Procedures for the Mandatory Medical Treatment of Children Having Mental Dysfunction or Behavioural Disorders Due to the Use of Alcoholic Beverages, Narcotic, Toxic or Other Intoxicating Substances and Procedures for the Provision of Mandatory Medical Treatment for Addiction to Alcohol, Narcotic and Psychotropic Substances at Social Correctional Education Institutions

Issued pursuant to
Section 48, paragraph five and Section 49, paragraph three of
the Protection of the Rights of the Child Law
and Section 14, paragraph two of
the Law on the Application of Compulsory Measures of a Correctional Nature to Children

I. General Provisions

1. These Regulations prescribe the procedures for the mandatory medical treatment of children having mental dysfunction or behavioural disorders due to the use of alcoholic beverages, narcotic, toxic or other intoxicating substances, as well as the procedures for the provision of mandatory medical treatment for addiction to alcohol, narcotic and psychotropic substances at social correctional education institutions.

2. A child's continuing and systematic mandatory medical treatment for addiction to alcohol, narcotic, psychotropic or other intoxicating substances (hereinafter - narcological assistance) shall be organised and provided by a certified narcologist (hereinafter - narcologist) in co-operation with the family doctor and other medical practitioners, a psychologist, a social worker and a social pedagogue.

3. Narcological assistance shall include, in light of medical technologies, the diagnosis and medical treatment of a child's narcological disease at an outpatient or inpatient medical treatment institution and a social correctional education institution, as well as work with the patient's immediate family.

4. Outpatient narcological assistance shall be provided according to the place of residence of a child. If a narcologist is not available in the respective administrative territory, the Health Fund shall enter into an agreement with a narcologist from the nearest district regarding the provision of this particular service.

5. Narcological assistance shall be provided only with a child's consent, as well as that of at least one of his or her parents, a guardian or an Orphans' Court (parish court).

6. Narcological assistance shall be provided without the consent of a child and at least that of one of his or her parents, a guardian or an Orphans' court (parish court) only in those cases where a child has such severe intoxication from alcohol, narcotic or psychotropic substances that his or her life is endangered, or if mental dysfunction has arisen due to which he or she is endangering his or her family, himself or herself or other persons.

7. Expenses associated with the provision of narcological assistance to children shall be covered from funds of the State budget.

II. Outpatient Narcological Assistance

8. A child shall receive outpatient narcological assistance in the following cases:

8.1. if he or she has an appointment with a medical practitioner;

8.2. at the child's own initiative or at that of at least one of his or her parents, a guardian or an Orphans' court (parish court);

8.3. at the recommendation of other authorities (e.g. police authorities, social welfare service, educational institutions);

8.4. after medical treatment at an inpatient medical treatment institution; and

8.5. where there is a relevant decision by a court.

9. The narcologist, according to the child's state of health as diagnosed during examination, shall draw up a plan for continuing medical treatment and prescribe medical treatment for him or her at an outpatient or inpatient medical treatment institution.

10. In order to prevent the recurrence of the disease and to motivate the child to continue medical treatment, the narcologist shall prescribe and provide outpatient case monitoring in the following cases:

10.1. if the child has suffered psychosis caused by intoxication from alcohol or other substances;

10.2. if the child has received a diagnosis of addiction to alcohol or other substances;

10.3. if the child has received a diagnosis of addiction to narcotic, psychotropic or other addictive substances; and

10.4. if the child is a user of alcohol, narcotic or psychotropic substances.

11. The duration of the outpatient case monitoring of a child in cases specified in Sub-paragraphs 10.1, 10.2 and 10.3 of these Regulations shall be three years, but in the case specified in Sub-paragraph 10.4 of this Regulation - one year.

12. If a child has been ordered to visit a narcologist by a medical practitioner, the narcologist shall inform the respective medical practitioner in writing about the results of examinations within 5 working days following the consultation.

13. If by a court decision a child has an imposed obligation to undergo medical treatment for addiction to alcohol, narcotic or psychotropic substances, but the child has not undertaken any medical treatment within 5 working days' time, the narcologist shall inform the local government in the territory of which the child's place of residence is registered.

III. Inpatient Narcological Assistance

14. The medical treatment of a child at an inpatient medical treatment institution shall include the following treatment stages:

14.1. acute somatic treatment and the treatment of psychopathological symptoms - the average duration of medical treatment is three to ten days; and

14.2. the subsequent psychotherapeutic motivational medical treatment programme.

15. A child shall be hospitalised if:

15.1. so ordered by a narcologist; or

15.2. due to the use of alcoholic beverages, narcotic, psychotropic or other intoxicating substances acute mental dysfunction or behavioural disorders have arisen for the child which could endanger his or her health.

16. In the case specified in Sub-paragraph 15.2 of this Regulation the emergency medical care service shall deliver the child to the nearest inpatient medical treatment institution capable of providing the appropriate medical care.

17. If a child has been hospitalised at an inpatient medical treatment institution in conformity with the provision specified in Sub-paragraph 15.2 of these Regulations, the attending physician shall provide consultation with a narcologist for the child within a period of two working days. The narcologist shall draw up a medical treatment plan and prescribe continuing medical treatment at an outpatient or inpatient medical treatment institution for the child to undergo the course of a psychotherapeutic motivational medical treatment programme.

18. If at least one of the parents or the guardian of a child refuses narcological assistance for him or her, the attending physician shall inform the narcologist and the Orphans' Court (parish court) according to the child's place of residence in writing within 5 working days.

19. If a child arbitrarily stops narcological treatment, the attending physician shall within 24 hours inform in writing at least one of the parents of the child, the guardian or the Orphans' Court (parish court) according to the child's place of residence.

20. Upon the completion of the course of a psychotherapeutic motivational medical treatment programme, the attending physician shall assign the child to a social rehabilitation institution or for subsequent outpatient medical treatment and inform in writing thereof the narcologist according to the child's place of residence.

IV. Narcological Assistance at Social Correctional Education Institutions

21. Within ten working days' time after a child has been placed at a social correctional education institution, the head thereof shall provide him or her with consultation by a narcologist.

22. The narcologist shall consult the child, draw up his or her continuing medical treatment plan and treat the child at the social correctional education institution in collaboration with a psychologist and a medical staff member at the social correctional education institution.

23. If acute mental dysfunction or behavioural disorders have arisen for the child due to his or her use of alcoholic beverages, narcotic, psychotropic or other intoxicating substances and they can endanger the child's health, the head of the social correctional education institution shall immediately organise the hospitalisation of the child at the nearest inpatient medical treatment institution. If the child arbitrarily stops narcological treatment at the inpatient medical treatment institution, the attending physician shall immediately, but no later than within a period of 24 hours inform the head of the social correctional education institution thereof.

24. No later than five days before the child is expected to leave the social correctional education institution, the narcologist at the institution shall inform in writing the narcologist according to the child's place of residence thereof.

V. Closing Provisions

25. These Regulations shall come into force on 1 January 2004.

Prime Minister E. Repše

Acting for the Minister for Health,
Minister for Special Assignments -
Children and Family Affairs A. Baštiks

Translation © 2005 Tulkošanas un terminoloģijas centrs (Translation and Terminology Centre)