The structure of restrictions on the vital activity of the contingent of disabled people in psychoneurological care homes

Authors:

Chernyakina Tatyana Sergeevna, Grand PhD in Medical sciences, Professor, Head of the Department for Monitoring the Observance of the Rights of Persons with Disabilities of the Institute for Rehabilitation and Habilitation of Persons with Disabilities of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Professor of the Department of Preventive Medicine of the North-Western State Medical University named after I.I. Mechnikov, 47 Piskarevsky Ave., 195067 St. Petersburg, Russian Federation, Contact number: 8-950-028-61-93; e-mail: maimulovt@mai.ru; https://orcid.org/0000-0002-2854-3248.

Svintsov Alexander Anatolyevich, PhD in Medical sciences, Associate Professor, Director of the Institute for Rehabilitation and Habilitation of Disabled People of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Associate Professor of the Department of Geriatrics and Nursing of the North-Western State Medical University named after I.I. Mechnikov, 47 Piskarevsky Ave., 195067 St. Petersburg, Russian Federation; e-mail: aleksv53@yandex.ru; https://orcid.org/0000-0002-5310-1433.

Vladimirova Oksana Nikolaevna, Grand PhD in Medical sciences, Rector of the St. Petersburg Postgraduate Institute of Medical Experts, acting head of the Department of medical, social and psychological aid, 11/12 Bolshoi Sampsonievsky Ave, 194044 St. Petersburg, Russian Federation; e-mail: vladox1204@yandex.ru; http://orcid.org/0000-0001-6692-2882.

Shestakov Vladimir Petrovich, Grand PhD in Medical sciences, Professor, head of the Scientific Direction of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: schestakov.v.p@yandex.ru.

Rocheva Yana Sergeevna, PhD in Sociological sciences, Associate Professor, leading researcher of the Department for Monitoring the Observance of the Rights of Persons with Disabilities of the Institute for Rehabilitation and Habilitation of Persons with Disabilities of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Associate Professor of the Department of Public Relations, Saint Petersburg Electrotechnical University “LETI”, 5 Professora Popova Street, 197376 St. Petersburg, Russian Federation; e-mail: rocheva_yana@mail.ru; https://orcid.org/0000-0002-7162-8917.

Kolyuka Olga Evgenievna, senior researcher of the Department for Monitoring the Observance of the Rights of Persons with Disabilities of the Institute for Rehabilitation and Habilitation of Persons with Disabilities of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: problemkom@mail.ru; https://orcid.org/0000-0003-0199-4679.

Raduto Vladimir Ivanovich, senior researcher of the Department for Monitoring the Observance of the Rights of Persons with Disabilities of the Institute for Rehabilitation and Habilitation of Persons with Disabilities of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: radutoy@mail.ru; https://orcid.org/0000-0003-4930-1202.

Annotation:

Introduction. The adoption by the international community of the UN Convention on the Rights of Persons with Disabilities, ratified by Russia in May 2012, influenced the change in the state’s policy towards persons with disabilities, which is aimed at deinstitutionalization, enabling disabled people to lead an independent lifestyle in the local community. To solve the problem of deinstitutionalization of disabled people living in neuropsychiatric care homes, not by closing existing organizations, but by a differentiated approach to solving the issue of the transition of a disabled person with mental disorders to independent life, it is necessary to determine the possibility of their adaptation in various spheres of life. In this regard, an urgent task is to determine the structure and distribution of disabled people with mental disorders living in neuropsychiatric care homes in the country, according to the presence of their disabilities.

Aim. The aim of the work is to determine the structure of the contingent living in neuropsychiatric care homes for the disabled with mental disorders, according to the limitations of life, which allows identifying those who are able to lead an independent lifestyle.

Materials and methods. The research material was reflected in the conclusions of individual rehabilitation / habilitation programs, the results of an in-depth examination by expert doctors of the Federal Bureau of Medical and Social Expertise to determine the presence of disability in disabled people aged 18 years and older with mental disorders living in neuropsychiatric care homes (155 994 people) of 80 subjects of the Russian Federation in 2019. The paper uses general scientific methods of statistical analysis of structure and distribution, comparative, logical theoretical analysis, synthesis, generalization.

Results. According to the conclusions in individual rehabilitation/habilitation programs, two thirds of disabled people living in neuropsychiatric care homes in 80 subjects of the Russian Federation have disability group II (65.47 %), one third of disabled people have disability group I (33.86 %), and only 0.67 % have disability group III. Of all the disabled people living in psychoneurological care homes, 51.77 % have an individual rehabilitation / habilitation program, and with the conclusions of the Bureau of Medical and Social Expertise on the severity of disability — 47.38 %. Limitations in the categories of “ability to self-serve” were found in 77.40 % of disabled people, “ability to move independently” — in 24.57 %, “ability to orient” — in 62.02 %, “ability to control their behavior” — in 90.98 %, “ability to learn” — in 41.63 %, “ability to work” — in 90.28 %, “ability to communicate” — in 81.00 %.
According to different categories of disability, disabled people with mental disorders were distributed as follows: the 1st degree of severity was determined in 1.88-29.62 % of disabled people, the 2nd degree of severity — in 38.33-64.29 %, the 3rd degree of severity — in 23.33-39.43 %.
In the conclusions of persons with disabilities who have an individual rehabilitation / habilitation program, 0.77 % received recommendations on general and vocational education, 25.09 % received recommendations on vocational rehabilitation or habilitation, and only 2.92 % received a conclusion on the possibility of self-care and an independent lifestyle.

Discussion. The analysis of the obtained distribution of disabled people with mental disorders by the presence and severity of disability using the “Classification of the main categories of human activity and the severity of the limitations of these categories” (Order of the Ministry of Labour of Russia of August 27, 2019 N 585n) does not clearly identify a group of people who can lead an independent lifestyle, since the methodology does not prescribe an integral assessment of 8 criteria for disability.
The method proposed by the specialists of the Federal Bureau of Medical and Social Expertise is a test survey of specialists conducting evaluation testing to determine the nature and degree of violations in the social and social and environmental sphere of a disabled person’s life due to mental disorders, based on the International Classification of Functioning, Disability and Health. The developed method provides a point scale of ranges to assess the level of possibility of independent living of a disabled person. However, the results of testing the method are not given in the article.

Conclusion. Based on the received distribution of the contingent of disabled people with mental disorders living in neuropsychiatric care homes, the process of deinstitutionalization cannot be rapid and comprehensive. Psychoneurological care homes need to be transformed, refocusing on providing residents with a new system of services that will make it possible for them to live independently in society.
The obtained results of the analysis indicate the need for verification and validation of methods for determining the limitations of the life of disabled people in various fields, the development of a method for integral assessment of the degree of readiness of disabled people with mental disorders to independent life, taking into account behavioral disorders.

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