The system of coercive (court mandated) medical measures in the Russian Federation

Coercive treatment (CT) in Russia is a court mandated medical measure applied to persons who committed a punishable "socially dangerous act" (SDA) and who are suffering from a mental disorder if it is proved that their dangerousness is due to such disorder. The CT is applied to the irresponsible, to the person fallen ill after having committed the crime, and to the "partially responsible". There are four types of CT: 1) the outpatient CT is ordered to the patients who had committed the SDA in an acute psychotic state that has no tendency to be repeated or to the chronically ill patients after inpatient CT (the mean length of stay (LOS) in 2005 was 382.9 days). 2) The CT at a general (low security) psychiatric hospital is given to the patients suffering from a well curable acute disorder or relapse of chronic disorder. These patients are generally well adjusted to living in the community and their dangerousness is associated solely with their psychotic experiences; but their LOS is much longer (428.3 days) than that of the ordinary patients owing to the necessity to obtain a stable remission. 3) The dangerousness of the patients at a specialized (medium secure) hospital is caused by their deficient and personality disorders with antisocial orientations. The developing of socially acceptable stereotypes of conduct requires a long CT (603.4 lays). 4) The patients of a specialized hospital with intensive observation are united by their particular dangerousness associated with mental disorder (aggressiveness, persistent recidivism, severe violation of hospital regimen; the LOS here exceeds 1,226 days). The above mentioned measures function as a system owing to their right choice, the possibility of their successive substitution, and active preventive follow ups after completion of CT. The effectiveness of CT remains moderate: about 1/3 of the discharged patients commit repeated SDA, there is a slow accumulation of long stay patients (10 years or more) in all types of hospitals.