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: firstname.lastname@example.org; 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: email@example.com; 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: firstname.lastname@example.org; 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: email@example.com.
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: firstname.lastname@example.org; 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: email@example.com; 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: firstname.lastname@example.org; https://orcid.org/0000-0003-4930-1202.
In the heading: Original researches
Year: 2022 Volume: 4 Journal number: 3
Article type: scientific and practical
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.
Keywords: disability, disabled people with mental disorders, independent lifestyle, neuropsychiatric care homes
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1. Drobot OS. Koncepciya nezavisimoj zhizni kak forma integracii invalidov v sovremennom mire [The concept of independent life as the form of integration of disabled people in the modern world]. Uchenye zametki Tihookeanskogo gosudarstvennogo universiteta [Academic Notes of Pacific State University]. 2011;2(1):22-7. (In Russian).
2. Klochko EYu. Doklad «Zarubezhnyj opyt social’noj integracii invalidov». [Report «Foreign experience of social integration of disabled»]. Available at: http://srv33768.httest.ru/istorii/mirovoj_opyt/doklad_ zarubezhnyj_opyt_socialnoj_integracii_invalidov. (accessed 15.03.2019). (In Russian).
3. Lelliott P, Audini B, Knapp M, et al. The mental health residential care study: classification of facilities and descriptions of residents. British Journal of Psychiatry. 1996;169:139-47.
4. Hefatha unternechmen mensch [Hefat Foundation in Germany: official site]. Available at: http://www. hephata-mg.de/.(accessed 25.03.2021).
5. Cyganok LA. Reformirovanie psihiatricheskoy sluzhby. Opyt SShA i Evropy: obzor reform v psihiatrii v SShA i Evrope, predposylki, sushhnost’ reform, problemy na puti ih realizacii, rezul’taty reform, plany na budushhee [Reforming the psychiatric service. The experience of the USA and Europe: review of reforms in psychiatry in the USA and Europe, prerequisites, essence of reforms, problems on the way to their implementation, results of reforms, plans for the future)] Nezavisimyy psihiatricheskiy zhurnal [Independent Psychiatric Journal]. 2007;3:64-74. (In Russian).
6. Uryadnickaya NA. Samoopredelenie i samostoyatel’naya zhizn’ [Self-determination and independent life]. Available at: http://psyjournals.ru/files/43850/SD_ XXI_2009_n3_Uryadnitskaya.pdf. (accessed 01.10.2021). (In Russian).
7. Corvinos F. The impact of environmental factors on outcome in residential programs. Hospital and Community of Psychiatry. 1987;38(8):848-52. DOI:10.1176/ps.38.8.848.
8. Barrette PA. 1,005 Delayed Days: A Study of Adult Psychiatric Discharge. Psychiatric Services. 198; 32(4): 266-8. doi:10.1176/ps.32.4.266
9. O pravah invalidov: Konvenciya: OON, 13 dekabrya 2006 g. Sobranie zakonodatel’stva Rossijskoj Federacii, 2013. № 6, st. 468. [On the Rights of Persons with Disabilities: Convention: UN, December 13, 2006. Collection of Legislation of the Russian Federation, 2013. № 6, st. 468.]. (In Russian).
10. O ratifikacii Konvencii o pravah invalidov: Federal’nyj zakon ot 12 maya 2012 g. N 46-FZ [On ratification of the Convention on the Rights of Persons with Disabilities: Federal Law No. 46-FZ of May 12, 2012]. Available at: http://publication.pravo.gov.ru/Document/ View/0001201205040005. (accessed 29.05.2022). (In Russian).
11. Pervonachal’nyj doklad Rossijskoj Federacii o vypolnenii Konvencii o pravah invalidov «O merah, prinyatyh dlya osushchestvleniya obyazatel’stv po Konvencii o pravah invalidov, i o progresse, dostignutom v soblyudenii prav invalidov v techenie dvuh let posle ee vstupleniya v silu dlya Rossijskoj Federacii» [Initial report of the Russian Federation on the implementation of the Convention on the Rights of Persons with Disabilities «On measures taken to implement the obligations under the Convention on the Rights of Persons with Disabilities and on progress made in respecting the rights of persons with disabilities within two years after its entry into force for the Russian Federation»]. Moskva [Moscow]. 2014;196 p. Available at: http//oshi. org.ru. (accessed 27.09.2021). (In Russian).
12. Limankin OV, Trushchelyov SA. Psihosocial’naya reabilitaciya bol’nyh s psihicheskimi rasstrojstvami i rasstrojstvami povedeniya [Psychosocial rehabilitation of patients with mental and behavioral disorders]. Rossijskij psihiatricheskij zhurnal [Russian Psychiatric Journal]. 2019;6:4-15. DOI: 10.24411/1560-957X-2019-11949 (In Russian).
13. Golubeva NS, Ivanov ES. Psihonevrologicheskij internat: kachestvo zhizni umstvenno otstalyh molodyh lyudej [Psychoneurological care home: quality of life of mentally retarded young people]: Materialy mezhdunarodnoj nauchno-prakticheskoj konferencii studentov, aspirantov i molodyh specialistov «Psihologiya XXI veka» 22-24 aprelya 2005 goda [Materials of the international scientific and practical conference of students, postgraduates and young specialists «Psychology of the XXI century» April 22-24, 2005]. Pod redakciej VB Chesnokova. [Edited by VB Chesnokov]. St. Petersburg. 2005; 627 p. Available at: http://www.psyhodic.ru/arc. php?page=2147 (accessed 17.10.2021). (In Russian).
14. Kos AV, Karpova GG, Antonova EP. Kachestvo zhizni lic s ogranichennymi vozmozhnostyami v usloviyah prozhivaniya v internatah. [The quality of life of persons with disabilities living in care homes]. Zhurnal sociologii i social’noj antropologii [Journal of Sociology and Social Anthropology]. 2009;12(2):131-52. (In Russian).
15. Sergeeva NI. Social’no-psihologicheskie osobennosti invalidov s mental’nymi narusheniyami [Sociopsychological features of disabled people with mental disorders] Elektronnyj zhurnal «Praktika social’noj raboty. Otkrytyj metodicheskij resurs»: setevoe izdanie [Electronic journal «Practice of social work. Open methodological resource»: online publication]. 2020;4. Available at: Ы1р://центрсемья.рф/4-2020. (accessed 17.10.2021). (In Russian).
16. Gurovich IYa, Shmukler AB. Integration of mentally ill people with disabilities into society [Integration of people with disabilities into Russian society: theory and practice: collective. Monograph]. Pod red. Shapovalova VK [Ed. Shapovalova VK]. Moskva: Muravej [Moscow: Muravey]. 2006; 144-64. (In Russian).
17. Professional’naya orientaciya, professional’naya podgotovka i trudoustrojstvo pri umstvennoj otstalosti: Metodicheskoe posobie [Professional orientation, vocational training and employment in mental retardation: A methodological guide.]. Pod redakciej Starobinoj EM [Edited by EM Starobin] — St. Petersburg. 2010; 304 p. (In Russian).
18. Krivoruchko YuD, Filatkina NV. Osobennosti kontingenta psihonevrologicheskogo internata [Features of the psychoneurological care home contingent]. Rossijskij psihiatricheskij zhurnal [Russian Psychiatric Journal]. 2018;6:41-2. (In Russian).
19. Grebennikova VM, Nikitina NI, Agronina NI. Social’naya adaptivnost’ molodyh lyudej s mental’noj invalidnost’yu k samostoyatel’noj zhizni v sociume: sushchnost’, specifika, urovni proyavleniya, kriterii i pokazateli ih ocenki [Social adaptability of young people with mental disabilities to independent life in society: essence, specificity, levels of manifestation, criteria and indicators of their assessment]. Istoricheskaya i social’no-obrazovatel’naya mysl’ [Historical and socio-educational thought]. 2015;7(6)1:262-72. (In Russian).
20. Ob osnovah social’nogo obsluzhivaniya grazhdan v Rossijskoj Federacii [About the basics of social services for citizens in the Russian Federation]: Federal’nii zakon ot 28 dekabrya 2013 g. № 442-FZ [On the basics of social services for citizens in the Russian Federation: Federal Law No. 442-FL of December 28, 2013]. (In Russian).
21. Kozhushko LA, Gordievskaya EO, Demina EN. Soprovozhdaemoe prozhivanie: opyt, problemy, perspektivy razvitiya [Accompanied accommodation: experience, problems, development prospects]. Fizicheskaya i reabilitacionnaya medicina [Physical and Rehabilitation Medicine]. 2019;2(2):26-36. (In Russian).
22. Filippova MV, Fedorova PS, Bugajchuk TV. Specifika social’no-trudovoj reabilitacii invalidov s ogranichennymi intellektual’nymi vozmozhnostyami [Specifics of social and labor rehabilitation of disabled people with intellectual disabilities]. Sistemogenez uchebnoj i professional’noj deyatel’nosti: Materialy VII Mezhdunarodnoj nauchno-prakticheskoj konferencii [Systemogenesis of educational and professional activity: Materials of the VII International Scientific and practical Conference]. 2015;308-10. (In Russian).
23. Maksimova NE, Klimok NV. Trudoustrojstvo lic s psihicheskimi rasstrojstvami na primere Tverskoj oblasti [Employment of persons with mental disorders on the example of the Tver region]. Social’naya i klinicheskaya psihiatriya [Social and clinical psychiatry]. 2016;26(1):67-71. (In Russian).
24. Lyubov EB, Kulikov AN. Novye vozmozhnosti resocializacii bol’nyh s psihicheskimi rasstrojstvami [New possibilities of resocialization of patients with mental disorders]. Rossijskij psihiatricheskij zhurnal [Russian Psychiatric Journal]. 2019;3:18-24. DOI: 10.24411/1560-957H-2019-11924 (In Russian).
25. O klassifikaciyah i kriteriyah, ispol’zuemyh pri osushchestvlenii mediko-social’noj ekspertizy grazhdan federal’nymi gosudarstvennymi uchrezhdeniyami mediko-social’noj ekspertizy [About the classifications and criteria used in the implementation of medicosocial examination of the citizens of the Federal state institutions of medico-social examination]: Prikaz Mintruda Rossii ot 27.08.2019 N 585n [The order of the Ministry of Labour of Russia dated August 27, 2019 N 585n]. Available at: https://mintrud.gov.ru/docs/mintrud/orders/1386. (accessed 17.10.2021). (In Russian).
26. O social’noj zashchite invalidov v Rossijskoj Federacii: Federal’nyj zakon ot 24 noyabrya 1995 № 181-FZ [On social protection of invalids in the Russian Federation: Federal law of November 24, 1995 No. 181-FL]. Sobranie zakonodatel’stva Rossiyskoy Federacii 1995. № 48, st. 4563. [The collection of legislation of Russian Federation. 1995. No. 48, art. 4563]. (In Russian).
27. Kozlov SI, Gaubrih NYu, Yalamov AS, Mirzayan EI, Gerasimova EV. Obosnovanie metodiki po ocenke vozmozhnosti samostoyatel’nogo prozhivaniya grazhdan, stradayushchih psihicheskimi rasstrojstvami, v psihonevrologicheskom internate [Substantiation of the methodology for assessing the possibility of independent residence of citizens suffering from mental disorders in a neuropsychiatric care home]. Social’nye aspekty zdorov’ya naseleniya[setevoe izdanie] [Social aspects of public health] [online edition] 2019; 65(5):5. DOI: 10.21045/2071-5021-2019-65-5-5 (In Russian).