Rehabilitation of the mentally ill. Social rehabilitation of the mentally ill. The benefits of psychiatric rehabilitation
General Psychiatry A. Tiganov (ed.)
Its immediate tasks include: medical rehabilitation aimed at achieving the maximum possible clinical compensation, stopping the manifestations of the disease and preventing its undesirable consequences or reducing them; vocational and labor rehabilitation - returning to the patient the ability to participate in socially useful work, independent life support; social rehabilitation - restoration of the individual and social value of the patient.
A brief historical outline. The need for a humane attitude to the mentally ill and maintaining their social status was recognized by scientists in ancient times. So, Celius Aurelian (IV - V centuries AD) 1 in his instructions recommended benevolent, gentle treatment of the mentally ill, and when he was recovering he prescribed walking, pleasant conversations, reading, theater and rhetoric exercises. But a real shift in the corresponding psychiatric views occurred later, only in the XVIII century. The French physician Philippe Pinel stood at the origins of the no-restraint movement for the mentally ill and creating decent conditions for their detention. In England, the ideas of a humane attitude to the mentally ill were promoted by W. Tuke, who first organized a free-style shelter for them (1792). The actual abolition of measures of restraint psychiatry owes J. Conolly (1839). With the active participation of J. Esquirol in 1838, the first legislative act appeared in France protecting the rights and interests of the mentally ill. Similar laws by the middle of the XVIII century. were accepted in other European countries.
In Russia, for centuries, holy fools, wretched and lost their minds found refuge at the monasteries. It was only under Peter I that the first special houses for the mentally ill (dollar-houses) appeared. Later, in the reign of Catherine II, the Charter of Orders of public charity was published, which included houses for the insane, which prescribed a philanthropic attitude towards their inhabitants.
At the end of the XVIII - beginning of the XIX century. family patronage (especially developed in areas adjacent to large hospitals) began to occupy an important place in the charity of the mentally ill, in which elements of patient rehabilitation in its modern content were already more pronounced. Finally, in 1900 V.M. For the first time in Russia, Bekhterev opens a neuropsychiatric department in St. Petersburg’s Clinic for Mental Illness with a free exit for convalescents, which expanded the possibilities of their involvement in ordinary life. In new hospitals, specially equipped rooms for various crafts are beginning to be provided. The latter served both the goals of healing (labor therapy) and partly the entertainment of patients. For chronically ill patients, colonies were organized that were located mainly in rural areas, so that patients who retained their ability to work could engage in agricultural labor (gardening, field work, cattle breeding, etc.). So, in 1873, a large colony opened near Novgorod, and in 1881 in the village of Pokrovsko-Meshcherskoye near Moscow. In some colonies, the "open door" system began to be practiced. Already at that time V.I. Yakovenko, observing the negative consequences of a patient's long stay in a hospital and isolation from society, was one of the first Russian psychiatrists to express the idea of \u200b\u200bthe need for decentralization of psychiatric care. He proposed the design of a network of small hospitals, "put forward in the midst of everyday life." Later P.P. Kashchenko, heading the hospital in Nizhny Novgorod (1898-1920), turned it into an exemplary medical institution. The presence of workshops and vegetable gardens at the hospital allowed patients to participate in the labor process. He also organized a colony for the mentally ill, following the Western model, where he widely practiced the system of family patronage.
But the most active dissemination and implementation of the ideas of “non-oppression” in Russia is associated with the name of S. S. Korsakov and representatives of his school, to which Russian psychiatry owes that the main approaches to nosocomial rehabilitation of the mentally ill, relevant to the present, have been formed in Russia back at the beginning of our century. S.S. Korsakov, being the initiator and head of the zemstvo and city construction of psychiatric institutions, abolished all measures of physical restraint of patients (straitjackets, insulators, bars on windows, etc.). His interests also included protection of the civil rights of the mentally ill, conducting a forensic psychiatric examination, disseminating psychiatric knowledge among the population, and preventing mental disorders.
The followers of S.S. Korsakova V.P. Serbsky and P. B. Gannushkin did a lot to develop legislation on the mentally ill, address issues of the right to charity and security, sanity, capacity and ability to work, i.e. a complex of legal problems, without which a real resocialization of the mentally ill is impossible. Subsequently, the Zemstvo psychiatrist T.A. Geyer (one of the initiators of the creation of the Institute for Expertise on Disability and Organization of Labor of Persons with Disabilities) created the clinical foundations of medical and labor examination, employment of mentally ill patients, community-based care, psychotherapy and occupational therapy - all that later became part of the concept "social and labor rehabilitation".
Although the foundations of domestic social psychiatry were laid back in the Zemstvo period, their implementation on a national scale took place only in the 20-30s of the XX century, marked not only by the reconstruction of existing psychiatric hospitals, but also by the organization of community-based psychiatric services (neuropsychiatric rooms) in our country. , dispensaries) and the formation of a system of social and labor structure of patients.
Thanks to the development of a network of neuropsychiatric dispensaries, there is the possibility of outpatient treatment of mentally ill patients, reducing the length of their hospital stay. It became real to provide them with qualified medical and social assistance throughout their lives, observing the continuity of medical and rehabilitation measures between the hospital and the dispensary. The need for social isolation of patients and their separation from everyday life has disappeared. Monitoring of outpatient contingents has made adjustments to scientific ideas about the dynamics of mental illness, showing that for the greater extent, many patients do not need hospitalization, remain in society and, in the presence of favorable conditions, can remain able to work for a long time.
The basis for the social and labor rehabilitation of the mentally ill became day care centers at PND, labor therapy rooms and medical labor workshops. Occupational therapy is also widely practiced in psychiatric hospitals themselves, where in almost every department, the patients perform the simplest work (collect small parts of various devices, make artificial flowers, toys, glue packing boxes, etc.) in the hours prescribed by the internal schedule. Some patients perform outdoor work in the hospital. In hospitals with a well-established treatment and rehabilitation process, the organization of such classes occupies a rather large place along with cultural therapy (watching movies, using the library, etc.). However, this “nosocomial” rehabilitation at the present stage of the development of society could not satisfy either psychiatrists or patients, and in almost all countries rehabilitation measures began to be carried out outside medical psychiatric institutions on a higher technical basis.
An important incentive for the introduction of such occupational therapy was the dissemination of the ideas of sociotherapy. At the origins of the latter was the German psychiatrist N. Simon (1927), who considered the inclusion of a mentally ill patient in collective labor activity as a powerful factor in stimulating his social activity and overcoming the phenomena of pathological psychosocial adaptation to an unfavorable hospital environment. The system he proposed in a slightly modified form became widely known in the post-war years under the names "occupational therapy"; "industrial therapy", or "industrial rehabilitation" (industrial therapy, industrial rehabilitation). Its starting point was group work in medical workshops in conditions close to real production, but then such therapy was transferred to agricultural and industrial enterprises. This trend has become especially characteristic of post-war psychiatry.
The possibilities of such rehabilitation increased significantly after the introduction of effective antipsychotic drugs into clinical practice, which made it possible to achieve not only an improvement in the condition of many patients, but also their discharge from the hospital with a transfer to maintenance therapy. Therefore, the development of industrial rehabilitation in our country reached its greatest "peak" in the 70-80s. In the psychiatric literature of those years, its various organizational forms were widely covered and convincing data on its high effectiveness were cited [Melekhov D.E., 1974; Kabanov M.M., 1978; Krasik E.D., 1981]. Not only various forms of labor readaptation were developed, but also the corresponding medical and psychological effects on the patient during its implementation.
In our country, in large agricultural and industrial regions, special rehabilitation centers dealt with these issues. Briefly dwell on the characteristics of the most typical of them.
In 1973, a post-hospital rehabilitation center was established in the Odessa region, operating on the basis of an agricultural enterprise. Relations with the state farm, which were built on the principle of cost accounting, provided for the provision of a well-maintained dormitory for the patients (where they were fully self-catering), meals in the dining room and work. Qualified medical care was provided to patients with the rehabilitation service of the Odessa Psychiatric Hospital. Thus, in the rehabilitation process, psychosocial (sociotherapeutic) and biological methods of exposure were comprehensively used. Patients performed field work, were employed on a livestock farm, in specialized workshops for processing agricultural products. The rehabilitation process was carried out in stages, starting with the formation of professional skills and ending with rational employment at the state farm. The center was designed primarily for patients with chronic and continuously ongoing forms of mental illness, as well as suffering from frequent relapses. Among them prevailed persons with a long history of the disease (from 10 to 25 years), a long (more than 5-10 years) continuous stay in a psychiatric hospital, or frequent re-hospitalization. Observations of patients in this center showed that as a result of rehabilitation measures, the frequency of exacerbations significantly decreased, the length of the interictal spaces was increased, productive symptoms were softened, and the manifestations of the defect were compensated. About 60% of patients fully mastered production skills, the rest mastered them in a partial volume [Maryanchik R.Ya., 1977].
Rehabilitation centers provided significant financial benefits to healthcare by reducing the length of hospital stay of patients, the cost of their products, and the profits made from their sale. But such labor rehabilitation also pursued a more important goal - to make possible discharge, community-based existence and self-sufficiency of patients with disabilities who were in psychiatric hospitals for a long time, including the colonial type. At the same time, the tasks were set of restoring lost ties with relatives and acquaintances, revitalizing forgotten skills of proper behavior and self-care, as well as the emotionality of patients (with the additional use of cultural therapy, physiotherapy exercises, etc.). Industrial rehabilitation is widespread in Kaluga [Lifshits A.E., Arzamastsev Yu.N., 1978] and Tomsk [Krasik E.D. et al., 1981].
It should be noted that the organization of industrial rehabilitation gave significant advantages to patients compared to working in traditional medical and labor workshops. Such workshops were considered an intermediate link in the way of job placement for patients in a special workshop or in ordinary production. But labor in medical and labor workshops was not work in the legal sense, since the sick did not accrue seniority, did not start work books, instead of a salary, they received a monetary reward. They were not issued a sick leave certificate (“sick leave”), and paid leave was not provided. Thus, they remained in the position of patients of the medical institution and it was not possible to talk about their true compensation. The social status of patients under the conditions of work at a regular industrial enterprise was fundamentally changing.
In the Kaluga Regional Psychiatric Hospital No. 1 in 1973, on the basis of medical and labor workshops, a special workshop of the turbine factory was opened, which became not only a center for labor and social rehabilitation, but also a place for industrial training of patients in an industrial enterprise.
Disabled people of groups I and II for mental illness worked in the workshop, as well as patients who did not have a disability, but who could not work in their usual conditions of normal production. Patients were enrolled in the staff of the special workshop and performed the corresponding production operations. Observance of working conditions, the correct use of patients' labor, the implementation of sanitary and hygienic measures and monitoring the mental state of patients were carried out by specialists of a psychiatric hospital. All this made it possible in many cases to achieve an increase in the level of social adaptation. Production tasks were selected for patients in strict accordance with the objectives of rehabilitation. The administration of the plant provided patients with one-time meals and payment for treatment, provided them with various types of labor, from simple cartoning to the assembly of electrical circuits of radio equipment. Since the workshop was located on the territory of the hospital, patients were able to work in it while they were still in the hospital. In turn, patients employed in the workshop, with a worsening condition or temporary disability, could be transferred to the hospital on a day or full hospital basis. Patients employed in the workshop were equated in their rights with the workers of the plant (they received salaries, allowances for the implementation of the plan, they had the whole range of social services provided by the plant). Moreover, as part of the trade union organization, patients were sometimes actively involved in public work, which helped restore real social skills and connections. In the absence of the need for daily psychiatric monitoring, patients could be transferred to normal production.
A similar organization of industrial rehabilitation, but to a greater extent, was carried out in the Tomsk region with the active participation of employees of the Department of Psychiatry of the Tomsk Medical Institute and the Tomsk Regional Psychiatric Hospital. Workshops of some Tomsk industrial enterprises were deployed in special rooms where patients were provided with various types of labor (up to and including work on machines). This allowed patients not only to receive a sufficiently good payment for the manufactured products, but also to make a significant contribution to the overall performance of the corresponding production. The latter was of great psychotherapeutic significance for patients, not to mention the fact that patients who had been ill for a long time with a severe mental defect and had been a "burden" for the family for many years turned into its active members and, to some extent, into "breadwinners." Some patients were employed in individually created conditions directly at Tomsk industrial enterprises or in suburban state farms. Industrial rehabilitation was carried out in several stages. The first of them lasting from 2 months to 2 years was a period of temporary employment, when patients, being in the regime of partial hospitalization, had the opportunity to gradually expand their social and professional activity. They were provided with systematic comprehensive assistance by medical and social workers, psychologists of special rehabilitation teams. The overall favorable effect of rehabilitation was achieved in 70% of patients who before that were almost completely socially and professionally maladaptated.
Great experience in the rehabilitation of mentally ill was in St. Petersburg, where the organizers of this case were the specialists of the Psychoneurological Institute. V.M. Bekhterev of the Ministry of Health of the Russian Federation [Kabanov M.M., 1978].
The development of rehabilitation programs has made it necessary to create some new organizational structures. So, for patients who did not have a family or lost it, special dormitories were organized, the lifestyle in which was as close to normal as possible. Here, patients who had previously been in a psychiatric hospital for chronicles for a long time could gradually restore the lost skills of everyday life. Such hostels played the role of an intermediate link between the hospital and real life and were often organized at a psychiatric hospital. Staying in such hostels was one of the most important stages in the process of resocialization of patients. However, this form has not yet received development adequate to its significance.
Despite the fact that industrial rehabilitation was an optimal form of patients returning to socially useful work, it was not widespread in the country. Even in the period of the 70-80s, it covered only a small part of those in need (about 8-10% of the total number of people with disabilities). There were not enough places in the special workshops. The types of labor offered in them, mostly unskilled, did not always take into account previous professional employment and practically excluded the participation in the rehabilitation programs of persons who had previously engaged in mental activity. Indicators of disability group withdrawal and return to normal production remained low. Most patients had a disability for life and, at best, could only work in specially created production conditions and under medical supervision. Given the unstable performance of mentally ill patients, the need for a gentle individual approach to them, the prejudiced attitude of labor collectives, the enterprise administration, in turn, did not show interest in expanding the network of special workshops or in accepting mentally ill people for regular production.
In foreign countries, the problem of the resocialization of mentally ill patients, which also became acute in the late 70s and early 80s, was to some extent related to the antipsychiatric movement, when the process of the so-called deinstitutionalization began - taking patients out of the walls of psychiatric hospitals with their closure. Discharged patients, being unable to lead an independent life and provide for themselves economically, joined the ranks of the homeless and unemployed. They needed not only psychiatric help, but also social protection and financial support, training of lost labor and communication skills.
With the close cooperation of psychiatric and social services funded by state funding, public and charitable foundations, many European countries have developed an extensive socio-rehabilitation system aimed at the gradual reintegration of mentally ill into society. The tasks of the institutions included in it are to provide mentally ill temporary housing, training and instilling in them the skills necessary in everyday life, improving their social and labor adaptability. For this purpose, special dormitories, hotels, the so-called halfway houses, in which patients not only live, are provided with psychiatric supervision, but also receive assistance in professional and labor promotion.
Patients discharged from the hospital in some countries have the opportunity to go to out-patient clinics and rehabilitation centers with a limited duration of stay. So, in France, it does not exceed 18 months. By the end of this period, the skills acquired by the patient are evaluated and his ability to return to work on a common basis or to limit himself to the level of medical and labor institutions is determined. Employment of patients in normal production conditions, but while maintaining constant monitoring of psychiatrists and social workers, is becoming increasingly widespread. Unfortunately, this form is highly dependent on employers.
According to the unanimous opinion of psychiatrists, the vast majority of patients in need of rehabilitation are patients with schizophrenia. They used special training programs (social skill training, communication training; occupational training) aimed at achieving autonomy in the patient's lifestyle, improving his social connections and preventing complete isolation (which is most important for schizophrenia patients). In rehabilitation, an individualized approach is of particular importance, taking into account the type and severity of the patient's dysfunction (lack of initiative and emotions, social and cognitive defect). Relatively recently, special computer programs appeared, built on the type of dialogue. They are designed to train concentration and other cognitive functions and can be used by patients on their own. The most common training methods aimed at correcting the patient’s social behavior (token economy programs; social skill training strategies) use the strategy of copying the correct behavior in everyday life: in addition to correcting emotional-volitional and cognitive impairments inherent in schizophrenia patients, they help to develop the necessary solutions to everyday problems and independent living skills, including the use of social benefits, financial resources.
Thus, modern rehabilitation approaches are aimed primarily at the personality of the patient, the development of lost skills and the activation of compensatory mechanisms. If the degree of insolvency of the patient does not allow him to function without outside help, then the state and society will take care of him. With regard to the implementation of rehabilitation programs, even economically developed countries with a high standard of living experience significant difficulties associated with financial provision. Following a period of optimism and unfulfilled hopes for a quick implementation of rehabilitation programs, a more balanced understanding of the real situation came. It became clear that the rehabilitation of the mentally ill is not a time-limited program, but a process that should begin at the stage of the initial manifestations of the disease and continue practically throughout life, which requires a lot of effort on the part of society as a whole and health authorities in particular. Inadequate financial support, partly due to the diversion of material resources to solving more pressing issues (in particular, the fight against AIDS), led to the curtailment of rehabilitation programs in many countries, as a result of which many mentally ill people began to return to psychiatric hospitals.
In Russia in recent years due to the general deterioration of the economic situation, the closure of some state-owned enterprises and the emergence of unemployment, rehabilitation of the mentally ill has also become an impossible task. Institutions of a rehabilitation orientation provided earlier by the state fell into decline - medical and labor 362
workshops, artels and production, using the labor of people with disabilities. Due to insufficient material resources, vocational training programs for the mentally retarded in auxiliary schools and boarding schools are being curtailed, and vocational schools that host their graduates are being closed. The medical and social service focused on the re-socialization of the mentally ill has still not been developed. At the same time, enterprises and organizations of psychosocial assistance appeared operating on a commercial basis, without any connection with state institutions (hospitals and dispensaries). But due to the high cost of the services they provide, they remain practically inaccessible to the majority of the poor mentally ill.
Under the circumstances, the need emerged to find new ways of organizing social and labor adaptation of the mentally ill and the mentally retarded. One of the most promising areas is the formation of non-state charitable foundations, clubs for social support of the mentally ill, associations of their relatives and other public organizations interested in their social reintegration. Created by one of the first in 1991 with the active participation of a group of psychotherapists, the patients themselves and their relatives, the Human Soul charity fund implements a set of programs aimed at improving social competence and social rehabilitation of mentally ill persons with disabilities. In the framework of one of them, the Moscow Club Fund, patients have the opportunity to improve their professional skills and gain experience in clerical work, catering and leisure activities, employment and networking with employers, which they need for subsequent employment in ordinary workplaces. The fund provides patients with material support, free meals in a charity cafeteria. A special program dedicated to the further development of the system of non-governmental organizations provides for the training of regional representatives of this movement in Russia.
1) principle partnerships(the patient is an equal partner in the treatment and rehabilitation process); 2) principle of versatility (diversity) of efforts(in various areas of the patient's life: professional, family, social, study, leisure, etc .; 3) the principle unity of psychosocial and biological methods of treatment;4) principle graduationefforts (from simple employment therapy, performing individual operations to complex skills and integration into society.) MM Kabanov also highlights the stages of rehabilitation: rehabilitation therapy (prevention of the development of a defect with the help of environmental therapy, stimulation of activity), readaptations(adaptation to life in a community-based environment, taking into account the flaws inflicted by the disease) includes training in a new specialty, therapy with employment and entertainment, educational work with patients and their relatives, supporting drug therapy; actually rehabilitation (restoration of individual and social value of the patient) through rational life and employment, expansion of social contacts and the role of the social worker is important here as nowhere else.
Medical and labor workshops, rehabilitation centers. Employment of the mentally ill, specialty training. The place of a social worker in the system of rehabilitation of the mentally ill.
Significant progress has been made in the treatment of acute mental disorders, the use of psychotropic drugs allows you to eliminate the acute manifestations of the disease, (delirium, hallucinations, etc.)
However, mental illness causes significant changes in the personality of patients and the corresponding violations adapt to the social environment, which are not corrected by medicines. If the result of chronic somatic illnesses leading to disability is to some extent recognized as painful, then in the case of unfavorable mental illness this understanding is not always enough. Despite this, many mentally ill people are aware of what has happened to them and are trying to restore their social status. The main task of rehabilitation, as a system of measures aimed at preventing disability and restoring personal and social status, is to help victims to return (if possible) to their previous place of work, to occupy their former position in the family, and to adequately participate in public life.
Already in the subacute period of the disease, it is important not to let the patient feel his inferiority, treats him like a person not to offend, spare the feeling of personal dignity. It is dangerous to keep the patient in sparing hospital conditions, which, along with the consequences of the disease, leads to the phenomenon of hospitalism (humility to fate, resigned mode, passive acceptance of what happened). Paternalism is equally unproductive - the paternal care of the mentally ill, the solution of all social issues for them. This is a manifestation of the dominant position of the doctor, social worker, psychologist in relations with the patient. One cannot impose a professional, one-sided vision of a problem without the participation of a rehabilitated person. Only the patient's informed consent to participate in rehabilitation activities can contribute to the effective outcome of joint efforts. Only during the period of the exacerbation of the disease, a protective regime with control over the patient’s behavior is necessary, in the future (in the recovery period) all restrictions should be lifted sequentially with the possibility of free movement and a regime of partial hospitalization, allowing the patient not to lose touch with their usual environment. On this way, semi-stationary forms of service for the mentally ill (day hospitals, rehabilitation centers, etc.) may be useful. Some patients, due to the emerging mental defect, will not be able to return to a full-fledged social life, therefore their rehabilitation potential may be limited to working in special workshops at industrial (agricultural) enterprises or even only in medical and production workshops of neuropsychiatric institutions. In some of the most unfavorable cases, the doctor, social worker, psychologist will have to restore the elementary social skills of the patient (hygiene, personal care, communication, etc.). People who have lost their ability to work are assigned a disability group with the appropriate pension benefits through MREC. The question may arise of determining judicial incapacity and imposing guardianship.
In any case, clear (accessible) recovery goals agreed with the patient should be formulated, which will force him to follow the rehabilitation program.
The best option for rehabilitation measures is a team method of work with the participation of a psychiatrist, psychologist, social worker, nurse, occupational therapist, who, being specialists in their field of activity, contribute to a single plan for restoring the patient’s personality. Without a psychologist, it is impossible to correctly establish the degree of violation of mental functions, without a social worker it will be difficult to find adequate work for the sick person, defend his interests, train social skills, establish the right family relationships. Families need knowledge and skills on how to get along with a mentally ill family member and how to resolve a stressful situation arising from a mental illness. And here the help of a psychologist and a social worker is indispensable. Rehabilitation goals are also served by public associations of relatives of the mentally ill and self-help groups (clubs) of former patients (“peer to peer”).
67. Labor examination of the mentally ill.
Labor examinationit is carried out by MREC (medical rehabilitation commissions), which, in the presence of signs of disability due to mental illness, determine the appropriate disability group and outline a set of measures for medical and social rehabilitation of mentally ill persons with disabilities.
Disability examination is carried out by medical advisory
commissions (WCC) and MREC
Issues of temporary disability, as well as facilitation of conditions
labor for a certain period after discharge (exemption from work in
night shift, in the sun, business trips) decides VKK. Issued sick
a sheet for a period of 4 months with continuous treatment and 5 months with interruption
on a sick leave. If the patient needs for aftercare
extend sick leave, this issue is solved by VTEC. With persistent loss
disability (in the chronic course of the disease, frequent exacerbations,
a sharp decrease in performance, professional skills) VTEK establishes
pushes the disability group.
Disability group I is assigned to patients with complete permanent loss
disability with the need for constant care and supervision of
sick Disability group II is determined with complete permanent loss
professional disability, however, patients can perform
thou unskilled work and service yourself; Group III disabled
Nomination is assigned to persons who have partially lost their ability to work. They need
are given in reducing the working day, reducing the volume of labor activity
te, transfer to a lower qualification job. Disability with children
It is established for persons under 16 years of age (for students under 18 years of age). If invasive
leadership occurred in a working teenager or secondary student
university and university under the age of 18
years, then he is established disability due to the disease. Re-
visualization of disabled people of the II and III groups is carried out in a year, 1 group
py - after 2 years, and with chronic psychoses and phenomena of persistent defect
that disability is established indefinitely and re-examination is not
held.
68. Forensic examination of the mentally ill. Legal capacity. Custody, indications for custody.
Forensic Psychiatric Examinationapplies to persons who committed crimes and in respect of whom the investigation or court had doubts about their mental fullness at the time of the commission of the wrongful act. Forensic psychiatric examination also considers issues of legal capacity. Forensic psychiatric examination is carried out on the grounds in the manner prescribed by the legislation of the Republic of Belarus.
legal capacity from 2 sides: the criminal code - was it adequate at the onset, civil - at giving, will
Rehabilitation in Psychiatry
Occupational therapy of patientschained to the bed (Otis Historical Archives Nat "l Museum of Health & Medicine )
Rehabilitation is a set of measures aimed at the full or partial restoration of the personality of a sick person, his social and labor status. Unlike treatment aimed at eliminating, reducing the manifestations of the disease, rehabilitation is aimed at strengthening, strengthening, growing the healthy sides of the patient’s personality, compensating for the mental functions lost during the illness due to its intact part. Rehabilitation is spoken of as “an effect that attempts to detect and develop the capabilities of patients - unlike a treatment that directly addresses patients' failure.” (Martin (1959). Thus, rehabilitation is a wonderful complement to and completes drug and psychotherapeutic treatment.
The basic principles of rehabilitation originated in ancient times, even the ancient Greek and Roman doctors offered walking methods, rhetoric exercises, plant care, etc. as healing methods. Subsequently, the medieval perception of insanity, not so much as a mental illness, but as lack of content, a kind of spiritual “perversion”, put him in a castle, depriving any hope of a cure. However, the placement of the mentally ill in monasteries often provided them with a kind of “rehabilitation” lifestyle: a measured, clearly defined regime, physical labor, etc. The era of enlightenment brought a new assessment of mental illness - the concept of insanity arose as a result of an improper, immoral lifestyle. Accordingly, such methods as limiting unwanted contacts, hard mode, reading the right literature, and physical labor begin to use in treatment. Later, the concepts of degeneration and moral insanity contributed to reinforcing the point of view on mental illness as manifestations of “immorality”, “lack of will”, and “weakness”. To some extent, this point of view persists today, many of our patients hear the same advice from friends and relatives: “Get a hold of yourself”, “Throw these nonsense out of your head”, “Stop lounging and everything will pass”, etc. . However, all these methods, resembling outwardly some rehabilitation measures, had a completely different direction: not the restoration of lost functions and adaptation due to the safe sides of the psyche, but some kind of “re-education” of the patient.
Modern rebuilding does not set the task of "educating the patient" or its treatment. She turns to the surviving part of the psyche, seeking to teach patients how to use their strengths. Rehabilitation in psychiatry consists of three areas:
· Medical rehabilitation - treatment of residual manifestations of the disease, maintaining and strengthening remission, maintaining the patient’s mood to comply with the doctor’s recommendations and continuing treatment (including through psycho-educational programs).
· Occupational and labor rehabilitation - rehabilitation.
· Social rehabilitation - restoration of the individual and social value of the patient, his self-esteem, relations with the environment, the fight against stigma.
Psycho education occupies a special place in the rehabilitation of the mentally ill. It represents a comprehensive system of psychotherapeutic work with the patient and his relatives, including teaching them the basics of psychiatric literacy and methods of coping with problems caused by mental illness.
How to take a family member's illness? How to understand the patient? How to survive in severe trials? How to help a loved one? What help can a family provide in the treatment and rehabilitation of a sick person? How to decide to see a doctor and what to ask?
This article is intended to help people with mental illness and their loved ones cope with everyday problems that arise when living together.The most common problems encountered in such families, as well as some effective approaches to everyday communication, are considered. The advice that will be given can be helpful to anyone who has experienced schizophrenia or other serious mental illness in their family.
Psychosocial rehabilitation: a modern approach
T.A. Solokhin
The definition of psychosocial rehabilitation
its goals and objectives
A World Health Organization report on mental health (2001) said: “Psychosocial rehabilitation is a process that enables people with poor health or people with disabilities as a result of mental disorders to reach their optimal level of independent functioning in society.
We add to this definition that it is a constant, continuous process, which includes a set of medical, psychological, pedagogical, socio-economic and professional measures.
Activities for psychosocial rehabilitation vary depending on the needs of patients, the place where rehabilitation interventions are carried out (hospital or society), and also on the cultural and socio-economic conditions of the country in which mentally ill people live. But the basis of these events, as a rule, is:
· Labor rehabilitation;
· employment;
· Vocational training and retraining;
· Social support;
· Ensuring decent living conditions;
· Education;
Psychiatric education, including training on how to manage painful symptoms
· The acquisition and restoration of communication skills;
· The acquisition of independent living skills;
· Realization of hobbies and leisure, spiritual needs.
Thus, even from an incomplete list of the above measures, it can be seen that the psychosocial rehabilitation of the mentally ill is a comprehensive process aimed at the restoration and development of different spheres of human life.
Recently, the interest of scientists, practitioners, patients themselves and their families in psychosocial rehabilitation has increased. Currently, there are a large number of models of psychosocial rehabilitation and views on its methods. However, all scientists and practitioners agree that the result of rehabilitation measures should be reintegration (return) of the mentally ill in society. At the same time, patients themselves should feel themselves to be no less full citizens than other groups of the population. With that said, rehabilitation goal can be defined as follows: this is an improvement in the quality of life and social functioning of people with mental disorders by overcoming their social exclusion, as well as increasing their active life and civic position.
The 1996 Statement of Psychosocial Rehabilitation, developed by the World Health Organization and the World Psychosocial Rehabilitation Association, lists the following rehabilitation tasks:
· Reducing the severity of psychopathological symptoms with the help of the triad - drugs, psychotherapeutic methods of treatment and psychosocial interventions;
· Increasing the social competence of mentally ill people through the development of communication skills, the ability to overcome stress, as well as work;
· Reduction of discrimination and stigma;
· Support for families in which someone suffers from a mental illness;
· Creation and maintenance of long-term social support, satisfaction of at least the basic needs of mentally ill people, which include housing, employment, leisure activities, the creation of a social network (social circle);
· Increasing the autonomy (independence) of the mentally ill, improving their self-sufficiency and self-defense.
B. Saraceno, head of the mental health department of the World Health Organization, commented on the importance of psychosocial rehabilitation as follows: “If we hope for the future of psychosocial rehabilitation, this should be psychiatric care at the patients’ place of residence - affordable, complete, allowing mentally ill patients to be treated and receive serious support. With such help, hospitals are not needed, and the medical approach should only be used to a small extent. In other words, the psychiatrist should be a valuable consultant in this service, but not necessarily its owner or ruler. ”
Brief historical background
In the history of rehabilitation of the mentally ill, a number of important points can be singled out, which played a significant role in its development.
1. The era of moral therapy (moral therapy).This rehabilitation approach, developed at the end of the 18th - beginning of the 19th centuries, consisted in providing mentally ill people with more humane help. The basic principles of this psychosocial impact remain valid to this day.
2. Introduction of labor (professional) rehabilitation. In Russia, this approach to the treatment of mentally ill began to be introduced in the first third of the XIX century and is associated with the activities of V.F. Sabler, S.S. Korsakova and other progressive psychiatrists. For example, as noted by Yu.V. Cannabih, among the important transformations carried out by V.F. Subler in 1828 in the Preobrazhensky hospital in Moscow, include "... the device of garden and needlework."
Occupational therapy as a direction of modern Russian psychiatry began to be given special attention, starting from the 50s of the last century. There was a network of medical labor workshops and special workshops where mentally ill people who were in inpatient and outpatient treatment could work. With the beginning of socio-economic reforms in the 90s of the last century, about 60% of institutions involved in labor rehabilitation (medical-production workshops, specialized workshops at industrial enterprises, etc.) were forced to cease their activities. However, at the present time, employment and occupational therapy are the most important components in psychosocial rehabilitation programs.
3. The development of community-acquired psychiatry. Shifting the emphasis in the provision of psychiatric care to out-of-hospital services and the realization that the patient can be treated not far from the family and from the workplace was of great importance for the recovery of a sick person.
In the 30s of the last century, neuropsychiatric dispensaries began to open in our country and semi-stationary forms of care were created, which was of great rehabilitation value.
In the 50-60s, psychiatric wards were widely developed in polyclinics, central district hospitals and other institutions of the general medical network, at industrial enterprises, in educational institutions, day and night half-hospitals, as well as other forms of assistance aimed at meeting the needs of mentally ill patients.
In foreign countries (Great Britain, Japan, Canada, etc.), aid consumer organizations and support groups began to be actively created during this period.
The development of community-based psychiatry also provides for the active identification of persons in need of psychiatric care for the early initiation of treatment and to combat the consequences of disability and social failure.
4. The emergence of centers of psychosocial rehabilitation. The beginning of their discovery falls on the 80s of the twentieth century. The first centers (clubs) were created by the patients themselves (for example, the Club House in the USA), and their activity is aimed at helping patients cope with the problems of everyday life, developing the ability to work even in the presence of disability. Therefore, at the beginning, such centers focused on activities that would help patients cope with life difficulties, not succumb to them, as well as on improving health, and not on getting rid of symptoms of mental illness. Centers for psychosocial rehabilitation played a huge role in the development of such a field of knowledge as rehabilitation of people with disabilities due to mental illness. Currently, this form of assistance is widely used in the USA, Sweden, and Canada; the number of rehabilitation programs in them varies significantly (from 18 to 148).
In Russia, such centers (institutions) began to be created in the mid-90s of the XX century, but so far they are clearly not enough. As a rule, these are non-governmental institutions. An example is the Club House in Moscow, which existed until 2001. Currently, the rehabilitation centers operating in our country specialize in a specific area - art therapy, corrective interventions, leisure activities, psychotherapy, etc.
5. Development of skills necessary to overcome life's difficulties. The emergence of this direction is due to the fact that for the effective solution of problems that arise, people suffering from serious mental disorders need certain knowledge, skills. The development of skills is based on methods developed taking into account the principles of social learning. In this case, methods of active-directive learning are used - behavioral exercises and role-playing games, the sequential formation of behavioral elements, mentoring, prompting, and also a generalization of acquired skills is carried out. It is proved that the development of skills develops the ability of people with severe mental disorders to have an independent life.
Modern approaches to psychosocial rehabilitation in Russia
The accumulation of scientific data on the rehabilitation of mentally ill patients and practical experience has contributed to the fact that in our country, along with comprehensive treatment, including drug and labor therapy, physiotherapy, cultural and educational and recreational activities, the following types of psychosocial interventions have developed in the framework of psychosocial rehabilitation :
· Educational psychiatry programs for patients;
· Educational programs in psychiatry for relatives of patients;
· Trainings on developing daily independent life skills - training in cooking, shopping, family budgeting, housekeeping, use of transport, etc .;
· Trainings on the development of social skills - socially acceptable and confident behavior, communication, solving everyday problems, etc .;
· Trainings on the development of mental state management skills;
· Self-help and mutual assistance groups of patients and their relatives, public organizations of consumers of psychiatric care;
· Cognitive-behavioral therapy aimed at improving memory, attention, speech, behavior;
· Family therapy, other types of individual and group psychotherapy.
Comprehensive programs of psychosocial rehabilitation are carried out in many regional psychiatric services, both on the basis of psychiatric institutions, and directly in the community. Here are just a few examples.
In Tver, on the basis of the regional neuropsychiatric dispensary, a food workshop has been opened where mentally ill people work and products are sold through a regular distribution network. In addition, in the same clinic there is a ceramic workshop and a workshop for painting fabrics, where people suffering from mental illness successfully work. All products of these enterprises are in demand among the population.
In the Tambov Regional Psychiatric Hospital, the department of psychosocial rehabilitation conducts the following programs: educational in the field of psychiatry, art therapy, leisure, therapy with holidays, including personal ones (birthdays of patients, etc.). A “Support House” was opened at the hospital, where patients who have been hospitalized for a long time, after being discharged from it, receive independent life skills and only after that they return home. In the community, with the participation of professionals, the We Theater has opened, in which patients, their relatives, and students of the theater school play.
Important rehabilitation work is carried out in many psychiatric hospitals in Moscow. For example, hospitals No. 1, 10 and 14 have open studios for patients, apply occupational therapy, implement psychiatric educational programs for patients and their relatives, and organize trainings to develop social and independent life skills.
In the Sverdlovsk region, teams of interagency cooperation have been created, which include employees of medical, educational, professional institutions, employment agencies and social protection institutions, which makes it possible to comprehensively solve the problems of mentally ill patients and provides a multilateral approach to their rehabilitation.
Questions about rehabilitation
which are most often asked by the relatives of patients
Very often, relatives of mentally ill people ask us: when can rehabilitation measures be started? Rehabilitation in patients with mental disorders, as with somatic diseases, is recommended to begin with stabilization of the condition and the weakening of pathological manifestations. For example, the rehabilitation of a patient with schizophrenia should be started with a decrease in the severity of symptoms such as delusions, hallucinations, thinking disorders, etc. But even if the symptoms of the disease remain, rehabilitation can be carried out within the limits of patients' ability to respond to training and respond to psychosocial interventions. All this is necessary to increase the functional potential (functionality) and reduce the level of social deficiency.
Another question: what is meant by social impairment and a decrease in the patient’s functional capabilities? A sign of social failure is, for example, a lack of work. In mentally ill patients, the unemployment rate reaches 70% and higher. It's related with a decrease in their functionality due to the presence of psychopathological symptoms and cognitive (cognitive) functions. Signs of reduced functionality are low physical endurance and tolerance of work, difficulties in following instructions and working with other people, difficulties in focusing, solving problems, and inability to adequately respond to comments and seek help.
The phenomenon of homelessness also refers to social insufficiency of the mentally ill.
Unfortunately, our society is still not able to completely solve the problems of employment, housing in patients with severe mental disorders and thereby reduce their social deficiency. At the same time, psychosocial rehabilitation programs can increase the patient’s competence, give him the opportunity to acquire stress coping skills in psycho-traumatic situations and in the difficulties of everyday life, skills to solve personal problems, self-care, professional skills, which ultimately helps to increase functional potential and reduce social failure .
Which specialists are involved in psychosocial rehabilitation?Patients and their relatives should be aware that psychosocial rehabilitation is carried out by psychiatrists, psychologists, social workers, employment specialists, occupational therapists, nurses, as well as relatives and friends of mentally ill people.
Are there any special principles, methods, approaches in the work of specialists who are involved in the psychosocial rehabilitation of people with severe mental disorders?
All specialists involved in the rehabilitation of patients with mental disorders undergo training, which includes the development of special methods and techniques. The work of a rehabilitologist is complex, lengthy, creative. It is based on the following principles:
· Optimism regarding the achievement of the result;
· Confidence that even a slight improvement can lead to positive changes and improve the quality of life of the patient;
· The conviction that motivation to change one’s position can arise not only due to special rehabilitation measures in relation to the patient, but also due to his own efforts.
What else, in addition to developing useful skills, can help the patient in restoring functionality?
At the beginning of the lecture, we talked about an integrated approach to rehabilitation. Once again, we list the aspects that are important for a person suffering from a severe mental illness:
· Improving family relationships;
· Labor activity, including transitional (intermediate) employment;
· Expansion of communication opportunities, which is achieved by participation in club activities and other special programs;
· Socio-economic support;
Decent housing, including its protected forms.
What can a family do for the psychosocial rehabilitation of a patient?
The important role of the family in the psychosocial rehabilitation of a patient with severe mental illness has been proven. This involves performing various functions. First of all, it should be said that the relatives of patients should be considered as allies in treatment. They not only have to learn a lot, but they themselves often possess a large amount of knowledge and experience - this makes a significant contribution to the rehabilitation process. For a doctor, relatives can be a valuable source of information about the patient’s condition, sometimes they are more than specialists aware of some aspects of his illness. Often the family plays the role of a link between the patient and the psychiatric care system. Relatives help other families whose lives have been invaded by a mental illness with advice, share their own experience in solving problems. All this allows us to say that the relatives of patients are both teachers and educators for other families and even professionals.
The most important function of loved ones is caring for a sick person. Relatives should take into account that patients with schizophrenia feel best if there is a certain order, rules and permanent duties for each family member in the house. It is necessary to try to establish a regimen corresponding to the capabilities of the patient. Relatives can help patients to instill personal hygiene skills, accurate dressing, regular and accurate food intake, as well as the correct intake of medications and the control of side effects of medications. Over time, you can instruct the patient to do some housework (washing dishes, cleaning the apartment, caring for flowers, pets, etc.) and outside the house (shopping at the store, visiting the laundry, dry cleaning, etc.).
Family participation in psychiatric education programs is another important contribution to the psychosocial rehabilitation of a sick relative. The importance of family psychiatric education has already been discussed in previous lectures. Recall once again that knowledge of the basics of psychiatry and psychopharmacology, the ability to understand the symptoms of the disease, the development of communication skills with a sick person in the family provide a real opportunity to reduce the frequency of exacerbations of the disease and repeated hospitalizations.
Protecting the rights of the patient. Family members can make a significant contribution to the fight against stigma and discrimination, as well as to improving legislation regarding mentally ill people and members of their families. However, for this, relatives must act together in an organized manner: create support groups and organizations of aid consumers. In this case, they will not only gain the support of people who are faced with similar problems, but will also become a force that both professionals and authorities will be responsible for providing quality psychiatric and social assistance.
In addition, working as a team, relatives of patients themselves can conduct psychosocial rehabilitation programs - leisure, holiday therapy, educational programs for the population to reduce stigma and discrimination of patients, and, together with professionals, implement educational programs in the field of psychiatry, vocational training, development of social skills and many others.
In almost half of the regions of Russia, patients, relatives of patients and professionals have created support groups, public organizations that conduct active work on psychosocial rehabilitation directly in the community, relying on its resources, outside the walls of hospitals or dispensaries. The next section of the lecture is devoted to the contribution of social forms of assistance to the psychosocial rehabilitation of patients and their families.
Community forms of assistance
Goals and objectives of public organizations
Consumers of psychiatric care - patients and their families have long been perceived as passive participants in the care process. What types of help the patient needs, professionals determined, not recognizing the treatment needs and personal desires of the patients themselves and their relatives. In recent decades, the situation has changed, which is associated with the development of the movement of consumers of medical and psychiatric care, the creation of public organizations.
For a long time, in many countries the significance of the contribution of the social movement to the development of psychiatric services and to the implementation of psychosocial rehabilitation programs is beyond doubt.
It is noteworthy that the social movement in psychiatry abroad was initiated by one of its consumers - Clifford Byrnes (USA), who himself was a patient in a psychiatric hospital for a long time. Around this man, at the beginning of the last century, well-known American doctors, members of the public came together to seek the best conditions for treatment and care for the mentally ill. As a result of such joint activities, the National Committee of Mental Hygiene was formed in 1909.
In Canada, the USA, England, Japan, Australia, India and many other countries, patients and their relatives satisfy part of their needs through numerous non-governmental - public organizations of aid consumers, including national ones. Significant success in uniting patients and their families was achieved, for example, by the World Fellowship for Schizophrenia and Allied Disorders.
Until 1917, there were public forms of trusteeship for mentally ill people in Russia, whose main tasks included attracting the public to charitable assistance, providing psychiatric institutions with funds from donations, etc. The greatest activity in the development of such forms of assistance occurred during the period of Zemstvo medicine, when night and day shelters, lodging houses, free dining rooms for the disadvantaged were opened, patronage forms of service for the mentally ill were organized.
In modern Russia, the activities of public organizations of consumers of psychiatric care have intensified only in the last 10-15 years, but by the end of the 90s of the last century, there were several dozen organizations working in the field of mental health. In 2001, the All-Russian Non-Governmental Organization of Persons with Disabilities was created due to mental disorders and their relatives "New Opportunities", the main purpose of which is to provide practical assistance to such people with disabilities, to improve their position in society. Today, more than 50 regional departments operate within the framework of this organization, the members of which are mainly patients and their relatives.
An analysis of the activities of various regional public organizations working in the field of mental health showed that the goals of many of them are similar - this is the integration into society of people with mental health problems through their socio-psychological and labor rehabilitation, protection of their rights and interests, changing the image of the mentally ill person in society, mutual support of the mentally ill and their families, assistance in crisis situations, prevention of disability due to mental illness. In other words, the activities of public organizations are aimed at improving the quality of life of the mentally ill and their relatives.
Non-governmental organizations also provide the opportunity to communicate, exchange experiences, develop a sense of ownership: relatives of patients see that they are not alone, that there are a lot of such families.
The functions of public associations are:
· Creation of self-support and mutual support groups;
· Conducting group developmental work with patients of different ages, leisure programs;
· The organization of painting workshops, arts and crafts, theater studios, summer recreation camps;
· Conducting training seminars for relatives, as well as for professionals working with the mentally ill.
Many organizations have developed the most interesting techniques, accumulated rich experience.
Foreign experience shows that in a number of countries the movement of consumers has significantly influenced mental health policies. In particular, the employment of people with mental health problems has increased in the traditional mental health system, as well as in other social services. For example, in the Department of Health, British Columbia, Canada, a person with a mental disorder has been appointed director of alternative treatment and can now have a significant impact on mental health policies and services.
Protecting the rights of the mentally ill is an important task of many public organizations in our country. It is known that the Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens in its provision” provides for a special article - No. 46 “Control of public associations over the observance of the rights and legitimate interests of citizens in the provision of psychiatric care”. In this article of the law and in the commentary to it, the importance of the activities of public associations for both patients and psychiatric institutions is noted, the obligation of the administration of these institutions to provide assistance to representatives of public organizations, provide them with the necessary information, the right of public organizations to appeal against actions of persons in court is noted who violated the rights and legitimate interests of citizens in the provision of psychiatric care. The right of representatives of public associations to be included in various councils, commissions of psychiatric institutions, and health authorities created to monitor the quality of care for the mentally ill, the conditions of their maintenance, and the improvement of the working forms of psychiatric services has been introduced. The importance of the joint activities of public organizations and state psychiatric institutions in attracting the attention of the media, health authorities, government circles and society as a whole to the current problems of psychiatry, changing the negative image of the mentally ill and psychiatric institutions is noted.
As the consumer aid movement intensifies, the human rights function should be developed in terms of lobbying the interests of the mentally ill and their families among lawmakers, politicians, public figures, and work with them should be ongoing.
Another aspect of the human rights activities of public organizations of aid consumers may be related to the protection of psychiatric institutions themselves, when, for example, they are facing a reduction in funding.
The role of professionals
We see it in the initiation of relatives and patients themselves to create public organizations or support groups. It is professionals who can play a crucial role at the stage of formation of such organizations.
Subsequently, professionals should provide assistance to the organization in the development of activities - to constantly advise its leaders or support groups on educational issues in the field of psychiatry, including legal aspects.
Professionals can also help with the organization's strategic plans. The extremely useful help of professionals to public consumer organizations can be the publication of newspapers, booklets, and manuals for families of the mentally ill.
Thus, the development of the social movement of consumers of psychiatric care is becoming an important link in the modern system of psychiatric care, able to satisfy many of the needs of mentally ill patients, their position in society, reduce the burden of the disease, improve the quality of life of patients and their families.
Activities of a public organization
“Family and Mental Health”
All authors of this manual are members of the Center for Social and Psychological and Informational Support Family and Mental Health NGO, which received legal status on June 6, 2002. The initiators of its creation are the employees of the organization of psychiatric services of the Scientific Center for Mental Health of the Russian Academy of Medical Sciences and parents patients with mental disorders.
In 1996, virtually the first in Moscow, a socio-psychological school was opened to support families of the mentally ill, which formed the basis of our future organization. Thus, the official registration was preceded by a six-year period of activity, during which extensive experience has been accumulated in the field of psychosocial rehabilitation of people with mental disorders and their relatives.
Currently, members of our organization are not only mental health professionals, but also people with mental health problems, their relatives and friends.
The social movement draws the attention of the authorities to the most pressing problems, forcing them to look for ways to solve them. Participation in the work of a public organization contributes to the formation of an active citizenship among patients with mental illnesses and members of their families, and stimulates the search for ways to improve their position in society.
Why did we name our organization “Family and Mental Health”?
This title reflects two fundamental values \u200b\u200bof our lives - family and mental health.
Mental health is essential to the well-being of individuals, societies and countries. It is inseparable from physical health and has a huge impact on the cultural, intellectual, creative, industrial and defense potential of any nation. The role of the family in the life of a person suffering from a mental disorder is enormous. A family is confronted with a mental illness at the earliest stage before a physician, and may contribute to or counteract its early recognition and effective treatment.
The family provides the sick person with care and emotional support, which professionals often cannot.
Good relations between family members are the key to favorable conditions for recovery, rehabilitation and medical recommendations.
In the family, each member is influenced by others and in turn influences them. If something goes wrong in the family, this may interfere with its normal functioning. Therefore, one of the main tasks that we set for ourselves is the socio-psychological and informational support of the family, as well as the harmonization of family relationships.
We perceive our organization as a large and friendly family, each member of which is ready to take care of others and come to the aid of those who need it. Therefore, members of our organization can become not only people who have mental health problems, but also their families, friends, as well as doctors, teachers and psychologists, musicians and artists. Our understanding of the family is not limited to the immediate environment of the patient - it includes those who are not indifferent to the fate of people with mental health problems.
Purpose of our organizationand - improving the quality of life of families with mental health problems through overcoming their social exclusion, involvement in society, and the formation of an active civic and life position.
The main activities of the organization
1. Socio-psychological and informational support.
2. Psychiatric education.
3. Psychosocial rehabilitation.
4. Implementation of programs to reduce social stigma and discrimination against people with mental disorders and their families.
5. Participation in the development of the social movement in psychiatry.
6. The release of non-fiction literature on the problems of psychiatry and mental health.
7. Conducting conferences and seminars on mental health for professionals and consumers of mental health care.
Our organization has the following programs.
1. For patients with mental health problems:
· Training on developing communication skills. The goal is the development and improvement of communication skills and confident behavior in everyday life;
· Educational program in psychiatry. The goal - the provision of knowledge in the field of psychiatry, training in the timely recognition of painful manifestations and their control, awareness of the need for early seeking help;
· Training of social skills. The goal - the development of independent life skills in society, including self-care, home economics, everyday life skills;
· Art therapy. The goal is the development of personality, the activation of imagination and creativity;
· Group-analytical psychotherapy. The goal is to develop self-confidence, master the skills of a harmonious life with other people, and increase resistance to stress.
The Center "Family and Mental Health" has art studios, a workshop of arts and crafts, and a music studio. Medical advisory assistance is being carried out in order to correct treatment.
The results of comprehensive work with patients indicate the development of personality, the development of an adequate strategy for coping with the disease, the formation of responsibility for one's social behavior, the restoration of broken social contacts and the increase of social competence.
2. For relatives of patients:
· Psychiatric education program. The goal is information support, the formation of partnerships with medical personnel. Provides knowledge about mental illness and their treatment, discusses the features of communication with a mentally ill family member, as well as familiarization with the modern system of psychiatric, social and legal assistance;
· Group-analytical psychotherapy. The goal is to develop skills to solve family problems, reduce stress associated with the presence of a mental illness in a family member, identify their own needs, increase life satisfaction. Classes are taught by experienced psychotherapists and psychologists;
· Psychological counseling (individual and family). The goal is to improve the psychological state of relatives, providing them emotional support.
3. For the family as a whole:
· Leisure program. The goal is to improve leisure activities, harmonize family relationships. Celebratory concerts, themed musical evenings are held regularly, which traditionally end with a family tea party. All members of the organization actively participate in the preparation and implementation of the program.
· Educational program "Moscow Studies on Saturdays." The goal is personal development, improving leisure and relaxation. The program includes visits to museums, exhibition halls, guided tours of Moscow.
Concluding the lecture on the issues of psychosocial rehabilitation, one should emphasize once again the invaluable contribution of this direction to the restoration of mentally ill people, the activation of their civil and life position, as well as to improving the quality of life of their families.
Cit. “Mental health: a new understanding, a new hope”: a report on the state of healthcare in the world. WHO, 2001.
Rehabilitation of the mentally ill has its own characteristics, which are primarily associated with the fact that in case of mental illness, like under any other conditions, social connections and relationships are seriously disrupted. Rehabilitation of mental patients is understood as restoring the individual and social value of patients, their personal and social status. The basis of all rehabilitation measures, all methods of exposure is an appeal to the patient’s personality. Rehabilitation is at the same time the goal - the restoration or preservation of the status of a person, the process and method of approaching a sick person.
Social rehabilitation is a system of measures aimed at returning patients to a socially useful life.
All rehabilitation measures should be aimed at involving the patient himself in the treatment and rehabilitation process. It is impossible to rehabilitate the patient without his active participation in this process. This principle of rehabilitation of the mentally ill is called the principle of partnership according to Kabanov.
Rehabilitation impacts should be diverse and versatile - this is the second principle of rehabilitation. Distinguish between psychological, professional, family, cultural, educational and other areas of rehabilitation.
The dialectical unity of socio-psychological and biological methods in overcoming the disease is the third principle of rehabilitation: biological methods of treatment, socio- and psychotherapy, rehabilitation should be carried out in a complex.
The fourth principle of rehabilitation - the principle of stepwise transition - comes down to the fact that all rehabilitation effects should gradually increase and often switch from one to another.
The main objective of treatment-activating regimes is to prevent the development of hospitalism and create opportunities for successful rehabilitation of patients on an outpatient basis. There are four main modes: guarding the patient in bed and requires constant monitoring by the medical staff, sparing complete freedom in the ward, but it is forbidden to enter the hospital without unaccompanied personnel, activating the provision of maximum comfort for patients in the ward, organization of full employment, patients are provided the right to independently leave the hospital department and the regime of partial hospitalization, their treatment in some cases in a day hospital, in rugih - night dispensary.
Social rehabilitation measures should be carried out in stages.
The first stage is rehabilitation therapy, preventing the formation of a personality defect.
The second stage is the rehabilitation of various psychosocial effects on the patient.
The third stage - perhaps a more complete restoration of the rights of the patient in society, the creation of optimal relations with others, assistance in the domestic and labor structure.
53. Rehabilitation after somatic illness.
Psychological rehabilitation is designed to solve a wide range of tasks of psychological assistance to persons with disabilities, and, above all, such as:
1. Normalization of the mental state.
2. Restoring impaired lost mental functions.
3. Harmonization of the self-image with the current socio-personal situation, wounding, disability, etc.
4. Assistance in establishing constructive relationships with reference individuals and groups, etc.
Thus, the goal of psychological rehabilitation is to restore mental health and effective social behavior.
Recovery of psychological and social adaptation after a stroke
There is a pronounced motor and speech deficit, pain, loss of social status. Such patients need a warm psychological climate, the creation of which should largely be facilitated by explanatory conversations conducted with relatives and close psychologists.
In the process, there is a psychological correction of the following disorders of higher mental functions: cognitive impairment; emotional-volitional disorders; bills gnosis, often spatial disorientation in space.
Psychological rehabilitation after abortion
Termination of pregnancy is not only a great physical, but also psychological stress for any woman. The course of psychological rehabilitation after abortion is shown to all women, without exception.
The main treatment method is psychotherapeutic sessions, which a woman should attend for at least 1-2 months. As a rule, they give fairly quick positive results: a woman gets rid of heavy thoughts, becomes more sociable, open to the outside world, ceases to avoid sexual intercourse with her partner, and begins to make plans for the future.
Psychological rehabilitation for cancer treatment
There is an opinion in the world that cancer is incurable. That is why many people, having heard this diagnosis, panic. That is why the psychological rehabilitation of cancer patients is primarily aimed at a change in public opinion.
The first rule of psychological rehabilitation for cancer patients is to make a person want to fight it.
The psychological rehabilitation of a person with this disease largely depends on loved ones who surround him or her. Relatives should discuss the existing problem, give examples of other people who were eventually cured of cancer. A sick person should communicate with such people as often as possible.
If a person strives for his recovery and does everything necessary to achieve it, then a positive result will not take long.
Rehabilitation after a heart attack.
The purpose of using psychotherapy in the treatment of myocardial infarction is the psychological adaptation of patients and orientation to an active lifestyle.
The rehabilitation program includes components such as psychoregulation based on disseminated hypnosis, ideomotor training, adaptation training, and training in autotraining and self-regulation techniques are also used.
A significant aspect is social rehabilitation. Social rehabilitation is the restoration of a person’s social activity as a subject of public life; in medical terms, it is the elimination of health disorders as the cause of disabilities.
