Prevention of Dangerous Acts of Persons with Mental Disorders: Organization, Statistics, Trends

Dangerous and violent acts of mentally disordered persons that pose a threat to the health and lives of people around them frequently attract the media attention and become a subject of public debates. Prevention of such actions is one of the most important tasks of the psychiatric care system. This article describes the organization of psychiatric prevention at federal and regional levels, involving all medical organizations that provide outpatient and inpatient psychiatric care. The primary focus is on forensic psychiatric prevention of dangerous behavior of the mentally ill. One of the forms of preventive measures is active dispensary observation of patients prone to dangerous acts due to their mental condition. This observation is carried out by medical organizations together with the internal affairs’ agencies. However, the key issue of forensic psychiatric prevention is the execution of the compulsory medical measures imposed by the court and provided for by the Criminal Code of the Russian Federation. Besides, the measures aimed at preventing repeat crimes also include psychiatric care of convicts as a separate branch of forensic psychiatric prevention. The authors present the data of ten-year monitoring of medical services that make it possible to assess the scope, main directions and effectiveness of prevention. This investigation uses the data from the state statistical reports for the Russian Federation and the subjects of the Russian Federation from 2008 to 2017. On this basis, the authors identify the trends in prevention of the dangerous acts of mentally disordered offenders in the psychiatric care system and formulate the main directions for the improvement. In this connection, the authors pay special attention to the use of standardized risk assessment tools to predict dangerous behavior of the mentally ill as one of the ways to increase the effectiveness of psychiatric prevention. Such tools are widely used in foreign forensic psychiatric practice, as well as in criminal justice institutions. The authors describe principal methodological approaches to the development of such tools in foreign and domestic research. According to the authors, the use of such techniques for the risk assessment of dangerous behavior in mentally disordered persons and the development of individual medical and rehabilitation plans on their basis would expand the possibilities for forensic psychiatric prevention.