Stages of social psychological rehabilitation of mental patients. Measures to help a person with mental illness - what modern science offers

The goal of rehabilitation in medicine is considered to be complete or partial restoration(preservation) of the individual and social value of the patient, his personal, social and labor status. Her immediate tasks include: medical rehabilitation, aimed at achieving the maximum possible clinical compensation, relieving the manifestations of the disease and preventing it undesirable consequences or their reduction; vocational rehabilitation- returning the patient’s ability to participate in socially useful work and independent life support; social rehabilitation- restoration of the individual and social value of the patient.

Brief historical sketch. The need for a humane attitude towards the mentally ill and maintaining their social status was recognized by scientists back in ancient times. Thus, Caelius Aurelian (IV - V centuries AD) 1 in his instructions recommended benevolent, gentle treatment of the mentally ill, and prescribed walks, pleasant conversations, reading, theater and exercises in rhetoric for those recovering. But a real shift in the corresponding psychiatric views occurred later, only in the 18th century. At the origins of the movement for “no-restraint” of the mentally ill and the creation of conditions worthy of human beings was the French doctor Philippe Pinel. In England, the ideas of a humane attitude towards the mentally ill were promoted by W. Tuke, who first organized a free shelter for them (1792). Psychiatry owes the actual abolition of restraint measures to J. Conolly (1839). With the active participation of J. Esquirol In 1838, the first legislative act protecting the rights and interests of the mentally ill appeared in France. Similar laws by the middle of the 18th century. have been adopted in other European countries.

In Russia, for centuries, the holy fools, the wretched and those who have lost their minds found refuge in monasteries. Only under Peter I did the first special homes for the mentally ill (dolgauzes) appear. Later, during the reign of Catherine II, the Charter of the Orders of Public Charity was published, which included asylums for the insane, which prescribed a philanthropic attitude towards their inhabitants.

At the end of the 18th - beginning of the 19th centuries. Family patronage began to occupy a significant place in the care of the mentally ill (especially developed in areas adjacent to large hospitals), in which elements of the rehabilitation of patients in its modern content became more obvious. Finally, in 1900 V.M. Bekhterev, for the first time in Russia, opens a neuropsychiatric department at the St. Petersburg Clinic for Mental Illnesses with free access for those recovering, which expanded the possibilities for their integration into ordinary life. New hospitals are beginning to provide specially equipped rooms for various crafts. The latter served both the purposes of healing (occupational therapy) and partly for the entertainment of patients. Colonies were organized for chronically ill patients, which were located mainly in rural areas, so that patients who retained the ability to work could engage in agricultural work (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, watching negative consequences a patient's long stay in a hospital and isolation from society, one of the first Russian psychiatrists expressed the idea of ​​​​the need for decentralization of psychiatric care. He proposed a project for establishing a network of small hospitals, “pushed into the very thick of everyday life.” Later, P.P. Kashchenko, head of 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 as much as possible. He also organized a colony for the mentally ill, following a Western model, where he widely practiced a system of family patronage.

But the most active dissemination and implementation of the ideas of “non-restraint” in Russia is associated with the name of S.S. Korsakov and representatives of his school, to whom domestic psychiatry owes the fact that the main approaches to in-hospital rehabilitation of mentally ill patients, relevant to this day, were formed in Russia back at the beginning of our century. S.S. Korsakov, being the initiator and leader of the zemstvo and city construction of psychiatric institutions, abolished all measures of physical restraint for patients (straitjackets, isolators, bars on windows, etc.). His interests also included issues of protecting the civil rights of the mentally ill, conducting forensic psychiatric examinations, disseminating psychiatric knowledge among the population and preventing mental disorders.

The followers of S.S. Korsakov, V.P. Serbsky and P.B. Gannushkin, did a lot to develop legislation on the mentally ill, resolve issues of the right to charity and support, sanity, legal capacity and ability to work, i.e. a complex of legal problems, without considering which the real resocialization of mentally ill people is impossible. Subsequently, the zemstvo psychiatrist T.A. Geyer (one of the initiators of the creation of the Institute for the Examination of Working Capacity and Labor Organization of Disabled Persons) created the clinical foundations of medical labor examination, employment of the mentally ill, out-of-hospital 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 in national scale occurred only in the 20-30s of the 20th century, marked not only by the reconstruction of existing psychiatric hospitals, but also by the organization in our country of out-of-hospital psychiatric services (psychoneurological offices, dispensaries) and the formation of a system of social and labor placement for patients.

Thanks to the development of a network of psychoneurological dispensaries, it became possible to provide outpatient treatment for mentally ill patients and reduce the length of their hospital stay. It has become possible to provide them with qualified medical and social care throughout their lives, maintaining continuity of treatment and rehabilitation measures between the hospital and the dispensary. The need for social isolation of patients and separation from everyday life has disappeared. Observation of outpatient populations has made adjustments to scientific ideas about the dynamics of mental illnesses, showing that over the course of most of them many patients do not require hospitalization, remain in society and, given favorable conditions, can remain able to work for a long time.

The basis for social and labor rehabilitation of mentally ill patients has become day hospitals for mental health problems, occupational therapy rooms and occupational therapy workshops. Occupational therapy is also widely carried out in psychiatric hospitals themselves, where in almost every department, during the hours provided for by the internal regulations, patients perform the simplest work (assembling small parts of various devices, making artificial flowers, toys, gluing together packaging boxes, etc.). Some patients perform outdoor work on the hospital premises. In hospitals with a well-organized treatment and rehabilitation process, the organization of such activities occupies a fairly large place along with cultural therapy (watching films, using the library, etc.). However, this “in-hospital” rehabilitation at the present stage of development of society could not satisfy either psychiatrists or patients, and in almost all countries, rehabilitation measures began to be carried out outside psychiatric institutions on a higher technical basis.

An important stimulus for the introduction of such occupational therapy was the spread of the ideas of sociotherapy. The origins of the latter were the German psychiatrist N. Simon (1927), who considered the inclusion of a mentally ill person in collective work 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 name “occupational therapy”; “industrial therapy”, or “industrial rehabilitation” (industrial therapy, industrial rehabilitation). Its starting point was group work in medical workshops in conditions close to actual production conditions, but then such therapy was transferred to agricultural and industrial enterprises. This trend became especially characteristic of post-war psychiatry.

The possibilities of such rehabilitation have 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 transfer to maintenance therapy. Therefore, the development of industrial rehabilitation in our country reached its greatest “flourishing” in the 70-80s. The psychiatric literature of those years widely covered its various organizational forms and provided convincing data on its high efficiency[Melekhov D.E., 1974; Kabanov M.M., 1978; Krasik E.D., 1981]. Not only various forms of labor readaptation have been developed, but also corresponding medical and psychological influences on the patient during its implementation.

In our country, in large agricultural and industrial regions, special rehabilitation centers dealt with these issues. Let us briefly look at the characteristics of the most typical of them.

In 1973, a post-hospital rehabilitation center was created in the Odessa region, operating on the basis of an agricultural enterprise. The relationship with the state farm, built on the principle of self-financing, provided for the provision of patients with a comfortable hostel (where they were fully self-service), food in the canteen and work. Qualified medical care was provided to patients by the rehabilitation service of the Odessa Psychiatric Hospital. Thus, psychosocial (sociotherapeutic) and biological methods of influence were comprehensively used in the rehabilitation process. The patients performed field work, were employed on a livestock farm, and 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 on the state farm. The center was designed primarily for patients with chronic and ongoing forms of mental illness, as well as those suffering from frequent relapses. Among them, people with a long history of illness (from 10 to 25 years), long-term (more than 5-10 years) continuous stay in a psychiatric hospital or frequent rehospitalizations predominated. Observations of patients in this center showed that as a result of rehabilitation measures, the frequency of exacerbations was significantly reduced, the duration of interictal intervals increased, productive symptoms were mitigated, and manifestations of the defect were compensated. About 60 % patients fully mastered production skills, the rest mastered them partially [Maryanchik R.Ya., 1977].

Rehabilitation centers provided significant financial benefits to healthcare by reducing the length of stay of patients in the hospital, the cost of the products they produced, and the profits received from their sale. But such labor rehabilitation also pursued a more important goal - to make possible the discharge, out-of-hospital existence and self-sufficiency of disabled patients who had been in psychiatric hospitals for a long time, including colonial ones. At the same time, the tasks were set to restore lost connections with relatives and friends, revive forgotten skills of correct behavior and self-care, as well as the emotionality of patients (with the additional use of cultural therapy, physical therapy, etc.). Industrial rehabilitation has become 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 provided significant advantages to patients compared to work in traditional occupational therapy workshops. Such workshops were considered an intermediate link on the way to employing patients in a special workshop or in regular production. But work in medical labor workshops was not work in the legal sense, since patients were not paid seniority, work books were not created; instead of salaries, they received monetary rewards. They were not given a certificate of incapacity for work (“sick leave”), and were not provided with paid leave. They thus remained in the position of patients of a medical institution and it was not possible to talk about their true compensation. The social status of patients in working conditions at an ordinary industrial enterprise changed radically.

In Kaluga Regional Psychiatric Hospital No. 1 in 1973, on the basis of medical workshops, a special turbine plant workshop 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. The workshop employed people with disabilities of groups I and II due to mental illness, as well as patients who did not have disabilities, but due to their condition could not work in normal production conditions. Patients were enrolled in the staff of a special workshop and performed relevant production operations. Compliance with working conditions, correct use of patients' labor, implementation of sanitary and hygienic measures and monitoring of the mental state of patients was carried out by specialists from the 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 plant administration provided patients with one meal and payment for treatment, and provided them with various types of labor of varying complexity, from simple cardboard work to assembling electrical circuits for radio equipment. Since the workshop was located on the territory of the hospital, patients had the opportunity to work in it while still in the hospital. In turn, patients employed in the workshop, if their condition worsened or were temporarily incapacitated, could be transferred to the hospital for day or full hospitalization. Patients employed in the workshop were equal in their rights to factory workers (they received wages, bonuses for fulfilling the plan, had the whole complex social services provided by the factory). Moreover, being part of a trade union organization, patients were sometimes actively involved in social work, which contributed to the restoration of real social skills and connections. If there was no need for daily psychiatric observation, patients could be transferred to regular production.

A similar organization of industrial rehabilitation, but on a larger scale, 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. In special premises, workshops of some Tomsk industrial enterprises were set up, where patients were provided with types of labor of varying complexity (including work on machines). This allowed patients not only to receive fairly good payment for the products produced, but also to make a significant contribution to overall efficiency work of the relevant production. The latter had enormous psychotherapeutic significance for patients, not to mention the fact that long-term ill patients with severe mental defects, who had been a “burden” for the family for many years, turned into active members and, to some extent, “breadwinners.” Some patients were employed in individually created conditions directly at industrial enterprises in Tomsk or on 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 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 beneficial effect of rehabilitation was achieved in 70 % patients who were previously almost completely socially and professionally maladjusted.

There was extensive experience in the rehabilitation of mentally ill patients in St. Petersburg, where the organizers of this case were specialists from the Psychoneurological Institute named after. 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. Thus, for patients who did not have a family or had lost one, special dormitories were organized, the way of life in which was as close as possible to the usual. Here the patients who were previously long time in a psychiatric hospital for chronic patients, they could gradually restore 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 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 the optimal form of returning patients to socially useful work, it was not widespread in the country. Even in the 70-80s, it covered only a small part of those in need (about 8-10% of the total number of disabled people). There were not enough places in the special workshops. The types of labor offered in them, mostly low-skilled, did not always take into account previous professional employment and practically excluded participation in rehabilitation programs of persons who had previously worked mental activity. The rates of removal of the disability group and return to normal production remained low. Most of the patients had lifelong disabilities and, at best, could only work in specially created production conditions and under medical supervision. Considering the unstable performance of mentally ill people, the need for a gentle individual approach to them, and the prejudiced attitude of work collectives, enterprise administrations, in turn, showed no interest in expanding the network of special workshops or hiring mentally ill people into regular production.

In foreign countries, the problem of resocialization of mentally ill people, which also became acute in the late 70s and early 80s, was to a certain extent associated with the antipsychiatric movement, when the process of so-called deinstitutionalization began - removing patients from the walls of psychiatric hospitals and closing them. Discharged patients, 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 for lost labor and communication skills.

With the close cooperation of psychiatric and social services, existing through government funding, public and charitable foundations, an extensive social rehabilitation system has been formed in many European countries, aimed at the gradual reintegration of mentally ill people into society. The objectives of the institutions included in it are to provide mentally ill people with a temporary place of residence, train and instill in them the skills necessary in everyday life, and improve their social and labor adaptability. For this purpose, special hostels, hotels, so-called halfway houses were created, in which patients not only live, are provided with psychiatric observation, but also receive assistance in professional and labor advancement.

Patients discharged from hospital in some countries have the opportunity to be admitted to out-patient clinics and rehabilitation centers with a limited period of stay. So, in France it does not exceed 18 months. By the end of this period, the skills acquired by the patient are assessed and his ability to return to work on a general basis or be limited to the level of medical and labor institutions is determined. The employment of patients in normal production conditions, but with constant supervision by psychiatrists and social workers, is becoming increasingly common. Unfortunately, this form largely depends on employers.

According to the unanimous opinion of psychiatrists, the vast majority of patients in need of rehabilitation are patients with schizophrenia. Special training programs were used for them (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 patients with schizophrenia). 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). More recently, special computer programs, built according to the type of dialogue. They are designed to train concentration and other cognitive functions and can be used by patients independently. 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 correct behavior in everyday life: in addition to correcting the emotional-volitional and cognitive disorders inherent in patients with schizophrenia, they help develop the skills necessary to solve everyday problems. independent living skills, including the use of social benefits, financial resources.

Thus, modern rehabilitation approaches are aimed primarily at the patient’s personality, 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 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 support. Following a period of optimism and unfulfilled hopes for the rapid implementation of rehabilitation programs, a more balanced understanding of the real state of affairs has come. It became clear that the rehabilitation of mentally ill people is not a program limited to one time or another, but a process that should begin at the stage of initial manifestations of the disease and continue almost throughout life, which requires a lot of effort on the part of society in general and health authorities in particular. Insufficient financial support, partly due to the diversion of material resources to solve 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 last years Due to the general deterioration of the economic situation, the closure of some state-owned enterprises and the emergence of unemployment, the rehabilitation of mentally ill people has also become a difficult task. Rehabilitation institutions that were previously provided by the state - medical and labor 362 - have fallen into disrepair.

workshops, artels and industries that used the labor of disabled people. Due to insufficient material resources, programs are being curtailed vocational training mentally retarded in auxiliary schools and boarding schools, the vocational schools that accepted their graduates are closed. Medical and social services focused on the resocialization of mentally ill people have not yet received their development. At the same time, enterprises and psychosocial assistance organizations operating on a commercial basis, without any connection with government institutions (hospitals and dispensaries), have emerged in the country. But due to the high cost of the services they provide, they remain practically inaccessible to the majority of low-income mentally ill people.

Under the current conditions, the need has emerged to find new ways to organize social and labor adaptation for the mentally ill and mentally retarded. One of the most promising directions It is envisaged the formation of non-state charitable foundations, social support clubs for mentally ill people, associations of their relatives and other public organizations interested in their social reintegration. Created 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 foundation implements a set of programs aimed at increasing social competence and social rehabilitation of mentally ill disabled people. Within the framework of one of them, the “Moscow Club Fund,” patients have the opportunity to improve their professional skills and gain work experience in the field of office work, catering and leisure, employment and establishing contacts with employers, which they need for subsequent employment in regular jobs. The foundation provides patients with financial support and 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.

The successful implementation of any rehabilitation programs requires active interaction between public and charitable organizations with various government and departmental structures involved in education, medical care, life support and the provision of social benefits to the mentally ill and mentally retarded.

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Comprehensive rehabilitation of mentally ill patients

We provide medical care for a variety of mental illnesses. We employ some of the best doctors in the field of psychiatry in Moscow. In addition to the medical part, during the recovery process or long-term intermission, patients need comprehensive rehabilitation.

Psychosocial rehabilitation

Social rehabilitation of mentally ill people is a unique service for Russia, the need for which is difficult to overestimate.

The World Health Organization definition states:

If a mental disorder is severe, lasts a long time, or is combined with other forms of mental disorders, for example, addictions, this inevitably leaves a certain imprint on the person’s personality. In some cases, the patient loses previously acquired social skills, communication skills, professional activity, sometimes even self-service skills.

In the Department of Psychiatry and Psychotherapy of Dr. Isaev’s Clinic, it is possible to conduct a course of psychosocial rehabilitation of the patient in a rehabilitation center specially created for this purpose near Moscow.

“Psychosocial rehabilitation is a process that enables ... persons with disabilities as a result of mental disorders to achieve their optimal level of independent functioning in society.”

Here, the patient will be fully or partially compensated for lost social skills under the patronage of experienced social workers, psychologists, teachers, and rehabilitation doctors. All work is continuously monitored by a psychiatrist, who, if necessary, prescribes or adjusts drug therapy.

Specialists

The center employs 3 psychiatrists, 5 clinical psychologists, 4 gestalt therapists, 10 social workers, 2 nurses.

In addition to the main specialists involved in the rehabilitation process, the center employs service staff: teachers of auxiliary disciplines - yoga, breathing exercises, as well as a cook, drivers, and security.

What results are we achieving?

As a result of rehabilitation, it is possible to achieve stable remission in the majority of our patients, as well as their return to society.

How it works?

The program consists of several blocks, which include correctional and educational elements. All this takes place under the supervision and guidance of psychiatrists and clinical psychologists.

Educational block - knowledge about the disease

Cognitive-behavioral block - communication skills

Psychodynamic block - awareness of feelings

• Awareness of the origins of maladaptive behavior, one’s feelings, desires, hidden motives that determine certain distortions in relationships with others
• Improving reality testing ability

As a result, adaptation to life in society occurs.

Psychological improvement, development of adaptive abilities, immunity to psychotraumatic influences, training in behavioral strategies that protect the individual from stress and psychogenic disorders are achieved.

The work uses modern methods of rehabilitation of persons with mental disorders. All activities are adapted to the characteristics of the patients. Below is a sample list of events held at the center.

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          Psychosocial rehabilitation: a modern approach
          T.A. Solokhin

          Definition of the concept of “psychosocial rehabilitation”,
          its goals and objectives

          The World Health Organization report on mental health (2001) states: “Psychosocial rehabilitation is a process that enables people who are frail or disabled as a result of mental disorders to achieve their optimal level of independent functioning in society.

          To this definition we add that this is a constant, continuous process that includes a complex of medical, psychological, pedagogical, socio-economic and professional measures.

          Psychosocial rehabilitation interventions vary depending on the needs of patients, the location where rehabilitation interventions are provided (hospital or community), and the cultural and socioeconomic conditions of the country in which mentally ill people live. But the basis of these events, as a rule, consists of:

          · labor rehabilitation;
          · employment;
          · professional training and retraining;
          · social support;
          · providing decent living conditions;
          · education;
          · mental health education, including training on how to manage painful symptoms;
          · acquisition and restoration of communication skills;
          · acquisition of independent living skills;
          · realization of hobbies and leisure, spiritual needs.

          Thus, even from an incomplete list of the listed activities it is clear that psychosocial rehabilitation of mentally ill people is a comprehensive process aimed at the restoration and development of various 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 methods of its implementation. However, all scientists and practitioners agree that the result of rehabilitation measures should be reintegration(return) mentally ill people to society. At the same time, patients themselves should feel no less full citizens than other groups of the population. With that said, goal of rehabilitation can be defined this way: this is an improvement in the quality of life and social functioning of people with mental disorders by overcoming their social alienation, as well as increasing their active life and civic position.

          The Statement on Psychosocial Rehabilitation, developed by the World Health Organization jointly with the World Association for Psychosocial Rehabilitation in 1996, lists the following: rehabilitation tasks:

          · reducing the severity of psychopathological symptoms using the triad - medications, psychotherapeutic treatments 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 activity;
          · reducing discrimination and stigma;
          · support for families in which someone is suffering mental illness;
          · creation and maintenance of long-term social support, satisfaction at least basic needs mentally ill people, which include providing housing, employment, organizing leisure time, creating a social network (social circle);
          · increasing the autonomy (independence) of mentally ill people, 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, then it should be psychiatric care in the patients’ place of residence - accessible, complete, allowing mentally ill people to be treated and receive serious support. With this type of care, hospitals are not needed and the medical approach should be used only to a minor extent. In other words, the psychiatrist should be a valuable consultant to the service, but not necessarily its master or ruler.”

          Brief historical background

          In the history of rehabilitation of mentally ill patients, a number of important moments can be identified that played a significant role in its development.

          1. The era of moral therapy. This rehabilitative approach, which developed in the late 18th and early 19th centuries, was to provide more humane care to the mentally ill. The basic principles of this psychosocial impact remain relevant to this day.

          2. Introduction of labor (professional) rehabilitation. In Russia, this approach to the treatment of mentally ill people began to be introduced in the first third of the 19th century and is associated with the activities of V.F. Sablera, S.S. Korsakov and other progressive psychiatrists. For example, as noted by Yu.V. Kannabikh, among the important transformations carried out by V.F. Sabler in 1828 at the Preobrazhenskaya Hospital in Moscow, include “... arrangement of gardening and handicraft work.”

          Occupational therapy as a direction of modern domestic psychiatry began to be given Special attention, starting from the 50s of the last century. There was a network of therapeutic labor workshops and special workshops where mentally ill people who were on inpatient and outpatient treatment. With the beginning of socio-economic reforms in the 90s of the last century, about 60% of institutions involved in labor rehabilitation (medical and industrial workshops, specialized workshops at industrial enterprises, etc.) were forced to cease their activities. However, even today, employment and occupational therapy are the most important components in psychosocial rehabilitation programs.

          3. Development of community psychiatry. Shifting the focus of mental health care to out-of-hospital services and realizing that the patient could be treated close to family and work was of great importance for the recovery of the sick person.

          In the 30s of the last century, psychoneurological dispensaries began to open in our country and semi-stationary forms of assistance were created, which had enormous rehabilitation significance.

          In the 50-60s, psychiatric offices 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.) during this period, organizations of aid consumers and support groups began to be actively created.

          The development of community psychiatry also involves the active identification of people in need of psychiatric care for early treatment and combating the consequences in the form of disability and social disadvantage.

          4. The emergence of psychosocial rehabilitation centers. Their discovery began in the 80s of the twentieth century. The first centers (clubs) were created by the patients themselves (for example, Clubhouse in the USA), and their activities are aimed at helping patients cope with the problems of everyday life and develop the ability to function even with disabilities. Therefore, at first in such centers the emphasis was placed on activities that would help patients cope with life’s difficulties, not succumb to them, as well as on improving health, and not on getting rid of the symptoms of mental illness. Psychosocial rehabilitation centers have played a huge role in the development of such an area of ​​knowledge as the 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, similar centers (institutions) began to be created in the mid-90s of the twentieth century, but so far there are clearly not enough of them. As a rule, these are non-governmental institutions. An example is the Club House in Moscow, which existed until 2001. Currently, rehabilitation centers operating in our country specialize in a specific area - art therapy, corrective interventions, leisure, psychotherapy, etc.

          5. Developing the skills necessary to overcome life's difficulties. The emergence of this direction is due to the fact that for effective solution problems arising, people suffering from serious mental disorders require certain knowledge, skills and abilities. The development of skills and abilities is based on methods developed taking into account the principles of social learning. In this case, methods of active-directive teaching are used - behavioral exercises and role-playing games, sequential formation of elements of behavior, mentoring, prompting, and also generalization of acquired skills is carried out. It has been proven that the development of skills and abilities develops the ability for independent living in people with severe mental disorders.

          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 currently in our country, along with complex treatment, including drug and occupational therapy, physiotherapy, cultural, educational and leisure activities, the following types of psychosocial interventions have been developed within the framework of psychosocial rehabilitation :

          · educational programs in psychiatry for patients;
          · educational programs in psychiatry for relatives of patients;
          · trainings to develop skills for daily independent living - training in cooking, shopping, drawing up a family budget, managing household, use of transport, etc.;
          · trainings on the development of social skills - socially acceptable and confident behavior, communication, solving everyday problems, etc.;
          · trainings to develop mental state management skills;
          · self- and mutual-help groups of patients and their relatives, public organizations of consumers of mental health care;
          · cognitive behavioral therapy aimed at improving memory, attention, speech, behavior;
          · family therapy, other types of individual and group psychotherapy.

          Comprehensive psychosocial rehabilitation programs are provided in many regional mental health services, both institutionally and in the community. Let's give just a few examples.

          In Tver, on the basis of the regional psychoneurological dispensary, a food shop has been opened, where mentally ill people work and the products are sold through a regular retail chain. In addition, in the same dispensary there is a ceramic workshop and a fabric painting workshop, where people suffering from mental illness successfully work. All products of these enterprises are in demand among the population.

          At the Tambov Regional Psychiatric Hospital, the department of psychosocial rehabilitation conducts the following programs: educational in the field of psychiatry, art therapy, leisure, therapy for holidays, including personal ones (patients’ birthdays, etc.). The hospital has opened a “Home with Support”, where patients who have been hospitalized for a long time, after being discharged from it, receive independent living skills and only then return home. In the community, with the participation of professionals, the theater “We” was opened, in which patients, their relatives, and students of the theater school perform.

          Important rehabilitation work is carried out in many psychiatric hospitals in Moscow. For example, in hospitals No. 1, 10 and 14, art studios are open for patients, occupational therapy is used, educational programs on psychiatry are implemented for patients and their relatives, and trainings are organized to develop social skills and independent living skills.

          In the Sverdlovsk region, interdepartmental cooperation teams have been created, which include employees of medical, educational, professional institutions, employment authorities and social protection institutions, which makes it possible to comprehensively solve the problems of mentally ill people and provides a multifaceted approach to their rehabilitation.

          Questions about rehabilitation,
          which are most often asked by patients’ relatives

          Very often relatives of mentally ill people ask us: When can rehabilitation activities begin? Rehabilitation in patients with mental disorders, as well as in somatic diseases, is recommended to begin when the condition has stabilized and weakened. pathological manifestations. For example, rehabilitation of a patient with schizophrenia should begin when the severity of symptoms such as delusions, hallucinations, thinking disorders, etc. decreases. But even if the symptoms of the disease remain, rehabilitation can be carried out within the limits of the patient’s ability to learn and respond to psychosocial interventions. All this is necessary to increase functional potential (functional capabilities) and reduce the level of social disability.

          Another question: What is meant by social impairment and decreased functional abilities of the patient? A sign of social insufficiency is, for example, lack of work. For mentally ill people, unemployment rates reach 70% or higher. It's connected with a decrease in their functionality due to the presence of psychopathological symptoms and impaired cognitive (cognitive) functions. Signs of decreased functionality include low physical endurance and work tolerance, difficulty following instructions and working with other people, difficulty concentrating, solving problems, as well as the inability to adequately respond to comments and seek help.

          The social deficiency of mentally ill people also includes the phenomenon of homelessness.

          Unfortunately, our society is not yet able to completely solve the problems of employment and housing for patients with severe mental disorders and thereby reduce their social insufficiency. At the same time, psychosocial rehabilitation programs improve the patient’s competence, give him the opportunity to acquire skills for overcoming stress in traumatic situations and the difficulties of everyday life, skills for solving personal problems, self-care, and professional skills, which ultimately helps to increase functional potential and reduce social disability .

          Which specialists deal with psychosocial rehabilitation? Patients and their families should be aware that psychosocial rehabilitation is provided 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 rehabilitation therapist is complex, lengthy, and creative. It is based on the following principles:

          · optimism about achieving results;
          · confidence that even a slight improvement can lead to positive changes and improve the patient’s quality of life;
          · the conviction that motivation to change one’s situation can arise not only due to special rehabilitation measures in relation to the patient, but also due to his own efforts.

          What else, besides developing useful skills, can help a patient restore functionality?

          At the beginning of the lecture we talked about integrated approach to rehabilitation. Let us once again list the aspects that are important for a person suffering from a severe mental illness:

          · improvement of family relationships;
          · labor activity, including transitional (intermediate) employment;
          · expanding communication opportunities, which is achieved by participating in club activities and other special programs;
          · socio-economic support;
          · decent housing, including its protected forms.

          What can the family do for the psychosocial rehabilitation of the patient?

          The important role of the family in the psychosocial rehabilitation of a patient with severe mental illness has now been proven. This involves it performing different functions. First of all, it should be said that patients' relatives must be considered as allies in treatment. Not only do they have to learn a lot, but they themselves often have 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 knowledgeable than specialists about certain aspects of his disease. Often the family acts as a link between the patient and the mental health care system. Relatives help other families whose lives have been affected by mental illness, providing advice and sharing their own experience in solving problems. All this allows us to say that relatives of patients are both teachers and educators for other families and even professionals.

          The most important function of loved ones is to care for a sick person. Relatives should take into account that patients with schizophrenia feel best if there is a certain order, rules and constant responsibilities in the house for each family member. We must try to establish a regimen that suits the patient’s capabilities. Relatives can help patients instill the skills of personal hygiene, careful dressing, regular and careful eating, as well as in taking medications correctly and monitoring the side effects of medications. Over time, you can entrust the patient with some work around the house (washing dishes, cleaning the apartment, caring for flowers, taking care of pets, etc.) and outside the home (shopping in a store, going to the laundry, dry cleaning, etc.).

          Family participation in mental health 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. Let us remind you once again that knowledge of the basics of psychiatry and psychopharmacology, the ability to understand the symptoms of the disease, and mastering the skills of communicating 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 improve legislation regarding people with mental illness and their families. However, for this, relatives must act together in an organized manner: create support groups and organizations of help consumers. In this case, they will not only gain the support of people facing similar problems, but will also become a force to be reckoned with by both professionals and government agencies responsible for providing quality mental health and social care.

          In addition, working in a team, relatives of patients can themselves conduct psychosocial rehabilitation programs - leisure, holiday therapy, educational programs for the population in order to reduce stigmatization and discrimination of patients, and by teaming up 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 and public organizations that provide 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 public forms of assistance to the psychosocial rehabilitation of patients and their families.

          Public forms of assistance

          Goals and objectives of public organizations

          Consumers of mental health care—patients and members of their families—have long been perceived as passive participants in the process of providing care. What types of help the patient needed were determined by professionals, without recognizing the needs and own desires of the patients and their relatives in treatment. In recent decades, the situation has changed, which is associated with the development of the movement of consumers of medical and psychiatric care, and the creation of public organizations by them.

          For a long time now, in many countries, the significance of the contribution of the social movement to the development of psychiatric services and 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, famous American doctors, members of the public to push for better treatment and care for the mentally ill. As a result, such joint activities in 1909 the National Committee of Mental Hygiene was formed.

          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 care consumers, including national ones. For example, the World Fellowship for Schizophrenia and Allied Disorders has made significant progress in bringing patients and their families together.

          In Russia, until 1917, there were public forms of care for the mentally ill, the main tasks of which included attracting the population to provide 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 care centers were created shelters, shelters, free canteens were opened for the disadvantaged, and patronage forms of serving the mentally ill were organized.

          IN modern Russia The activities of public organizations of mental health consumers 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, an all-Russian public organization of people with disabilities due to mental disorders and their relatives “New Opportunities” was created, the main goal of which is to provide practical assistance to such people with disabilities and improve their position in society. Today, within the framework of this organization there are more than 50 regional branches, 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 - 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 for mentally ill people 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 mentally ill people and their relatives.

          Public organizations also provide the opportunity to communicate, exchange experiences, and develop a sense of belonging: 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- and mutual support groups;
          · conducting group developmental work with patients of different ages, leisure programs;
          · organization of painting workshops, decorative and applied arts, theater studios, summer recreation camps;
          · Conducting training seminars for relatives, as well as for specialists working with mentally ill people.

          Many organizations have developed interesting methods and accumulated a wealth of work experience.

          International experience shows that in a number of countries the consumer movement has significantly influenced mental health policies. In particular, the employment of people with mental health disorders in the traditional mental health system, as well as in other social services, has increased. For example, in the Ministry of Health of the Province of British Columbia (Canada), for the position of director of alternative treatment a person with a mental disorder has been appointed and can now have a significant impact on mental health policy and services.

          Protecting the rights of the mentally ill is an important task for 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 during 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.” This article of the law itself and the commentary to it note the importance of the activities of public associations for both patients and psychiatric institutions, define the obligation of the administration of these institutions to assist representatives of public organizations, provide them with the necessary information, and note the right of public organizations to appeal in court the actions of individuals who violated the rights and legitimate interests of citizens when providing them with psychiatric care. The right of representatives of public associations to be included in various councils, commissions of psychiatric institutions, health authorities created to monitor the quality of care for the mentally ill, the conditions of their detention, and improve the forms of work of psychiatric services has been introduced. The importance of joint activities of public organizations and state psychiatric institutions to attract the attention of the media, health authorities, government circles and society as a whole to modern problems psychiatry, changing the negative image of mentally ill people and psychiatric institutions.

          As the movement of help consumers intensifies, the human rights function should be developed in terms of lobbying the interests of mentally ill people and members of their families among legislators, politicians, and public figures, and work with them should be constant.

          Another aspect of the advocacy work of public consumer organizations may be related to the protection of psychiatric institutions themselves when, for example, they are threatened with funding cuts.

          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 vital role in the formation of such organizations.

          Subsequently, professionals should assist the organization in developing its activities - constantly advising its leaders or support groups on issues of education in the field of psychiatry, including legal aspects.

          Professionals can also help create strategic plans for an organization. Extremely useful assistance from professionals to public consumer organizations can be the publication of newspapers, booklets, and manuals for families of mentally ill people.

          Thus, the development of a social movement of consumers of mental health care is becoming an important link in the modern system of mental health care, capable of meeting many of the needs of mentally ill people, their position in society, reducing the burden of the disease, and improving the quality of life of patients and their family members.

          Activities of a public organization
          "Family and Mental Health"

          All authors of this manual are members of the public organization Center for Socio-Psychological and Information Support “Family and Mental Health”, which received legal status on June 6, 2002. The initiators of its creation are employees of the department of organization of psychiatric services of the Scientific Center for Mental Health of the Russian Academy of Medical Sciences and parents patients suffering from mental disorders.

          In 1996, the first socio-psychological school in Moscow was opened to support families of mentally ill people, which formed the basis of our future organization. Thus, official registration was preceded by a six-year period of activity, during which accumulated great experience work in the field of psychosocial rehabilitation of people with mental disorders and their relatives.

          Our members now include not only mental health professionals, but also people with mental health problems, their families and friends.

          The social movement draws the attention of the authorities to the most pressing problems and forces 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 illness and members of their families, and stimulates them to search for ways to improve their position in society.

          Why did we name our organization “Family and Mental Health”?
          This name reflects two fundamental values ​​of our lives - family and mental health.

          Mental health has great importance for the well-being of individuals, societies and countries. It is inseparable from physical health and has a huge impact on the cultural, intellectual, creative, productive and defense potential of any nation. The role of family in the life of a person suffering from a mental disorder is enormous. The family encounters mental illness before the doctor – in the most early stage, and may promote or counteract its early recognition and effective treatment.

          The family provides the sick person with care and emotional support that professionals often cannot provide.

          Good relationships between family members are the key to favorable conditions for recovery, rehabilitation and compliance with medical recommendations.

          In a family, each member is influenced by others and, in turn, influences them. If something is not going well in the family, it can interfere with its normal functioning. Therefore, one of the main tasks that we set for ourselves is socio-psychological and informational support for 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, not only people who have mental health problems, but also their families, friends, as well as doctors, teachers and psychologists, musicians and artists can become members of our organization. Our understanding of the family is not limited to the immediate environment of the patient - it also includes those who care about the fate of people with mental health problems.

          The purpose of our organization and – improving the quality of life of families with mental health problems by overcoming their social alienation, involving them in the life of society, and developing an active civic and life position.

          Main activities of the organization

          1. Social-psychological and informational support.
          2. Psychiatric education.
          3. Psychosocial rehabilitation.
          4. Conducting programs to reduce social stigma and discrimination against people with mental disorders and members of their families.
          5. Participation in the development of a social movement in psychiatry.
          6. Publication of popular scientific literature on problems of psychiatry and mental health.
          7. Conducting conferences and seminars on mental health issues for professionals and consumers of mental health care.

          Our organization conducts the following programs.

          1. For patients with mental health problems:

          · trainings to develop communication skills. The goal is to develop and improve communication skills and confident behavior in everyday life;

          · educational program in psychiatry. The goal is to provide knowledge in the field of psychiatry, training in timely recognition of painful manifestations and monitoring them, awareness of the need for early seeking help;

          · social skills training. The goal is to develop skills for independent living in society, including self-care, home economics, and daily living skills;

          · art therapy. The goal is personality development, activation of imagination and creativity;

          · group-analytical psychotherapy. The goal is to develop self-confidence, master the skills of living harmoniously with other people, and increase resistance to stress.

          The Family and Mental Health Center has an art studio, an arts and crafts workshop, and a music studio. Treatment and advisory assistance is provided 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 in social competence.

          2. For relatives of patients:

          · psychiatric education program. The goal is information support, the formation of partnerships with medical personnel. Knowledge about mental illnesses and their treatment is provided, the peculiarities of communication with a mentally ill family member are discussed, as well as familiarization with the modern system of psychiatric, social and legal assistance;
          · group-analytical psychotherapy. The goal is to develop skills in solving family problems, reduce stress associated with a family member having a mental illness, identify one’s own needs, and increase life satisfaction. Classes are conducted by experienced psychotherapists and psychologists;

          · psychological counseling (individual and family). The goal is to improve the psychological state of relatives and provide them with emotional support.

          3. For the family as a whole:

          · leisure program. The goal is to improve leisure time and harmonize family relationships. Festive concerts and themed musical evenings are regularly held, which traditionally end with a family tea party. All members of the organization take an active part in the preparation and implementation of the program.
          · educational program “Moscow Studies on Saturdays”. The goal is personal development, improvement of leisure and recreation. The program includes visits to museums, exhibition halls, and excursions around Moscow.

          Concluding the lecture on issues of psychosocial rehabilitation, it is necessary to once again emphasize the invaluable contribution of this area to the recovery of mentally ill people, the activation of their civic and life positions, as well as to improving the quality of life of their family members.

          Quote "Mental health: new understanding, new hope": a report on the state of global health. WHO, 2001.

          More

In tertiary psychoprophylaxis The social rehabilitation of patients is of primary importance.

An important role in the development of psychoprophylaxis is played by improving the structure and increasing the number of various psychiatric, psychotherapeutic and psychological institutions, especially those close to the population (day hospitals, night clinics, psychoneurological and psychotherapeutic offices at clinics, crisis centers, psychological services by telephone, etc.) , as well as improving methods of diagnosis and treatment of patients with initial, light forms mental disorders.

Rehabilitation is a system of state, socio-economic, medical, professional, pedagogical, psychological and other measures aimed at preventing the development pathological processes, leading to temporary or permanent loss of ability to work, to the effective and early return of sick and disabled people (children and adults) to society and to socially useful work. Rehabilitation is a complex process, as a result of which the patient develops an active attitude towards the impairment of his health and restores a positive perception of life, family and society. Rehabilitation includes prevention, treatment, adaptation to life and work after illness, and above all, a personal approach to the sick person.

Currently, it is customary to distinguish between medical, professional and social rehabilitation. For mental illnesses, rehabilitation has its own characteristics, primarily related to the fact that with them, like no other illnesses, serious disturbances occur in the personality, its social connections and relationships, loss of social skills, including due to a long stay in the clinic and hospitalism developing in patients. Rehabilitation of mentally ill people is understood as their resocialization, restoration or preservation of individual and social value, their personal and social status. The priority direction of the reforms carried out in foreign psychiatry in recent years, the active implementation of which is being prepared in our country, has been the transition from an exclusively medical model of care to a biopsychosocial model.

Abroad, the problem of resocialization of mentally ill people became acute in the late 1970s and early 1980s, when, under the influence of the antipsychiatric movement, a huge number of patients were discharged and psychiatric hospitals were closed. Discharged patients, 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, financial support, and training for lost labor and communication skills.

With the close cooperation of psychiatric and social services, existing through government funding, public and charitable foundations, an extensive social rehabilitation system has been formed in many European countries, aimed at the gradual reintegration of mentally ill people into society. The objectives of the institutions included in it are to provide mentally ill people with a temporary place of residence, train and instill in them the skills necessary in everyday life, and improve their social and labor adaptability. For this purpose, special hostels and hotels were created in which patients not only live, are provided with psychiatric observation, but also receive assistance in professional and labor adaptation. The employment of patients in normal production conditions, but with constant supervision by psychiatrists and social workers, is becoming increasingly common. Unfortunately, this form largely depends on employers.

Reform of the organization of psychiatric care in no way means an immediate reduction in the bed capacity of psychiatric hospitals. But in the future this is inevitable. An alternative to specialized psychiatric hospitals may be the creation of short-stay units for acute psychotic patients within the structure of large multidisciplinary hospitals. World experience shows that moving patients with mental disorders outside the walls of psychiatric institutions helps not only to reduce cases of hospitalization, but also their social adaptation. This will improve the quality of examination and treatment. The maintenance of people with mental disorders in the new conditions will not differ from other contingents, their social rejection due to stigmatization will decrease. In connection with the specialization of city multidisciplinary hospitals, it seems possible to expand the network of specialized psychosomatic and somatopsychiatric departments.

The main link should be the outpatient service. According to V.Syastrebov, a significant part of the currently hospitalized patients (up to 40%) could do without hospitalization. In recent years, due to the general deterioration of the economic situation, the closure of some state-owned enterprises and the emergence of unemployment, the rehabilitation of mentally ill people has also become a difficult task. Rehabilitation institutions previously provided by the state - medical and labor workshops, artels and industries where disabled people could work - have fallen into disrepair. Due to insufficient material resources, vocational training programs for the mentally retarded in auxiliary schools and boarding schools are being curtailed, and the vocational schools that accepted their graduates are closing.

Under the current conditions, the need has emerged to find new ways to organize social and labor adaptation for the mentally ill and mentally retarded. In modern socio-economic conditions, only the development of out-of-hospital care can help achieve the main goal - the true rehabilitation of patients, their adaptation to difficult living conditions. At the same time, not only the strategy, but also the tactics of providing assistance change. There is a need for a transition from a predominantly medical model to a multiprofessional model - a team method), when specialists from different fields work with the patient at the same time. This is a psychiatrist, psychotherapist, psychologist, psychiatric nurse, social worker, activation therapist, etc. Only in this case there is an integrated approach to treating the patient, which takes into account all his problems - medical, social, psychological, etc.

Modern trends in the treatment of mentally ill people are focused on restoring their individual and social status through rehabilitation measures. Rehabilitation is aimed at early and effective treatment, disability prevention, timely and effective return sick and disabled people into public life and work and restoration of their autonomy. Restoring social connections lost during illness is of great importance. This is possible thanks to the use of current legislation, the implementation of comprehensive measures of a medical, socio-economic, psychological, pedagogical, and legal nature.

Forms and methods of rehabilitation are varied. These include differentiated treatment regimens, occupational and psychotherapy, physical therapy, cultural and mystical therapy (art therapy), special methods of social activation of patients (self-organization, self-service, training, social skills), career guidance, individual and collective forms of patronage, etc. Rehabilitation measures should be started as early as possible (after relief of the acute psychotic state).

In international practice, there are three stages of rehabilitation: medical, professional, social. There is no clear boundary between them, but at each stage specific tasks must be solved, the purpose of which is to restore the individual and eliminate social maladjustment. At the medical stage of rehabilitation, they try to eliminate productive psychopathological symptoms and prevent the development of hospitalism (the so-called hospital dementia), disability and social failure. The professional stage involves consolidating what has been achieved therapeutic effect and restoration of ability to work and social connections. The method of the social stage of rehabilitation is aimed at maximizing the restoration of the patient’s social status and ensuring social adaptation and employment.

It is impossible to solve these problems without a clear individual comprehensive program of psychiatric rehabilitation adopted for a psychiatric institution, city, district, region. It needs to take into account the patient population, socio-economic and demographic factors, the structure and functions of psychiatric institutions, employment, relevant legislation, and the employment opportunities of local authorities.

To implement such a program, special units are created in the management bodies of psychiatric institutions, which must ensure the analysis of information, coordination and control over its implementation.

In carrying out rehabilitation, the main role belongs to the doctor, so when developing a rehabilitation program, he must take into account the individuality, profession and interests of the patient, the characteristics of the course of the disease, clinical and social-labor prognosis, and the like.

The effectiveness of rehabilitation is assessed according to clinical-psychological, social-labor and socio-economic criteria. It is important to cover indicators of recovery of working capacity, the structure of disability, indications for rehospitalization, efficiency of use of hospital beds, employment of patients, etc.

Rehabilitation in psychiatry

Rehabilitation is a set of measures aimed at full or partial restoration of the personality of a sick person, his social and labor status.

In contrast to treatment aimed at eliminating and reducing the manifestations of the disease, rehabilitation is aimed at strengthening, strengthening, and growing healthy aspects of the patient’s personality, compensating for mental functions lost during illness at the expense of its intact part. Rehabilitation is described as “an intervention that attempts to discover and develop the capabilities of patients - as opposed to treatment that directly addresses the failure of patients” (Martin (1959). Thus, rehabilitation is a wonderful complement and completion of drug and psychotherapeutic treatment.

The basic principles of rehabilitation originated in ancient times; even ancient Greek and Roman doctors suggested walking, rhetoric exercises, caring for plants, etc. as healing methods. Subsequently, the medieval perception of madness not so much as a mental illness, but as obsession, a kind of mental “perversion,” placed him under lock and key, depriving him of any hope of cure. However, the placement of mentally ill people in monasteries often provided them with a kind of “rehabilitative” way of life: a measured, clearly scheduled regime, physical work etc. The era of enlightenment brought a new assessment of mental illness - the concept of insanity arose as a consequence of an incorrect, immoral lifestyle. Accordingly, treatment begins to use such methods as limiting unwanted contacts, strict regimen, reading properly selected literature, and physical labor. Later, the concepts of degeneration and moral insanity helped to consolidate the view of mental illness as manifestations of “immorality”, “lack of will”, “weakness”. To some extent, this point of view continues today; many of our patients hear the same advice from friends and relatives: “Pull yourself together,” “Get this nonsense out of your head,” “Stop being idle and everything will pass,” etc. . However, all these methods, while outwardly resembling some rehabilitation measures, had a completely different focus: not the restoration of lost functions and adaptation due to the intact aspects of the psyche, but some kind of “re-education” of the patient.

Modern rehabilitation does not aim to “educate the patient” or treat him. She taps into the remaining parts of the psyche 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 disposition to comply with doctor’s recommendations and continue treatment (including with the help of psychoeducational programs).

· Vocational rehabilitation – restoration of working capacity.

· Social rehabilitation – restoration of the patient’s individual and social value, his self-esteem, relationships with the environment, the fight against stigmatization.

Psychoeducation 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.

Rehabilitation of mentally ill patients federal program

Psychosocial rehabilitation: a modern approach

Definition of the concept of “psychosocial rehabilitation”,

The World Health Organization report on mental health (2001) states: “Psychosocial rehabilitation is a process that enables people who are frail or disabled as a result of mental disorders to achieve their optimal level of independent functioning in society.

To this definition we add that this is a constant, continuous process that includes a complex of medical, psychological, pedagogical, socio-economic and professional measures.

Psychosocial rehabilitation interventions vary depending on the needs of patients, the location where rehabilitation interventions are provided (hospital or community), and the cultural and socioeconomic conditions of the country in which mentally ill people live. But the basis of these events, as a rule, consists of:

· vocational training and retraining;

· providing decent living conditions;

· mental health education, including training on how to manage painful symptoms;

· acquisition and restoration of communication skills;

· acquisition of independent living skills;

· realization of hobbies and leisure, spiritual needs.

Thus, even from an incomplete list of the listed activities it is clear that psychosocial rehabilitation of mentally ill people is a comprehensive process aimed at the restoration and development of various 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 methods of its implementation. However, all scientists and practitioners agree that the result of rehabilitation measures should be the reintegration (return) of mentally ill people into society. At the same time, patients themselves should feel no less full citizens than other groups of the population. With this in mind, the goal of rehabilitation can be defined as follows: it is improving the quality of life and social functioning of people with mental disorders by overcoming their social alienation, as well as increasing their active life and civic position.

The Statement on Psychosocial Rehabilitation, developed by the World Health Organization jointly with the World Association for Psychosocial Rehabilitation in 1996, lists the following goals for rehabilitation:

· reducing the severity of psychopathological symptoms using the triad - medications, psychotherapeutic treatments 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 activity;

· reducing discrimination and stigma;

· support for families in which someone suffers from 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, organization of leisure, creation of a social network (social circle);

· increasing the autonomy (independence) of mentally ill people, improving their self-sufficiency and self-defense.

Brief historical background

In the history of rehabilitation of mentally ill patients, a number of important moments can be identified that played a significant role in its development.

1. The era of moral therapy. This rehabilitative approach, which developed in the late 18th and early 19th centuries, was to provide more humane care to the mentally ill. The basic principles of this psychosocial impact remain relevant to this day.

2. Introduction of labor (professional) rehabilitation. In Russia, this approach to the treatment of mentally ill people began to be introduced in the first third of the 19th century and is associated with the activities of V.F. Sablera, S.S. Korsakov and other progressive psychiatrists. For example, as noted by Yu.V. Kannabikh, among the important transformations carried out by V.F. Sabler in 1828 at the Preobrazhenskaya Hospital in Moscow, include “... arrangement of gardening and handicraft work.”

Occupational therapy as a direction of modern domestic psychiatry began to receive special attention starting from the 50s of the last century. There was a network of therapeutic labor workshops and special workshops where mentally ill people undergoing 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 and industrial workshops, specialized workshops at industrial enterprises, etc.) were forced to cease their activities. However, even today, employment and occupational therapy are the most important components in psychosocial rehabilitation programs.

3. Development of community psychiatry. Shifting the focus of mental health care to out-of-hospital services and realizing that the patient could be treated close to family and work was of great importance for the recovery of the sick person.

In the 30s of the last century, psychoneurological dispensaries began to open in our country and semi-stationary forms of assistance were created, which had enormous rehabilitation significance.

In the years, psychiatric offices in clinics, central district hospitals and other institutions of the general medical network, industrial enterprises, educational institutions, day and night semi-hospital hospitals, as well as other forms of assistance aimed at meeting the needs of the mentally ill have received widespread development.

In foreign countries (Great Britain, Japan, Canada, etc.) during this period, organizations of aid consumers and support groups began to be actively created.

The development of community psychiatry also involves the active identification of people in need of psychiatric care for early treatment and combating the consequences in the form of disability and social disadvantage.

4. The emergence of psychosocial rehabilitation centers. Their discovery began in the 80s of the twentieth century. The first centers (clubs) were created by the patients themselves (for example, Clubhouse in the USA), and their activities are aimed at helping patients cope with the problems of everyday life and develop the ability to function even with disabilities. Therefore, at first in such centers the emphasis was placed on activities that would help patients cope with life’s difficulties, not succumb to them, as well as on improving health, and not on getting rid of the symptoms of mental illness. Psychosocial rehabilitation centers have played a huge role in the development of such an area of ​​knowledge as the 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, similar centers (institutions) began to be created in the mid-90s of the twentieth century, but so far there are clearly not enough of them. As a rule, these are non-governmental institutions. An example is the Club House in Moscow, which existed until 2001. Currently, rehabilitation centers operating in our country specialize in a specific area - art therapy, corrective interventions, leisure, psychotherapy, etc.

5. Developing the skills necessary to overcome life's difficulties. The emergence of this direction is due to the fact that in order to effectively solve emerging problems, people suffering from serious mental disorders need certain knowledge, skills, and abilities. The development of skills and abilities is based on methods developed taking into account the principles of social learning. In this case, methods of active-directive teaching are used - behavioral exercises and role-playing games, sequential formation of elements of behavior, mentoring, prompting, and also generalization of acquired skills is carried out. It has been proven that the development of skills and abilities develops the ability for independent living in people with severe mental disorders.

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 currently in our country, along with complex treatment, including drug and occupational therapy, physiotherapy, cultural, educational and leisure activities, the following types of psychosocial interventions have been developed within the framework of psychosocial rehabilitation :

· educational programs in psychiatry for patients;

· educational programs in psychiatry for relatives of patients;

· trainings to develop daily independent living skills - training in cooking, shopping, drawing up a family budget, housekeeping, using transport, etc.;

· trainings on the development of social skills - socially acceptable and confident behavior, communication, solving everyday problems, etc.;

· trainings to develop mental state management skills;

· self- and mutual-help groups of patients and their relatives, public organizations of consumers of mental health care;

· cognitive behavioral therapy aimed at improving memory, attention, speech, behavior;

· family therapy, other types of individual and group psychotherapy.

Comprehensive psychosocial rehabilitation programs are provided in many regional mental health services, both institutionally and in the community. Let's give just a few examples.

In Tver, on the basis of the regional psychoneurological dispensary, a food shop has been opened, where mentally ill people work and the products are sold through a regular retail chain. In addition, in the same dispensary there is a ceramic workshop and a fabric painting workshop, where people suffering from mental illness successfully work. All products of these enterprises are in demand among the population.

At the Tambov Regional Psychiatric Hospital, the department of psychosocial rehabilitation conducts the following programs: educational in the field of psychiatry, art therapy, leisure, therapy for holidays, including personal ones (patients’ birthdays, etc.). The hospital has opened a “Home with Support”, where patients who have been hospitalized for a long time, after being discharged from it, receive independent living skills and only then return home. In the community, with the participation of professionals, the theater “We” was opened, in which patients, their relatives, and students of the theater school perform.

Important rehabilitation work is carried out in many psychiatric hospitals in Moscow. For example, in hospitals No. 1, 10 and 14, art studios are open for patients, occupational therapy is used, educational programs on psychiatry are implemented for patients and their relatives, and trainings are organized to develop social skills and independent living skills.

In the Sverdlovsk region, interdepartmental cooperation teams have been created, which include employees of medical, educational, professional institutions, employment authorities and social protection institutions, which makes it possible to comprehensively solve the problems of mentally ill people and provides a multifaceted approach to their rehabilitation.

which are most often asked by patients’ relatives

Very often, relatives of mentally ill people ask us: when can rehabilitation activities begin? Rehabilitation for patients with mental disorders, as well as for somatic diseases, is recommended to begin when the condition has stabilized and the pathological manifestations have weakened. For example, rehabilitation of a patient with schizophrenia should begin when the severity of symptoms such as delusions, hallucinations, thinking disorders, etc. decreases. But even if the symptoms of the disease remain, rehabilitation can be carried out within the limits of the patient’s ability to learn and respond to psychosocial interventions. All this is necessary to increase functional potential (functional capabilities) and reduce the level of social disability.

Another question: what is meant by social impairment and decreased functional capabilities of the patient? A sign of social insufficiency is, for example, lack of work. For mentally ill people, unemployment rates reach 70% or higher. This is due to a decrease in their functional capabilities due to the presence of psychopathological symptoms and impaired cognitive (cognitive) functions. Signs of decreased functionality include low physical endurance and work tolerance, difficulty following instructions and working with other people, difficulty concentrating, solving problems, as well as the inability to adequately respond to comments and seek help.

The social deficiency of mentally ill people also includes the phenomenon of homelessness.

Unfortunately, our society is not yet able to completely solve the problems of employment and housing for patients with severe mental disorders and thereby reduce their social insufficiency. At the same time, psychosocial rehabilitation programs improve the patient’s competence, give him the opportunity to acquire skills for overcoming stress in traumatic situations and the difficulties of everyday life, skills for solving personal problems, self-care, and professional skills, which ultimately helps to increase functional potential and reduce social disability .

Which specialists deal with psychosocial rehabilitation? Patients and their families should be aware that psychosocial rehabilitation is provided 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?

· optimism about achieving results;

· confidence that even a slight improvement can lead to positive changes and improve the patient’s quality of life;

· the conviction that motivation to change one’s situation can arise not only due to special rehabilitation measures in relation to the patient, but also due to his own efforts.

What else, besides developing useful skills, can help a patient restore functionality?

At the beginning of the lecture we talked about an integrated approach to rehabilitation. Let us once again list the aspects that are important for a person suffering from a severe mental illness:

· improvement of family relationships;

· labor activity, including transitional (intermediate) employment;

· expanding communication opportunities, which is achieved by participating in club activities and other special programs;

· decent housing, including its protected forms.

What can the family do for the psychosocial rehabilitation of the patient?

The important role of the family in the psychosocial rehabilitation of a patient with severe mental illness has now been proven. This involves it performing different functions. First of all, it should be said that patients' relatives must be considered as allies in treatment. Not only do they have to learn a lot, but they themselves often have 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 knowledgeable than specialists about certain aspects of his disease. Often the family acts as a link between the patient and the mental health care system. Relatives help other families whose lives have been affected by mental illness, providing advice and sharing their own experience in solving problems. All this allows us to say that relatives of patients are both teachers and educators for other families and even professionals.

The most important function of loved ones is to care for a sick person. Relatives should take into account that patients with schizophrenia feel best if there is a certain order, rules and constant responsibilities in the house for each family member. We must try to establish a regimen that suits the patient’s capabilities. Relatives can help patients instill the skills of personal hygiene, careful dressing, regular and careful eating, as well as in taking medications correctly and monitoring the side effects of medications. Over time, you can entrust the patient with some work around the house (washing dishes, cleaning the apartment, caring for flowers, taking care of pets, etc.) and outside the home (shopping in a store, going to the laundry, dry cleaning, etc.).

Family participation in mental health 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. Let us remind you once again that knowledge of the basics of psychiatry and psychopharmacology, the ability to understand the symptoms of the disease, and mastering the skills of communicating 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 improve legislation regarding people with mental illness and their families. However, for this, relatives must act together in an organized manner: create support groups and organizations of help consumers. In this case, they will not only gain the support of people facing similar problems, but will also become a force to be reckoned with by both professionals and government agencies responsible for providing quality mental health and social care.

In addition, working in a team, relatives of patients can themselves conduct psychosocial rehabilitation programs - leisure, holiday therapy, educational programs for the population in order to reduce stigmatization and discrimination of patients, and by teaming up 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 carry out 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 public forms of assistance to the psychosocial rehabilitation of patients and their families.

Public forms of assistance

Goals and objectives of public organizations

Consumers of mental health care—patients and members of their families—have long been perceived as passive participants in the process of providing care. What types of help the patient needed were determined by professionals, without recognizing the needs and own desires of the patients and their relatives in treatment. In recent decades, the situation has changed, which is associated with the development of the movement of consumers of medical and psychiatric care, and the creation of public organizations by them.

For a long time now, in many countries, the significance of the contribution of the social movement to the development of psychiatric services and 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, famous American doctors and representatives of the public united to achieve better conditions of treatment and care for the mentally ill. As a result of such joint activities, the National Committee for 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 care consumers, including national ones. For example, the World Fellowship for Schizophrenia and Allied Disorders has made significant progress in bringing patients and their families together.

In Russia, until 1917, there were public forms of care for the mentally ill, the main tasks of which included attracting the population to provide 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 care centers were created shelters, shelters, free canteens were opened for the disadvantaged, and patronage forms of serving the mentally ill were organized.

In modern Russia, the activities of public organizations of mental health consumers 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, an all-Russian public organization of people with disabilities due to mental disorders and their relatives “New Opportunities” was created, the main goal of which is to provide practical assistance to such people with disabilities and improve their position in society. Today, within the framework of this organization there are more than 50 regional branches, 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 - 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 for mentally ill people 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 mentally ill people and their relatives.

Public organizations also provide the opportunity to communicate, exchange experiences, and develop a sense of belonging: 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- and mutual support groups;

· conducting group developmental work with patients of different ages, leisure programs;

· organization of painting workshops, decorative and applied arts, theater studios, summer recreation camps;

· Conducting training seminars for relatives, as well as for specialists working with mentally ill people.

Many organizations have developed interesting methods and accumulated a wealth of work experience.

International experience shows that in a number of countries the consumer movement has significantly influenced mental health policies. In particular, the employment of people with mental health disorders in the traditional mental health system, as well as in other social services, has increased. For example, the Ministry of Health in British Columbia, Canada, appointed a person with a mental disorder to the position of Director of Alternative Treatment, who can now have a significant influence on mental health policy and related services.

Protecting the rights of the mentally ill is an important task for 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 during 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.” This article of the law itself and the commentary to it note the importance of the activities of public associations for both patients and psychiatric institutions, define the obligation of the administration of these institutions to assist representatives of public organizations, provide them with the necessary information, and note the right of public organizations to appeal in court the actions of individuals who violated the rights and legitimate interests of citizens when providing them with psychiatric care. The right of representatives of public associations to be included in various councils, commissions of psychiatric institutions, health authorities created to monitor the quality of care for the mentally ill, the conditions of their detention, and improve the forms of work of psychiatric services has been introduced. The importance of joint activities of public organizations and state psychiatric institutions is noted to attract the attention of the media, health authorities, government circles and society as a whole to modern problems of psychiatry, changing the negative image of the mentally ill and psychiatric institutions.

As the movement of help consumers intensifies, the human rights function should be developed in terms of lobbying the interests of mentally ill people and members of their families among legislators, politicians, and public figures, and work with them should be constant.

Another aspect of the advocacy work of public consumer organizations may be related to the protection of psychiatric institutions themselves when, for example, they are threatened with funding cuts.

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 vital role in the formation of such organizations.

Subsequently, professionals should assist the organization in developing its activities - constantly advising its leaders or support groups on issues of education in the field of psychiatry, including legal aspects.

Professionals can also help create strategic plans for an organization. Extremely useful assistance from professionals to public consumer organizations can be the publication of newspapers, booklets, and manuals for families of mentally ill people.

Thus, the development of a social movement of consumers of mental health care is becoming an important link in the modern system of mental health care, capable of meeting many of the needs of mentally ill people, their position in society, reducing the burden of the disease, and improving the quality of life of patients and their family members.

Activities of a public organization

All authors of this manual are members of the public organization Center for Socio-Psychological and Information Support “Family and Mental Health”, which received legal status on June 6, 2002. The initiators of its creation are employees of the department of organization of psychiatric services of the Scientific Center for Mental Health of the Russian Academy of Medical Sciences and parents patients suffering from mental disorders.

In 1996, the first socio-psychological school in Moscow was opened to support families of mentally ill people, which formed the basis of our future organization. Thus, official registration was preceded by a six-year period of activity, during which extensive experience in the field of psychosocial rehabilitation of people with mental disorders and their relatives was accumulated.

Our members now include not only mental health professionals, but also people with mental health problems, their families and friends.

The social movement draws the attention of the authorities to the most pressing problems and forces 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 illness and members of their families, and stimulates them to search for ways to improve their position in society.

Why did we name our organization “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, productive and defense potential of any nation. The role of family in the life of a person suffering from a mental disorder is enormous. The family encounters mental illness before the doctor - in the earliest stage, and can promote or counteract its early recognition and effective treatment.

The family provides the sick person with care and emotional support that professionals often cannot provide.

Good relationships between family members are the key to favorable conditions for recovery, rehabilitation and compliance with medical recommendations.

In a family, each member is influenced by others and, in turn, influences them. If something is not going well in the family, it can interfere with its normal functioning. Therefore, one of the main tasks that we set for ourselves is socio-psychological and informational support for 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, not only people who have mental health problems, but also their families, friends, as well as doctors, teachers and psychologists, musicians and artists can become members of our organization. Our understanding of the family is not limited to the immediate environment of the patient - it also includes those who care about the fate of people with mental health problems.

The goal of our organization is to improve the quality of life of families with mental health problems by overcoming their social alienation, involving them in the life of society, and developing an active civic and life position.

Main activities of the organization

1. Social-psychological and informational support.

2. Psychiatric education.

3. Psychosocial rehabilitation.

4. Conducting programs to reduce social stigma and discrimination against people with mental disorders and members of their families.

5. Participation in the development of a social movement in psychiatry.

6. Publication of popular scientific literature on problems of psychiatry and mental health.

7. Conducting conferences and seminars on mental health issues for professionals and consumers of mental health care.

Our organization conducts the following programs.

1. For patients with mental health problems:

· trainings to develop communication skills. The goal is to develop and improve communication skills and confident behavior in everyday life;

· educational program in psychiatry. The goal is to provide knowledge in the field of psychiatry, training in timely recognition of painful manifestations and monitoring them, awareness of the need for early seeking help;

· social skills training. The goal is to develop skills for independent living in society, including self-care, home economics, and daily living skills;

· art therapy. The goal is personality development, activation of imagination and creativity;

· group-analytical psychotherapy. The goal is to develop self-confidence, master the skills of living harmoniously with other people, and increase resistance to stress.

The Family and Mental Health Center has an art studio, an arts and crafts workshop, and a music studio. Treatment and advisory assistance is provided 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 in social competence.

2. For relatives of patients:

· psychiatric education program. The goal is information support, the formation of partnerships with medical personnel. Knowledge about mental illnesses and their treatment is provided, the peculiarities of communication with a mentally ill family member are discussed, as well as familiarization with the modern system of psychiatric, social and legal assistance;

· group-analytical psychotherapy. The goal is to develop skills in solving family problems, reduce stress associated with a family member having a mental illness, identify one’s own needs, and increase life satisfaction. Classes are conducted by experienced psychotherapists and psychologists;

· psychological counseling (individual and family). The goal is to improve the psychological state of relatives and provide them with emotional support.

· leisure program. The goal is to improve leisure time and harmonize family relationships. Festive concerts and themed musical evenings are regularly held, which traditionally end with a family tea party. All members of the organization take an active part in the preparation and implementation of the program.

· educational program “Moscow Studies on Saturdays”. The goal is personal development, improvement of leisure and recreation. The program includes visits to museums, exhibition halls, and excursions around Moscow.

Concluding the lecture on issues of psychosocial rehabilitation, it is necessary to once again emphasize the invaluable contribution of this area to the recovery of mentally ill people, the activation of their civic and life positions, as well as to improving the quality of life of their family members.

Quote "Mental health: new understanding, new hope": a report on the state of global health. WHO, 2001.

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1. Principles and stages of rehabilitation of mentally ill patients in psychiatry and narcology.

Rehabilitation (Latin rehabilitatio - restoration of rights) is a system of medical, psychological and social measures that prevent further development of the disease, loss of performance and aimed at the earliest and most effective return of sick and disabled people to socially useful work and active social life.

The most important task of rehabilitation is to restore the personal (in one’s own eyes) and social (in the eyes of others) status of the patient - family, work, social.

M.M. Kabanov (1978) identified the basic principles and stages of rehabilitation of mentally ill patients.

The principle of partnership implies a constant appeal to the patient’s personality, joint and coordinated efforts of the doctor and the patient in setting tasks and choosing ways to solve them. The principle of versatility of influences indicates the need to use a system of various means and measures - from biological treatment to different types psychotherapy and socio-therapy, and the object of influence is the patient himself, his loved ones, and those around him. The principle of unity of psychosocial and biological methods of influence reflects the unity of treatment of the disease, influence on the patient’s body and rehabilitation of the patient himself. The principle of gradation includes a step-by-step transition from one rehabilitation measures to others.

The rehabilitation process is divided into three stages.

The first stage - rehabilitation therapy - is carried out in hospitals and semi-hospitals. Along with the necessary, and if necessary, intensive biological treatment, a set of measures is used aimed at preventing disability and the development of mental defects. Psychotherapy is widely used, including group and family therapy, employment therapy, and various types of sociotherapy. From a gentle regime in the acute period of the disease they move on to an activating one (self-care, amateur activities, participation in hospital self-government).

The second stage - readaptation - begins in stationary and semi-stationary conditions and continues in out-of-hospital conditions. Along with supportive biological therapy, occupational therapy is used, and, if necessary, training in a new profession. The goal of family psychotherapy is to adapt the patient to the family and the family to the patient.

The third stage - rehabilitation in the proper sense of the word - includes rational employment and everyday life, involvement in active social life.

Features of rehabilitation of patients with various mental disorders are described in the relevant chapters.

2. Histrionic personality disorder, variants, decompensation, therapy, prognosis.

Can be diagnosed if there is a tendency to self-dramatization, theatrical behavior, exaggerated expression of emotions, suggestibility and self-hypnosis, easy susceptibility to the influence of others; superficial and labile effectiveness; self-centeredness with the desire to forgive oneself everything and not take into account the interests of others; constant desire to be appreciated and slight vulnerability; thirst for situations where you can be the center of attention; manipulative behavior (any kind of manipulation) in order to achieve their goals.

Among the listed character traits, the most striking is the constant desire to be in the center of attention of others, demonstrativeness, and pretentiousness. For this purpose, they even resort to performances depicting suicide attempts. Suggestibility, often highly emphasized, is in fact very selective: one can only suggest that which does not contradict egocentric aspirations. But the level of aspirations is high: they claim much more than their abilities and capabilities allow.

Hysterical psychopaths are especially sensitive to situations that present them in an unfavorable light, infringe on honor and dignity, and to sexual conflicts. These individuals easily experience hysteroneurotic disorders: sensations of a lump in the throat, internal trembling, “vatness” in the legs, aphonia. Less often, more severe hysterical stigmas occur, up to paresis, paralysis, blepharospasm. Under the influence of severe mental trauma, hysterical psychoses can develop - twilight states consciousness, pseudodementia.

The formation of psychopathy occurs in childhood, adolescence, and youth (up to 20-25 years), coinciding with the period of character formation and personality maturation. Personality formation is completed by the age of 23-25, however, the main characterological properties, the “core” of personality are determined by the age of 17-20.

Decompensation is a sharpening of psychopathic traits, usually accompanied by behavioral disorders and social maladjustment. It occurs more often under the influence of unfavorable environmental factors, but is usually quite tolerated by healthy individuals. Sometimes decompensation occurs without visible reasons- due to endogenous mechanisms, for example after dysphoria in epileptoid psychopathy.

In women, severe decompensation of psychopathy, especially hysterical, often occurs during menopause

Psychopaths often create a stressful situation themselves, react pathologically to it and come out of this situation as even more psychopathic individuals (“psychopathic cycles”,

Treatment and rehabilitation

Drug treatment is required during decompensations, and in case of deep psychopathy almost always in the form of maintenance therapy. Decompensation in hysterical psychopathy is recommended to be treated with chlorpromazine. Psychotherapy should vary depending on the type of personality disorder. But they always start with individual psychotherapy - predominantly rational (explanatory, discussion). Hypnosis and other suggestive (suggestion-based) methods are most effective for hysterical psychopathy, but their effectiveness is usually short-lived. Following individual psychotherapy, they move on to family and group psychotherapy. The goal of family psychotherapy is to normalize intrafamily relationships, search for compromises, mutual understanding, correct assessment motives for each other's behavior. Group psychotherapy poses various tasks - training in contacts for anxious and schizoid types of psychopathy, behavior correction, etc.

Indications for emergency hospitalization in a psychiatric hospital without the patient’s consent are psychoses that develop at the height of decompensation (twilight states in hysterical psychopathy), as well as conditions during which patients become dangerous to others (tendency to aggression) or to themselves (suicidal intentions, self-mutilation).

3. Electroconvulsive therapy, methodology, indications, side effects and complications.

In the past, shock therapy occupied a leading position in the treatment of psychoses, especially schizophrenia. Currently, shock methods are used to a limited extent. To conduct shock therapy, it is necessary to have vital signs or written consent of the patient, and in case of his incapacity, the consent of relatives. Shock therapy is not used in children and adolescents.

The mechanisms of action of shock methods remain largely unclear. The most convincing ideas are those according to which healing effect shock methods are due to the mobilization of protective mechanisms, increasing the body's resistance to pathogenic onset under the influence of powerful repeated biological stress effects during sessions of electroconvulsive or insulin comatose therapy.

The effectiveness of shock methods is very significant. Remissions are often deeper and more persistent than with psychopharmacotherapy. It is believed that, unlike most psychotropic drugs, shock methods have therapeutic effect not only at the symptomatic, but also at the pathogenetic level. The limited use of these methods is largely due to the often negative attitude of patients and their relatives towards them.

Electroconvulsive therapy (ECT). The essence of the ECT technique is a short-term effect on the central brain structures of direct or alternating electric current, which results in an epileptiform seizure. For each patient, the voltage of the electric current and its exposure are selected, minimally sufficient to cause an epileptiform seizure.

Various modifications of ECT are used: with bipolar and unipolar application of electroconvulsor electrodes, with the use of muscle relaxants. The latter option is more gentle (the loss of consciousness is not accompanied by convulsions), but also less effective. 4 to 12 ECT sessions are performed, usually every other day

Indications for the use of ECT are severe and persistent endogenous depression, attacks of oneiric catatonia, hypertoxic schizophrenia, neuroleptic malignant syndrome, resistance of mental disorders to psychopharmacotherapy, etc.

Possible complications of ECT include respiratory arrest, cardiac dysfunction, damage to the musculoskeletal system (bone fractures, cracks in the vertebrae, dislocated joints, torn ligaments), as well as memory disorders, usually transient

The main contraindications for ECT are epilepsy, organic brain lesions, increased convulsive readiness, serious pathology osteoarticular system.

In addition, the attention of medical practitioners and researchers has been more focused on the variety of disease manifestations than on the manifestations of health

Stages of rehabilitation of mentally ill patients"

Rehabilitation (literally)

Prevention of the formation of mental defect (disability), hospitalization phenomena, elimination or reduction of these phenomena

Adaptation of the patient to life and work in out-of-hospital conditions

Restoring the individual and social value of the patient

The ratio and volume of biological and psychosocial assistance per different stages is different: if at the first stage biological treatment (medication, physiotherapy) plays a large role, being intensive and course-based, and other methods of sociotherapy and especially psychotherapy are additional, then at subsequent stages the role of psychosocial options

action becomes the leader.

Supportive pharmacoterapiya - small but constant doses of psychotropic drugs that maintain a stable mental state of the sick person.

Biological rehabilitation is increasingly becoming undermaintenance pharmacotherapy, or relief therapy, relieving acute symptoms that continue to bother the patient from time to time. At the readaptation stage, the patient adapts to the conditions external environment. Here attention is paid not only to the formation of a positive environment towards the patient, but also to the gradual activation of the patient himself, which can be carried out in the development of work skills, education and training of the sick person and his relatives. The final stage is about achieving ultimate goal- the most complete rehabilitation possible, restoration of the social value of patients, their return to the level of relationships with people around them that existed before the illness. Improving everyday life, possible employment, and establishing contacts with people indicate the achievement of this stage. Moreover, a person becomes rehabilitated in the wider community if normalization is carried out correctly.

Kabanov M. M. The problem of rehabilitation of mentally ill patients and the quality of their life (on the issue of mental health care) // Social and clinical psychiatry. - 2001. - No. 1. - P. 24.

zaiiya attitude towards him as a separate individual, which depends on changes in public perception of mental illness and mentally ill people in general.

6.2. Types of rehabilitation for mental disorders

To date, several typologies have emerged attempting to summarize rehabilitation impacts and identify priorities. recovery process. In most cases, although with different emphases, medical, psychological, social and vocational rehabilitation are mentioned. Naturally, preference is given to those types of rehabilitation that correspond to the degree of mental defect of the sick person. However, priority often also depends on the qualifications of specialists. Thus, doctors and medical professionals tend to develop methods medical rehabilitation, psychologists and psychotherapists are drawing attention to the psychological component of the recovery process, specialists in social professions are developing and deepening forms of social rehabilitation, and occupational therapists are still talking about the need for professional retraining, etc. A significant role in the transformation of the theoretical and applied foundations of rehabilitation is played by modern trends in the humanization and sociologization of psychiatric treatment.

The original typology, dating back to the early 1970s, included three types of rehabilitation: medical, vocational and social. At the same time, the importance was emphasized medicineskoy rehabilitation and treatment and rehabilitation measures aimed at restoring or compensating functions. Medical rehabilitation measures include pharmacotherapy, physical therapy, dietary food, physiotherapy and massage, spa treatment and other healing methods discussed above. An equally important role was given to professional rehabilitation, which during the Soviet period had significant ideological support. Labor-therapeutic activities were carried out primarily within the framework of stationary institutions, where labor workshops were created, which were quite adequately equipped with appropriate equipment - sewing, machine tools. Greenhouse farming and gardening were practiced, and the involvement of sick people in household work. Prevention of disability, preservation of residual working capacity, and return to work were considered the main objectives of labor rehabilitation.

More broadly, vocational rehabilitation is defined through the acquisition of a profession or the restoration of a professional

national working ability of persons who have lost their ability to work to one degree or another, retraining for available professions, which not only contributes to the preservation of work skills during the period of treatment, but also focuses on the return of professional status in society. Among its activities are vocational guidance, vocational education, retraining, and employment. The economic conditions of the transition period in Russia had a destructive effect on the occupational therapy system, but today new forms of vocational rehabilitation are emerging, for example occupational therapy (occupation therapy)tion therapy), which goes beyond medical institutions and is organized in social rehabilitation centers, societies for the disabled, and clubs. Many people with mental functioning disorders master activities that correspond to their abilities: music, art, reading, applied activities (various folk crafts, home economics, cooking).

Efforts are directed not only to helping patients master skills and career guidance; interaction with the community and employers is becoming increasingly important. Gain recognition concept protected employment mentally ill and disabled people, specialized wicker weaving workshops, ateliers and other enterprises are created. The role of specialists involved in vocational rehabilitation is to mediate and protect the labor rights of sick people; the efforts of public defenders are aimed at adapting the workplace to their functional capabilities, organizing special workshops and enterprises for people with disabilities, where working conditions and the working day can be made easier. In the process of activity, various needs of people are satisfied. In addition, in the labor process a person expresses and realizes himself, that is, he strengthens his psychological health. Therefore, professional rehabilitation is necessary and independent. Recently, there have been attempts to dissolve it in social rehabilitation. This is due to the fact that community resources are increasingly becoming needed to implement the tasks of vocational rehabilitation.

Social rehabilitation is of key importance because it coincides with the main goal of the systemic process and means the restoration or joining of patients to out-of-hospital social connections by facilitating their social communication, independent lifestyle and independent living, everyday and holiday pastime. However, a too general understanding of social rehabilitation as the restoration of social status does not clarify the specific methods and technologies that a specialist

can be used in practice. It is clear that everything that surrounds a person in society is social, and the social environment and its resources are the main agents of the individual’s rehabilitation, with both micro- and macro-society making a certain contribution. However, activities that take advantage of the beneficial effects of the social environment must be correlated with the particular difficulties of the patient.

Social rehabilitation is designed to address the social functioning problems faced by a mentally ill person. In fact, many mental illnesses tend to become chronic, and although the clinical picture becomes smoother and acute relapses are virtually eliminated thanks to maintenance doses of modern antipsychotics, mental functions, especially those responsible for social behavior, remain impaired. Mental disability and a high level of social maladaptation are the decisive reason for establishing disability in persons with psychotic disorders, mental retardation, senile dementia. According to Russian studies, in the general structure of disability, disability due to mental illness ranks third and accounts for about 10%.

There are many definitions disability as limitations on the capabilities, abilities, and life of an individual, including those arising as a result of social and cultural barriers. Regarding mental health problems, the following definition can be distinguished. Limitation of vital activityness - complete or partial loss of the ability or ability to independently provide for personal and social needs life due to mental or mental disorders, as well asthe resulting social barriers.

The position of a specialist involved in rehabilitation should be in such an attitude towards the factors of the social environment in which the latter are both restrictive conditions and resources. Only in this case does it become possible to consider subtypes of social rehabilitation as responding to the specific needs of a person maladapted as a result of mental illness.

Social rehabilitation is a generalized concept, which in turn is differentiated into areas corresponding to most problem areas of a sick person: social and everyday, social and environmental, socio-psychological, socio-pedagogical, social and labor, social and legal rehabilitation. The degree of demand for each rehabilitation resource varies depending on the degree of mental defect and social problems. It is natural that

with significant lesions and severe disability, the main attention should be paid to organizing the patient’s life and maintaining his capacity. At the same time, a moderate degree of mental impairment allows a person to adapt to the environment with great success, including employment or the ability to live independently.

Traditional rehabilitation measures are complemented by new directions. Employment, as has been shown, is still a priority, but at the same time, modern reality places extremely high demands on the performance of civil functions - paperwork with official authorities, receiving pensions and benefits, using benefits, making utility payments, and registering property rights. All these procedures are often very difficult for a sick person living independently. Therefore, the role of socio-legal and socio-economic protection and social assistance is increasing.

The approach to social rehabilitation as containing almost everything possible activities, which modern society offers to compensate for the limitations of a sick person’s life, is justified in the case when rehabilitation is implemented within the framework of social services. In work with mentally ill people, which is carried out by social work specialists and other non-medical specialists, social rehabilitation is considered leading. Indeed, the goals of social-domestic, social-environmental, socio-legal and other subtypes of social rehabilitation reflect the desire to increase the social competence and social value of the patient. At the same time, the adaptation component is clearly emphasized - adaptation to the environment with the help of social resources, at least achieved at the external level, and psychological limitations and opportunities remain secondary. Therefore it is psychological rehabilitationlitation is designed to activate the patient’s personality in the recovery process, to promote the return of self-esteem, self-acceptance, and affirmation of one’s personal status. When conducting it, attention is paid to subjective factors, such as self-knowledge, self-esteem, characterological characteristics, psychological difficulties and intrapersonal conflicts, and perception of the disease. In this case, the agent of change is not so much the social environment as the intact aspects and personal potential of a person with impaired mental health.

6.3. Psychosocial rehabilitation

Currently, most rehabilitation programs have a psychosocial orientation, which most adequately reflects the goals of restoring personal and social status. There is an increasing dominance of the psychosocial component in the activities of psychiatric institutions, which corresponds to the nature of the deficits of mentally ill patients. Almost all the effects of the therapeutic and rehabilitation stages are carried out indirectly through the psyche of the patient and his environment. Therefore, the idea of ​​psychosocial rehabilitation as comprising numerous occupational therapy, socio-legal, psychotherapeutic and other activities is justified. Technologically, it finds application in clearly structured psychoeducation modules, social skills training, independent living modules, employment management modules and other organized forms.

The origins of psychosocial rehabilitation technologies that are actively developing in Russia are in psychosocial theory, which equally takes into account psychodynamic and cognitive principles in psychotherapy, as well as the theory of community development and a systems approach in social work. According to this concept, all non-biological methods of influence are essentially psychosocial, i.e. oriented towards the person and his environment. This is where the true complexity of the approach lies. Specialized psychosocial rehabilitation programs have a clear organizational basis and implementation base - inpatient and dispensary psychiatric institutions. At the same time, some of its elements may well be implemented outside of specialized institutions, for example, in social service centers, which are gradually including groups of mental patients in their rehabilitation programs. The experience of the last five years shows that this concept, which is relatively new to our country, has earned recognition in many regions of Russia thanks to its reliable theoretical foundations, oriented to reality. According to I.Ya.Gurovich, Ya.A.Storozhakova, psiHosocial rehabilitation means the restoration of impaired or the formation of new cognitive, motivational and emotionalof personal resources in mentally ill patients with difficulties withsocial adaptation in order to integrate them into society.

Thus, the emphasis is again placed on increasing adaptability, but personal resources are recognized as decisive in the recovery process, which include skills of self-knowledge, social interaction, problem solving, coping.

Denmark with difficulties and many others. Indeed, during the course of illness, many operational skills and abilities are lost, from complex ones, such as the ability to speak, to simple ones, such as cooking skills, and elementary ones - body hygiene. A person’s experience accumulated throughout life also becomes irrelevant and is lost in illness. Many mental functions suffer - memory, attention, thinking. Sometimes atrophic phenomena associated with the decay may be observed mental activity, and the outcome of the disease is not always favorable. Therefore, technologies are needed to restore the lost quality of life as completely as possible, so that people with mental disorders can, if not completely recover, then function at the highest level possible for them.

Psychosocial rehabilitation is aimed at restoring damaged abilities and equipping a sick person with the skills necessary to exist in a social environment. Among tasks of psychosocial rehabilitation - to use the intact aspects of the patient’s personality and create on this basis a sufficiently high level of motivation for positive changes, to form a conscious attitude towards treatment and responsibility for one’s behavior. In this regard, the main condition for the success of rehabilitation is to involve the sick person in active participation in the recovery process, so his personality becomes the main instrument of change. This is all the more important since psychosocial rehabilitation involves progressive improvement in social functioning leading to independent living.

It is suggested that psychosocial rehabilitation can be carried out in three stages or phases. The first stage, which was discussed within the framework of the intervention, is the stage of active restorative influences, i.e. stage of psychosocial therapy. In fact, at this stage, intensive intervention takes place using a variety of psychosocial individual and group methods aimed at restoring the individual’s cognitive, motivational, emotional resources, as well as developing social adaptation skills. Psychosocial therapy may begin during the patient's hospital stay or be provided as part of an independent living setting.

The second stage is the stage of practical development of role functions and social positions that are close to the previous ones or new for the patient. The task of practical mastery meets the training principles - “mastered in safe conditions, try in real circumstances.” To scale life changes we are talking about the gradual restoration of independence and

» personal responsibility. Gradual mastery means generalization, i.e. generalization and distribution of restored skills, abilities and knowledge to all areas of life with constant complication of tasks. For example, when returning the skills of independent living with the corresponding development of organizational forms, the removal of restrictions looks like this: long-stay hospital - rehabilitation department - temporary places of residence (dormitory) - protected groups of residence - own housing. The restoration of work status occurs in a similar way: occupational therapy in a hospital setting - enterprises for people with certain disabilities - protected workplaces - work provided on a general basis.

The third stage is the stage of consolidation and support of full or partial social restoration. At this stage, psychosocial rehabilitation is aimed at repeating the success achieved and constantly seeking help whenever the need arises, since the effect of most educational, training and other programs lasts only for a certain time, and symptoms may periodically worsen. In addition, it has been proven that changes occur at a relatively fast pace at first, but weaken over time. In this case, it is necessary to carry out psychosocialal support.

The concept of psychosocial rehabilitation as a recovery system is characterized by certain principles.

The psychosocial rehabilitation process can begin

at any stage of psychiatric care, outside acute

conditions, but the prognosis is more favorable with earlier

beginning of psychosocial therapy. For different groups of patients

define three areas of psychosocial work. First

the direction is related to working with recently ill people,

i.e., it involves intervention immediately after the first psychotic episode

sky episode. The second direction is being developed for secondary

prophylaxis, prevention of repeated exacerbations and regional

nutritionalization. Frequent hospitalizations of patients require the involvement of

availability of many resources and means of mental health care, according to

this creates a need to develop special solutions

new programs for this category. Third direction

associated with a large number patients with long-term, sometimes many

years of age, hospital stays. Such patients are conditionally

called “settling”, and the main rehabilitation task in

In these cases, the development of independent living skills comes into play

niya as opposed to hospital.

It is necessary to formulate the purpose of each intervention with

determining the time period to give structure and release

responsibility for the process of psychosocial rehabilitation. Psychosocial interventions must be, firstly, differentiated and aimed at achieving a specific goal and, secondly, limited in time. In psychosocial rehabilitation, these conditions are best met by dividing programs into separate modules: a psychoeducational module, a module for developing communication skills, a module for independent living, and a module for organizing employment.

The choice of the form of intervention for each patient should

carried out in accordance with the characteristics of the psychosocial

problems. It is assumed that every mental health facility

ideally, it should have several

groups working continuously and performing different tasks.

If groups with mixed problems are observed,

it is necessary to combine activities of different content, directions

aimed at both developing communication and increasing knowledge about

illnesses and the formation of instrumental skills.

The sequence of psychosocial influences is carried out

is taking into account the ever closer approach to ordinary life

meeting requirements and achieving social competence.

The staged nature of the rehabilitation process should lead to

pursuit of the ultimate goal - independence and increased social

nal status of mentally ill patients. At the same time, it is taken into account

the highest possible level of recovery for everyone

of the individual, so, with a high degree of preservation of personality about

intermediate rehabilitation forms may not be used,

Upon completion of each stage or the entire psychotherapy program

social rehabilitation should pay attention to the necessary

duration of supporting continuous or intermittent psi

hosocial influences. This principle emphasizes the role of psi

hosocial support, individual case management and

booking of people with mental disorders.

An effective example of psychosocial rehabilitation technologies is independent living module. Restoring independent living skills is especially important for chronically ill people who, after long periods of institutionalized care or living alone, have difficulty performing daily self-care activities, laundry and cleaning, food preparation, and other self-support skills. Therefore, the groups participating in independent living modules primarily include patients with long-term hospitalization and loss or marked decline in daily living and self-care skills, as well as socially maladjusted chronic patients in outpatient settings, especially those living alone.

52. Rehabilitation of mental patients

Rehabilitation of mentally ill people has its own characteristics, which are associated primarily with the fact that with mental illness, like no other, social connections and relationships are seriously disrupted. Rehabilitation of mental patients is understood as restoring the preservation of the individual and social value of patients, their personal and social status. The basis of all rehabilitation measures, all methods of influence is an appeal to the patient’s personality. Rehabilitation is both a goal - restoration or preservation of the status of an individual, a process and a 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 recovery process. It is impossible to rehabilitate a patient without his active participation in this process. This principle of rehabilitation of mentally ill people is called the principle of partnership according to Kabanov.

Rehabilitation influences must be diverse and versatile - this is the second principle of rehabilitation. There are psychological, professional, family, everyday, cultural, educational and other spheres 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 combination.

The fourth principle of rehabilitation - the principle of gradual transition - boils down to the fact that all rehabilitation effects should gradually increase and often switch from one to another.

The main objective of treatment-activating regimens is to prevent the development of hospitalism and create opportunities for successful readaptation of patients in an outpatient setting. There are four main modes: protective - the patient's constant stay in bed and requires medical personnel to constantly monitor him; sparing complete freedom in the department, but it is prohibited to enter the hospital territory without accompanied by staff; activating providing patients with maximum freedom in the department; organization of full employment, patients are provided the right to independently leave the hospital department and a regime of partial hospitalization, treatment of them in some cases in a day hospital, in others - in a night dispensary.

Social rehabilitation measures should be carried out in stages.

The first stage is restorative therapy to prevent the formation of a personality defect.

The second stage is readaptation of various psychosocial influences on the patient.

The third stage is the possible more complete restoration of the patient’s rights in society, the creation of optimal relationships with others, and the provision of assistance in everyday life and work.

53. Rehabilitation after a somatic illness.

Psychological rehabilitation is designed to solve a wide range of problems of psychological assistance to persons with disabilities, and, above all, such as:

1. Normalization of mental state.

2. Restoration of impaired lost mental functions.

3. Harmonization of the self-image with the current social and personal situation: injury, disability, etc.

4. Assisting 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

Restoring psychological and social adaptation after a stroke

Here there is a pronounced motor and speech deficit, pain syndrome, and loss of social status. Such patients need a warm psychological climate, the creation of which should largely be facilitated by explanatory conversations conducted with family and friends by a psychologist.

In the process of work, psychological correction occurs the following violations higher mental functions: cognitive impairment; emotional-volitional disorders; accounts; gnosis, often spatial disorientation in space.

Psychological rehabilitation after abortion

Termination of pregnancy is not only a great physical, but also a psychological stress for any woman. A course of psychological rehabilitation after an abortion is recommended for all women, without exception.

The main method of treatment is psychotherapeutic sessions, which it is advisable for a woman to attend for at least 1-2 months. As a rule, they give fairly quick positive results: a woman gets rid of difficult thoughts, becomes more sociable, open to the world around her, stops avoiding sexual contact with her partner, and begins to make plans for the future.

Psychological rehabilitation in cancer treatment

There is an opinion in the world that cancer is incurable. This is why many people, upon hearing this diagnosis, panic. That is why psychological rehabilitation of cancer patients is primarily aimed at changing public opinion.

The first rule of psychological rehabilitation for cancer patients is to make the person want to fight it.

The psychological rehabilitation of a person with this disease largely depends on the close people who surround him or her. Relatives should discuss the problem and 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 be long in coming.

Rehabilitation after a heart attack.

The purpose of using psychotherapy in the treatment of myocardial infarction is the psychological adaptation of patients and orientation towards active image life.

The rehabilitation program includes such components as psychoregulation based on absent-minded hypnosis, ideomotor training, adaptation training, and auto-training and self-regulation techniques are also used.

A significant aspect is social rehabilitation. Rehabilitation in social terms is the restoration of human social activity as a subject of public life; V medically- this is the elimination of health disorders as the cause of impaired legal capacity.