

The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom. It covers the reception, care and treatment of mentally disordered people, the management of their property and other related matters, forming part of the mental health law for the people in England and Wales. In particular, it provides the legislation by which people diagnosed with a mental disorder can be detained in a hospital or police custody and have their disorder assessed or treated against their wishes, informally known as "sectioning". Its use is reviewed and regulated by the Care Quality Commission. The Act was significantly amended by the Mental Health Act 2007. A white paper proposing changes to the act was published in 2021 following an independent review of the act by Simon Wessely.

In United States and Canadian law, competence concerns the mental capacity of an individual to participate in legal proceedings or transactions, and the mental condition a person must have to be responsible for his or her decisions or acts. Competence is an attribute that is decision-specific. Depending on various factors which typically revolve around mental function integrity, an individual may or may not be competent to make a particular medical decision, a particular contractual agreement, to execute an effective deed to real property, or to execute a will having certain terms.

Michael Mark Welner is an American forensic psychiatrist and Chairman of The Forensic Panel. Welner is best known for his work in sensitive and complex litigation. He has acted as lead forensic psychiatric examiner in numerous criminal or court proceedings of national and international prominence, including precedent-setting trials and higher court decisions. Welner is also known for a number of innovations in forensic science, forensic psychiatry and justice, including protocols for prospective peer review in forensic medicine consultation, research to standardize an evidence-based distinction of the worst crimes, The Depravity Standard, and recommendations for upgrading forensic science assessment. He has been featured in network television news coverage of forensic psychiatry issues, has authored publications for professional and public audiences, and has contributed to emerging legislation on mental health reform.

Atascadero State Hospital, formally known as California Department of State Hospitals - Atascadero (DSHA), is located on the Central Coast of California, in San Luis Obispo County, halfway between Los Angeles and San Francisco. DSHA is an all-male, maximum-security facility, forensic institution that houses mentally ill convicts who have been committed to psychiatric facilities by California's courts. Located on a 700+ acre grounds in the city of Atascadero, California, it is the largest employer in that town. DSHA is not a general purpose public hospital, and the only patients admitted are those that are referred to the hospital by the Superior Court, Board of Prison Terms, or the Department of Corrections.

In the United States criminal justice system, a competency evaluation is an assessment of the ability of a defendant to understand and rationally participate in a court process.

<i>United States v. Binion</i>

United States v. Binion, 132 F. App'x 89, is a case in which the United States Court of Appeals for the Eighth Circuit applied two recent U.S. Supreme Court decisions, United States v. Booker and United States v. Fanfan, in upholding the sentencing decision by the trial court, the United States District Court for the Eastern District of Missouri.

Frendak v. United States, 408 A.2d 364 is a landmark case in which District of Columbia Court of Appeals decided that a judge could not impose an insanity defense over the defendant's objections.

Barefoot v. Estelle, 463 U.S. 880 (1983), is a United States Supreme Court case. The Court ruled on the admissibility of clinical opinions given by two psychiatrists hired by the prosecution in answer to hypothetical questions regarding the defendant's future dangerousness and the likelihood that he would present a continuing threat to society in this Texas death penalty case. The American Psychiatric Association submitted an amicus curiae brief in support of the defendant's position that such testimony should be inadmissible and urging curtailment of psychiatric testimony regarding future dangerousness and a prohibition of such testimony based on hypothetical data.

A psychiatric assessment, or psychological screening, is the process of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes. The assessment includes social and biographical information, direct observations, and data from specific psychological tests. It is typically carried out by a psychiatrist, but it can be a multi-disciplinary process involving nurses, psychologists, occupational therapist, social workers, and licensed professional counselors.

Political abuse of psychiatry, also commonly referred to as punitive psychiatry, is the misuse of psychiatry, including diagnosis, detention, and treatment, for the purposes of obstructing the human rights of individuals and/or groups in a society. In other words, abuse of psychiatry is the deliberate action of having citizens psychiatrically diagnosed who need neither psychiatric restraint nor psychiatric treatment. Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience. As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances. Nowadays, in many countries, political prisoners are sometimes confined and abused in psychiatric hospitals.

<span class="mw-page-title-main">Political abuse of psychiatry in Russia</span>

Political abuse of psychiatry implies a misuse of psychiatric diagnosis, detention and treatment for the purposes of obstructing the fundamental human rights of certain groups and individuals in a society. In other words, abuse of psychiatry including one for political purposes is the deliberate action of getting citizens certified, who, because of their mental condition, need neither psychiatric restraint nor psychiatric treatment. Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience. As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances. Nowadays, in many countries, political prisoners are sometimes confined and abused in mental institutions. Psychiatric confinement of sane people is uniformly considered a particularly pernicious form of repression.

The following outline is provided as an overview of and topical guide to psychiatry:

<span class="mw-page-title-main">Mental health in Russia</span>

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", 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.

<span class="mw-page-title-main">Mental health tribunal</span> Tribunal hearing for mental health treatment disputes

A mental health tribunal is a specialist tribunal (hearing) empowered by law to adjudicate disputes about mental health treatment and detention, primarily by conducting independent reviews of patients diagnosed with mental disorders who are detained in psychiatric hospitals, or under outpatient commitment, and who may be subject to involuntary treatment.

Involuntary commitment or civil commitment is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily.

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  36. World Psychiatric Association. "Obituary: Prof. Dr. Hussain Mubbashar Malik (1945-2020)." Available at: https://www.wpanet.org/post/obituary-prof-dr-hussain-mubbashar-malik-1945-2020
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