RESUMO
The Criminal Code of Mongolia, article 22.2 defines that a person who was imputable at the time of committing a crime but lost the ability to realize the socially dangerous nature of his/her act or omission or to control it due to chronic mental illness, temporary mental derangement, mental deficiency or another serious illness during the consideration of the case in court shall not be subject to criminal liability. A court shall apply to such a person compulsory measures of medical character and decide the matter of imposing punishment after his/her recovery.The Mental Health Law of Mongolia, article 3.1.13 also defines that socially endangered actions of persons with mental disorders means actions of persons who lost self control due to mental disorders by causing self harm, endangering safety of others and community. Therefore obvious need to study the causes of socially dangerous nature acts of patients to whom the court applied compulsory measures of medical character has been assessed.1. Study the diagnosis and mental states when the acts were committed.2. Study the ways of socially dangerous nature acts of mental health patients3. Duration of compulsory medical treatmentsStudy of medical history of those patients discharged from compulsory medical treatment shows that their mental illnesses were started from very young ages and continued in lengthy period of time. Patients with organic mental disorders (39.4%), schizophrenia, schizoid personalitydisorders and delusions (36.4%) were committed socially dangerous acts. Ways of socially dangerous acts were homicide, inflictions of bodily injuries to others including family members and hooliganism.30.3% of patients were in compulsory medical treatment for 10-12 months and 50% of them were with organic mental disorders. 18.2% of patients were in compulsory medical treatment for 25 months and over. 66.6% of them were diagnosed with schizophrenia, schizoid personalitydisorder and delusion.
RESUMO
Health expenditure towards mental health is only 2% of all other health expenditure allocated to public health. Currently almost 64% of all that fraction xpendituregoesto hospital based care. It means that there is lack of resources or limitation for development of community basedmental health services in this country, where hospital based mental health system is still remain in place. Long term chronic patients occupied most hospital beds are usually homeless, have no caregivers, no family protection or have a families that could not support their mentally ill members. Traditionally National Center for Mental Health has been offering community based rehabilitation scheme in form of developing labor skills but its coverage and accessibility remains short. In other words it is open for those who admitted to an inpatient service only.For last years the center has been forged partnership with international NGO namely AIFO in cooperation to gradually expand its works toward development of community based rehabilitation programs for people with mental health problems. Study basis is a current need for an expansion and coverage of mental health care and services and priority development of community based services over inpatient care.To asses a current situation of long term chronic patients admitted to inpatient service, their inclusion to CBR programs, expansion possibility of mental health servicesTotal 450 cases of history were registered in an inpatient care in 2013. 170 cases of them were belong to long term patients (1 and over years) with 94 male (55.3% )and 76 female (44.7%) patients. From perspective of age: adult (30-49 years old) consists of main percentage (66.4%)of long term patients. 64 (57.1%)of that age group patients have diagnosis of schizophrenia. Age group of 10-19 years old consists of 0.6% with mental retardation diagnosis. Research shows that long term patients mostly have affective disorders, organic psychosis, mental retardation and schizophrenia. Schizophrenic patients consist of most percentage (52.9%) of long termpatients. Inpatient stay duration spans from 1 to 36 years for long term patients and 17 patients of them have been on permanent basis at the center. These inpatient care users usually have been re-admitting after from 2 weeks to 1 month of duration breaks and they all suffer fromschizophrenia.Currently 170 patients out 450 or 1 in 3 admitted to inpatient service department at NCMH are chronic patients. 80.6% of those frequent users consist of labor intensive 20-49 year olds. Need to develop and conduct community based rehabilitation programs at primary, secondaryand tertiary level of public health services, include chronic patients and also need to set up a nursery for chronic mental health patients.