Institutional Vacuum
According to the Thematic Report of the People’s Advocate (Ombudsman) on the Prevention of Violence in the Context of Mental Disorders, the Ministry of Health provides discharged patients with access to local mental health centers exclusively on a voluntary basis, as national legislation does not provide for compulsory outpatient treatment. This approach makes it impossible to effectively monitor individuals at high risk of aggression, especially when a patient refuses to take medication, family members are uncooperative, and there is a history of violence or serious threats.
At the same time, the Ministry of Internal Affairs confirms that the police have no legal grounds for preventive monitoring of such citizens before they commit offenses, and information about the risk of violence is not systematically shared with local police officers. On the other hand, the Ministry of Labor and Social Protection clarifies that social services and residential centers are intended exclusively for individuals who do not pose a clear danger to the public, while patients experiencing an acute episode or exhibiting aggressive behavior are strictly referred to medical facilities.
Thus, upon returning to society, individuals with mental disorders and a propensity for violence find themselves in an institutional vacuum—between the healthcare system, which cannot compel treatment at home, and the social services sector, which refuses to accept dangerous patients. Although families are expected to play a key role in supporting the patient after discharge, there are no mechanisms in place to assess relatives’ ability to manage risks, and their refusal to cooperate limits the authorities’ actions to merely responding to emergency calls on a case-by-case basis.
This fragmentation among agencies—where doctors intervene only during a crisis, the police respond only after the fact, and social workers provide assistance only when there is no threat— — turns the post-discharge period into a high-risk zone, increasing the likelihood of violent recidivism in society.
When the system fails…
The report presents a series of analyses of specific situations. In particular, the starting point for the study was a tragic incident in the Kahul district, where a protracted family conflict led to the commission of an especially grave crime—a double homicide. What makes this case unique is that, prior to the tragedy, law enforcement agencies had received repeated reports, taken responsive measures, and applied the mechanisms provided for by law, including those related to combating domestic violence. Nevertheless, the incident exposed a failure in secondary and tertiary prevention systems, caused by blurred lines of responsibility and a lack of clear rules for coordination between the Ministry of Internal Affairs, the Ministry of Health, and the Ministry of Labor. The legal measures implemented were not integrated into a unified risk-reduction process, which ultimately led to an uncontrolled escalation of violence.
Solutions
The document contains key strategic recommendations for the government and relevant ministries aimed at eliminating the institutional gap that jeopardizes public safety following the discharge of high-risk psychiatric patients.
The government is advised to establish a permanent mechanism for interagency cooperation and to implement a unified tool for assessing the risk of violence, which would be mandatory for all agencies.
The Ministry of Health must develop regulations for mandatory risk assessments upon discharge, expand post-discharge monitoring services at the local community level, and open specialized secure wards in psychiatric hospitals (separate by gender, for forensic evaluations, and for minors).
The Ministry of Internal Affairs should clearly define the role of the police in the post-discharge phase and train officers in crisis intervention skills related to mental disorders, shifting the focus from response to prevention.
The Ministry of Labor and Social Protection is recommended to involve social workers in planning patient discharges and to develop support programs for families caring for aggressive patients.
The Ministry of Education, the Ministry of Justice, and local authorities must establish cooperation to identify threats early, protect at-risk children, and organize specialized training for judges and prosecutors.
The Ombudsman’s report will be presented at a public hearing of the relevant parliamentary committee on July 10.
Follow our updates
