Do I need a psychologist for MSE? A certificate of disability is issued to whom in psychiatry. Appeal against medical and social examination

What is a medical and social examination and what is the procedure for conducting it? What types of problems does the Bureau of Medical and Social Expertise solve? How does the medical and social commission determine the disability group?

Good afternoon, dear readers! You are on the website “HeatherBober.ru” and I am with you, Maria Darovskaya.

Today we will talk about medical and social examination, its nuances, goals and features.

First, let's find out what is commonly called a medical and social examination, and how it differs from other types of examinations.

1.What is a medical and social examination and who conducts it?

ITU- this is a procedure according to the results of which experts recognize a person as disabled or deny him this status.

If experts have determined that a person is truly disabled and in need of social protection, then they determine which disability group to classify him as and what rehabilitation measures are necessary.

The assessment is carried out comprehensively, clinical, everyday, functional, psychological indicators of the person are analyzed (see also “” and “”).

The analysis is performed based on criteria approved by the Federal authorities. The procedure itself is regulated by Federal Law, Articles 7 and 8.

Federal institutions - in particular, the ITU bureau - are responsible for conducting ITU. The study referral form was approved by the Ministry of Health and Social Development.

Task 3. Determination of the disability group

There are several categories of disability: groups I, II, III and the category “disabled child”.

Disabled people of groups I, II, III receive a labor pension. If a person has no work experience, then a social pension is established. This norm is regulated by Federal Law.

Task 4.

The decision to recognize a citizen as disabled or to deny him this status is made after receiving and reviewing the data.

A re-examination must be carried out in advance, before the period for which the disabled status was granted has expired.

Examination deadlines:

Task 5. Determining the causes of death of disabled people

To use the state service of determining what caused the death of a disabled person, a family member of the deceased must submit an application.

In addition to the application itself, you must provide a document confirming the identity of the applicant, a copy of the medical death certificate, an extract from the examination card of the pathologist, and a copy of the disability certificate of the deceased.

The causes of death are determined by the bureau in absentia.

The application is submitted and recorded in the journal immediately upon submission. If an application has been submitted but not provided all the necessary documents, the applicant must provide them within 10 working days.

The decision is made by the majority of experts. When carrying out, an act is drawn up and a protocol is kept. The conclusion is drawn up in paper or electronic form.

You can read about determining the causes of death in the article “”.

3. How to pass a medical and social examination - step-by-step instructions

Now we will look at the main steps that need to be taken to obtain disabled status.

Please note that if there are no grounds for obtaining disabled status, you will be denied.

Step 1. Getting directions

Your first action should be to make an appointment with your doctor. At the appointment, you must indicate that you want to receive a disability.

The doctor will record everything necessary in the medical record and write a referral for examination. After this, you will be scheduled for an inpatient examination. Do not hide your illnesses and injuries while undergoing it. You need to communicate with doctors, tell them in detail why you have this or that disease.

All information obtained during the examination will be included in your card.

Example
Vladimir had health problems sufficient to qualify for disability. But he didn’t go to the doctor, and he didn’t keep an outpatient card. When Vladimir wanted to receive the social status of a disabled person, he was refused.
After the refusal, he had to register and undergo regular medical examinations. A year later, during a re-examination, he was given the status of disabled person.
To obtain the status, you need to regularly visit your local doctor and have notes about this in your medical record. Inpatient treatment and examination will follow only after a long outpatient visit to a medical facility. If there are no regular requests for an outpatient treatment card, the status will be denied.
It is the lack of success in outpatient treatment and then inpatient treatment that is proof of persistent pathology. Extracts from the hospital must be certified by department seals. The referral is certified with the seal of the institution. The signatures of at least three doctors are also required.
Step 2. Compose an application for examination
A citizen can submit an application independently or entrust this to his representative. It indicates the name of the institution to which the application is being submitted, information about the applicant, formulates the request for an ITU, its goals, and sets the date for filing the application.
The recipient must sign the received application, thereby confirming its receipt.
A statement is also written when a referral to medical examination in a hospital is refused.
Documents for ITU are prepared by the clinic at the place of residence. The chairman of the medical commission is responsible for this aspect of the work. You need to contact him when preparing documents to obtain disability.
Step 3. Receive an invitation from the ITU Bureau
After submitting your application, you must wait until you receive an invitation. It can be compiled both in written and electronic form, including by publishing it on a specialized Internet portal.
Step 4. Collect the necessary documents
It is better to prepare the necessary documents before receiving the invitation. This way you will definitely have time to collect the entire package. You will need a passport, a referral to an ITU, and medical documents that confirm your health status.
If you did not have all the documents when submitting your application, you must submit them within 10 days.
Step 5. We are waiting for an assessment of the body’s condition
The study is carried out in the office at the place of residence or, if there is a conclusion, then at home. MSE can also be carried out on a permanent basis or in absentia. The subject expert may invite a specialist who will have the right to vote to perform the examination.
The specialists’ task is to study the documents, conduct an examination and decide whether to grant disabled status.
Step 6. We receive a medical and social examination report
The decision is made within 30 days from the date of registration. If the examination was carried out in absentia, then the decision and explanations for it are drawn up on paper or electronically. Based on the results, a report is drawn up, it is signed by specialists and the head of the bureau, and certified with a seal.
All documents, including the report, as well as the protocol and rehabilitation program, are entered into the personal file of the subject. You will receive certified copies of these documents if you write an application.
4. Where to get advice on solving ITU issues - review of the TOP 3 companies
When obtaining the status of a disabled person, legislative and bureaucratic obstacles may arise.
For this reason, we recommend that you obtain legal advice before completing the necessary paperwork. This will help reduce the processing time, simplify the procedure, and save you from multiple trips to government agencies.
1) Lawyer
“Pravoved.ru” provides legal advice and services for document preparation in various areas. From almost 17 thousand qualified and experienced lawyers from all over the country, you can always choose the right specialist for your situation.
The company offers both free and paid services. But even paid services have prices below the market average. After all, Pravoveda’s lawyers do not need an office to provide advice to clients.
You can get advice without leaving your apartment. When submitting a question on the website, you will receive the opinion of several experts, which is equivalent to a collegial meeting and eliminates the possibility of errors.
The site operates 24 hours a day, without days off or breaks. If necessary, you can meet with specialists offline if the case requires the direct presence of a lawyer.
2) Legal consultation “Your personal lawyer”
Experts from the legal consultation “Your Personal Lawyer” provide advice on legal issues. You can contact the company for help by leaving a request on the website or by calling. Responses to requests are sent within five minutes.
Experts also prepare articles on topics of their profile - real estate, social security, property, family and labor, civil, tax corporate law and others.
The Docexpress company provides advice on legal issues around the clock, using a 24-hour hotline. Legal assistance is provided to both individuals and legal entities.
The company also provides a free newsletter, and the website has a forum where you can see expert answers to questions already asked. The list of the main advantages of the organization includes the reliability of the information provided, speed, and quality.
5. What to do if you are refused an examination - 3 useful tips
It may happen that the assignment of disability is denied. This can happen for many different reasons.
If you are sure that the refusal is illegal, then let's look at what needs to be done to protest it.
If you receive a refusal, be sure to request a certificate of this in writing. You will be able to contact the bureau yourself for an examination if you have it in your hands.
If the examination shows that all signs of disability are present, then they will issue a certificate with which you need to go to the clinic and receive a referral form.
Tip 2. Use the services of a professional lawyer
A professional specialized lawyer will help with the procedure for challenging the refusal. The lawyer must have experience in such cases and the necessary level of qualifications.

Please make an effort to read. If you are embarrassed that a “crazy” is writing to you and ruining your forum with his presence (question-answer), then at least respond to the email. Hello, this is the second time I am contacting you. Last time I wrote that I was diagnosed with schizotypal personality disorder and that I wish to receive disability. But apparently you described the problem incorrectly since you did not find the formulated question. Again. Somewhere in the middle of last year, I was examined and treated by the military registration and enlistment office in a psychiatric hospital, and received a diagnosis. Now I need to get disability. But they don’t help me either in the psychiatric hospital or in Ch. ITU Bureau. On 02/09/10 I submitted an application for conducting an ITU to the main bureau No. 25 of Irbit and submitted all the necessary documents. There they gave me a PAPER so that on the 11th I would go to a psychiatric hospital because a visiting ITU team from Pervouralsk (chief ITU bureau No. 45) would arrive there on the 10th. They called me from the main bureau of Bureau No. 25 and said that the visit of the team from Bureau No. 45 was cancelled, they told me to I came to them. When I arrived, they told me that I would go to Pervouralsk on my own for medical examination since there were no specialists in psychiatry in bureau No. 25. They gave me back my documents and added my papers (statistical coupon No. 1, social diagnostic card, certificate of examination by the ITU bureau) in which only my full name, address and other data from the referral to ITU were filled in (no stamps or anything), they gave me a piece of notebook paper with the address Bureau No. 45 They didn’t give me any directions in the established form. I think they simply threw out my application addressed to someone there. Question. Is it possible to get me examined at my place of residence as required by law? That is, to come here from Pervouralsk. If it is possible to obtain an examination at the place of residence, how can this be achieved? Where to complain? More. In the medical documentation they wrote to me that I have thinking disorders: interruptions of thoughts, influxes of thoughts, confusion of thoughts, attention activity is scattered, unstable with rapid changes in direction, concentration and intensity, pseudo abstract thinking with a resonant tint, difficulties in concentrating. Increased exhaustion, distractibility. Changes in the motivational component of memory. Question: Do I have a chance to get disability? There still seems to be a problem. I spent 1.5 months in the hospital, the rest of the time I was treated as an outpatient, and during this time I constantly complained: interruptions in thoughts, confusion of thoughts, difficulties in concentrating. I heard that the necessary rehabilitation measures must take 4 months to obtain disability, I also heard that in the commentary to the law “On psychiatric care and guarantees of the rights of citizens during its provision” it is written that outpatient treatment also refers to rehabilitation measures. However, for some reason, doctors believe that it is necessary to spend 4 months in a hospital in order to receive disability. But nowhere does it say that a hospital is mandatory; after all, it is necessary to carry out the necessary rehabilitation measures. What is the need for a hospital if there is something in it, that you take the same medications on an outpatient basis and no one looks at you, whatever is there or here (the whole round consists of a dialogue - hello, how are you - normal) Question. Can they kick me off at the ITU by saying that I haven’t been in the hospital for 4 months? Please tell me, as a good lawyer, is it possible to get disability without having to stay in a hospital anymore? I’m ready to do anything to avoid being there, I’m ready for a bunch of ships if it helps, of course. If not, then I’ll forget about the disability. And further. Here someone wrote that the PND (psycho-neurological dispensary) does not issue copies of medical documents to him, citing the fact that these are medical. documents contain information about third parties. You answered that you don’t understand how this could be. Yes, this can happen. For example, some respectable citizen (neighbor, co-worker, or finally a member of your household), noticing a not entirely normal (in aggravated) person behaving inappropriately (aggressive, considering himself a messiah, etc.), calls the police or an ambulance. When this police (ambulance) arrives, it must write down all the information that served as the basis for the call, as well as everything about the caller. This information (signs of a mental disorder) is a necessary basis for the court to order a compulsory examination or treatment and, naturally, information in court cannot be given from an anonymous person. Also, according to the rules for maintaining a medical history in a psychiatric hospital, doctors are required to include in it who provided information about a mental disorder. Therefore, information from third parties appears there. Another example. When I went in for examination, my mother filled out (in front of me in the emergency department) a questionnaire in which she wrote that I had become more aggressive. At the trial, when I was trying to get my copy of the story out, the director was crazy. Department. referred to my mother as a third party. Subsequently, my mother was summoned to court where she gave her consent for me to receive a copy of the medical history. Happy End.

An expert assessment of working capacity is carried out on the basis of a thorough study of the clinical picture of the disease. The doctor must determine not only the degree of disability, but also the further prognosis of the disease and the conditions under which the ability to work could be restored.

An exceptionally large contribution to the development of issues of assessing the ability to work of mentally ill people was made by Soviet psychiatrists G.A. Geyer and D.E. Melekhov.

The timing of granting sick leave to a mentally ill person is regulated by general provisions on the duration of temporary disability of patients. However, the usual period of 4 months is not mandatory. An important measure for the prevention of disability is the active treatment of patients with prolonged attacks of the disease without transferring them to disability after the specified period. Sometimes for “follow-up treatment” it is necessary to extend the certificate of incapacity for another 2-3, less often 4, months.

To resolve the issue of a patient’s ability to work, the expert needs detailed knowledge about the patient’s previous social and labor behavior and a correct assessment of the prognostic value of his clinical condition during the examination period. All this will allow you to make the right expert opinion.

If a persistent decline or loss of ability to work is established, the expert must also determine its degree, which corresponds to 3 groups of disability.

I. disability group is assigned to patients who need supervision and are unable to care for themselves. This may include patients with profound dementia as a result of degenerative atrophic processes in the brain or organic damage to the central nervous system (trauma, intoxication, infection, etc.), as well as end-states in schizophrenia. Patients with chronic, treatment-resistant delusional, hallucinatory and affective disorders may also be suitable for assignment to disability group I, if they are completely maladapted socially and professionally and require observation.

II. The disability group is assigned to patients with severe psychoorganic (intellectual-mnestic) decline, patients with persistent delusional and hallucinatory disorders, prolonged depressive states, persistent severe obsessive, phobic and hysterical disorders that are resistant to therapy.

III. The disability group is most often assigned for unexpressed mental disorders of various origins that prevent the patient from continuing to work in his specialty. However, these patients are able to work in easier or less difficult conditions. For example, a train driver with phobic reactions may be transferred to work in repair shops.

Required information when sending to ITU: n At the time of initial treatment - data on the diagnosis in a psychiatric hospital; in the absence of such, a commission examination by psychiatrists of the IPD for the initial diagnosis of schizophrenia; when re-applying - data on outpatient and inpatient treatment for the past expert period; experimental psychological examination with an assessment of the state of mental processes (endogenous type changes) and, if necessary, an assessment of intelligence according to Wechsler, expert opinions: psychiatrist, pediatrician, orthopedic traumatologist, neurologist, ophthalmologist, etc., characteristics from the place of study, or extract from the rehabilitation center for the disabled (defectologist's report), instrumental and laboratory research methods (MRI of the brain, EEG, ultrasound of the vessels of the head and neck, etc.): necessary in the presence of a concomitant or complicating component (for example, schizophrenia against the background of organic brain damage brain).

Clinical-expert-functional diagnosis consists of the following characteristics: a) the type and rate of the disease; b) stage of development of the disease; c) main maladaptive syndromes (“positive” and “negative” register); their persistence and severity; d) type of remission, its persistence and severity. For example: Schizophrenia, paranoid form, continuously progressive type of course, moderately progressive in pace. Persistent severe Kandinsky-Clerambault syndrome.

Mental disorders to varying degrees occur in 20–25% of the population. Severe disease leads to loss of ability to work and self-care skills. To provide social and financial assistance to such patients, psychiatric disability is issued.

This process takes some time and has its own characteristics. Relatives of persons with mental disabilities do not always have complete information about the examination, the procedure for referral for medical and social examination, benefits and restrictions for such disabled people.

Procedure for referral to ITU

When a person of working age seeks medical help, a psychiatrist assesses his condition and decides on further tactics. If the patient is actually unable to work, he is issued a certificate of temporary incapacity for work and a treatment regimen is determined. Depending on the severity of the disorder, the threat to life and health, the patient may undergo therapy:

on an outpatient basis;
in the day department;
in a 24-hour hospital.

If during treatment signs of disability persist, the sick leave is extended. If the prognosis is unfavorable, after 4 months the patient is subject to referral for a medical and social examination (MSE) to establish disability. After the examination, there are three possible scenarios:

The patient is given disability of the first, second or third group.
They refuse to recognize you as a disabled person and recommend that you go to work.
They are sent for further treatment or additional examination to a medical institution with an appearance at the commission later.

When people of retirement age or their relatives seek help, the doctor assesses the degree of mental dysfunction and recommends a course of treatment for 4 months. More often these are patients with toxic, vascular or atrophic brain lesions (after strokes, arterial hypertension, Alzheimer's disease, chronic alcoholism). If the prognosis for the patient is clearly unfavorable, the duration of treatment before referral for disability may be reduced.

Important! Disability due to mental illness after a traumatic brain injury, stroke or brain surgery is issued no earlier than 6 months later. Until this period expires, a neurologist deals with issues of disability.

Before completing documents for the commission, the patient undergoes a full examination, which includes:

experimental psychological research;
electroencephalography with consultation with a neurologist;
results of laboratory tests of blood and urine;
instrumental diagnostic methods (computer or magnetic resonance imaging, examination of the vessels of the neck and brain).

Before undergoing MSA, it is important to have all the results of laboratory and instrumental diagnostic methods

If necessary, the patient is examined by other specialists and the appropriate conclusion is drawn up. Hospitalization in a 24-hour hospital is carried out only for medical reasons; it is not necessary to “go to the hospital” even before the initial disability.

For what diseases is the patient entitled to incapacity for work?

Sometimes patients turn to a psychiatrist with a request to apply for a pension. They report the inability to find a job, are interested in benefits, as well as what diseases qualify for disability. The commission decides to refer not all persons observed by a psychiatrist to MSE. For example, a patient with neurosis cannot count on being recognized as having lost his ability to work. However, if the symptoms of the disease are severe, he can undergo examination to change the diagnosis and conduct a labor examination.

The majority of people with mental illness suffer from the following disorders:

schizophrenia;
autism;
oligophrenia (mental retardation);
organic brain lesions;
dementia (dementia);
endogenous affective disorders.

Disability groups

To make decisions about the presence of permanent disability, specialists assess the degree of impairment of the following mental functions:

behavior,
consciousness,
memory,
attention,
thinking,
intelligence,
emotions,
volitional sphere.

Depending on the severity of personality changes, the ITU Bureau recognizes a person as a disabled person of the first, second or third group. Group 3 disability is issued to patients with moderate mental impairment. Such patients receive job recommendations. They can work in gentle conditions: with shorter shift durations and different standards for meeting the plan.

Group 2 disability can be given to patients with severe mental disorders. Their condition is characterized by more frequent exacerbations (decompensations), violations of basic functions allow them to work for a short time - 2-3 hours a day and only in specially created conditions. Group 1 disability is given to a patient who has been diagnosed with a severe mental disorder. Not only the ability to work is lost, but also the ability to self-service. Due to the severity of memory and thinking disorders, and severe psychotic symptoms, such patients require constant outside care.

Initially, disability of groups 2 and 3 is issued for 1 year, and group 1 – for 2 years. Elderly patients with dementia are given a pension for life. Upon repeated appearance, the psychiatric ITU extends the disability for 1 year or gives the group an indefinite period. The period from initial exit to registration of disability without further re-examination is determined on an individual basis.

Individual rehabilitation program

In case of mental illness, the patient or his relatives receive an individual rehabilitation program (IPRA). This document describes in detail recommendations on the scope of medical or social assistance, a list of individual rehabilitation means needed by the patient, recommendations on the patient’s work (conditions, positions) or study, data on referral to a specialized boarding home.

The patient receives care in the medical institution where he is being observed. Thus, the rehabilitation program may include:

psychological and medical assistance indicating the frequency of planned hospitalizations;
accompaniment of a hospital social worker when applying for a pension and benefits;
need to consult a lawyer.

Thus, when registering a disability due to a mental illness, the patient may be prescribed hygiene products (absorbent underwear, diapers) if there are mobility impairments or the patient has urinary and fecal incontinence. If there are opinions from other specialists, the IPRA also indicates means of technical rehabilitation (mattresses, wheelchairs, hearing aids, orthoses, shoes and other products).

Important! A disabled person can receive hygiene or technical products for free even if they monetize their social package.

Limitations and benefits for people with mental illness

Patients often ask the doctor about what the pros and cons may be. The main provisions should be listed. Persons with disabilities due to mental illness are transferred to a dispensary observation group. This limits their ability to obtain employment for certain types of work, obtain a weapons license, and does not allow them to engage in adoption or become guardians of adults.

If there are problems with housing, disabled people of groups 1 and 2 can apply for improvement of their living conditions. If the patient cannot take care of himself fully, a social worker visits him: pays bills, brings food and medicine. To obtain such assistance, a disabled person must submit a conclusion on the possibility of home-based services.

Mental illnesses are in fourth place in the frequency of patients receiving disability status

Patients who have not monetized their social package can receive preferential medications according to the list. And if there are concomitant diseases (for example, asthma, bronchitis, arthritis) and there are no mental contraindications, they undergo treatment in a sanatorium once a year. Passing final exams (OGE, Unified State Exam) for disabled people takes place in gentle conditions. When registering for a boarding home, places first of all are given to disabled people of group 1.

Registration of disability due to mental illness makes it possible to receive a pension if it is impossible to find a job or hold a job, free medicines, hygienic and technical means of rehabilitation. If the patient's health condition stabilizes, the commission does not recognize him as disabled.