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Obtaining disability for a child. The work of a psychologist in the bureau of medical and social examination. Is a psychiatrist’s opinion needed to register a disability?

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

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

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

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

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

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

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

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

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

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

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

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

Procedure for referral to ITU

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Disability groups

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

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

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

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

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

Individual rehabilitation program

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

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

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

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

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

Limitations and benefits for people with mental illness

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

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


Mental illnesses are the fourth most common disability status for patients.

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

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

Due to the nature of my work as a clinical psychologist, I often come across people who are disabled people who have received a disability group for mental illness. And this, unfortunately, is a very large segment of the population. It would probably be wrong to generalize this category, despite their identical status, because all these people are different and individual, but they are united by common difficulties and problems and, in my opinion, this disability does not always help them. The majority of people observed in a psychoneurological dispensary and having a chronic mental illness are an extremely unprotected category and here’s why. Predicting the development and course of a disease is extremely difficult and requires enormous experience.

Psychiatric disability

With mental disorders (illnesses), the most complex integrative level of human activity suffers, which leads to the loss of the unity of the body as a whole, disrupts correct orientation and adaptation to changing living and working conditions. Mental illnesses especially deeply and uniquely disrupt a person’s work activity. In some cases, this is due to high fatigue or disturbances in the pace of mental processes. In others, in particular with organic destructive diseases, the ability to acquire new knowledge, skills and abilities, and to use past professional experience is lost.

When determining the cause of disability (from a general illness, an illness since childhood, from a work injury, from occupational poisoning, from a wound and shell shock at the front, from a disease associated with being at the front or military service), psychiatric medical examiners are guided by the relevant instructions and methodological letters . A significant expansion of the network of specialized psychiatric medical examiners has significantly improved the quality of medical and labor examination of mentally ill patients. However, the analysis shows that the most common defects in the work of MSE are insufficient consideration of the characteristics of the clinical course, stage of the disease, compensatory formations and social criteria of disability.
Low rates of rehabilitation of disabled people are due in some cases to inadequate treatment.

Disability due to mental illness. how does this happen?

Disability groups As with other diseases, mental illness can be assigned to one of three disability groups. Let's look at each of them in more detail. 1 group. The first disability group can be assigned to those patients whose condition requires constant monitoring and outside care. That is, this category of people is not able to take care of themselves and be responsible for their actions and actions.
They are assigned the most severe 3rd degree of restriction of life activities, and in particular, the ability to take care of themselves, move independently, the ability to navigate, communicate, and control their behavior. Most often, group 1 is prescribed to oligophrenics, people with the final stage of schizophrenia, and with severe damage to the central nervous system. 2nd group.

Shiza.net: schizophrenia forum - treatment with communication

Referring mentally ill patients for an initial examination to the ITU to determine the disability group is a very responsible decision of the attending physician and the IC and must be convincingly argued. It is unacceptable for medical institutions to refer patients to the ITU if the diagnosis has not been clarified and the necessary treatment has not been carried out in an inpatient or outpatient setting. Not a disability group should be established for mentally ill people only on the basis of being on a temporary disability certificate for 4 or 5 months a year, since the duration of temporary disability in itself cannot serve as a basis for determining the disability group.

Medical and social examination

The patient (or his legal representative) must explain all his problems, which the doctor will add to his chart, and write a referral to visit the necessary specialists. After passing through specialists, you will need to undergo examination in a hospital. Remember that if you decide to apply for disability, then you do not need to hide the essence of your illness; tell your doctors about all your problems.

Attention

Also tell us why you developed the disease and what you think is your ability to work. The doctor should record all this information in your outpatient card. After the examination, you will be given a referral for a medical and social examination (MSE), certified by the seal and signature of the head physician.


The next step will be a visit to the ITU office, where they will set a date for the examination. After passing the ITU, you will be diagnosed with a disability or denied it.

Info

If you do not agree with the decision of the commission, then you have the right to appeal this decision by writing a statement to the main ITU bureau. In addition, you have the right to conduct an independent examination, where the doctors examining you will have nothing to do with the ITU. And, as a last resort, you can appeal the decision through the court.


If you are diagnosed with a disability, then in a year or two you will be re-examined. When a disability of the 1st group is established, re-examination takes place once every 2 years, and once a year when the 2nd and 3rd groups are established. You should also receive a certificate of disability and an individual rehabilitation program (IRP). In conclusion, you need to contact the Pension Fund at your place of residence to apply for a pension and the social security authorities to receive the benefits you are entitled to.

Receive disability due to mental vomiting.

Documents required for registration of disability To register disability in psychiatry, the following package of documents is required: Application for medical examination; Passport and its copy; A copy of the work record book, if available; In some cases, a certificate of income is required; Outpatient card of the patient; Extracts from hospitals, with copies attached to them; Characteristics from work or study; In case of an industrial injury, a report filled out in Form N-1. For re-examination, you need to submit 2 documents: Amount of pension and EDV for disability Monthly pension for disabled people in 2014: For I disability group - 8,647.51 RUB. ; For disability group II – RUB 4,323.74. ; For disability group III - RUB 3,675.20. ; Group I disabled people since childhood – 10,376.86 rubles. ; Group II disabled persons from childhood – 8,647.51 RUR. ; Disabled children – 10,376.86 rubles.

Disability in schizophrenia

However, in cases where mental disorders, despite active treatment, are persistent or irreversible and interfere with the performance of professional work, there is a need to establish a disability group. The creation of easier working conditions in the previous profession (exemption from work on night shifts, from additional workloads, business trips) or the transfer of a patient to another job without reducing qualifications and maintaining earnings should be carried out according to the conclusion of the Institutional Inspectorate of medical institutions. In such cases, the recommendations of the VC play a decisive role in preserving the ability to work in a number of mental illnesses and contribute to the formation of a favorable psychological state of patients.

Psychiatric disability

In order to improve the quality of the documents sent, MSEs must conduct systematic training of doctors of medical institutions on MSE for mental illnesses. Despite the fact that the Referral to MSE (form No. 88) contains data from the dynamic observation of a medical institution, when examining patients, MSEs should also in their documentation to reflect clinical and work history, professional route, results of examination of the patient’s mental state, and make a clinical diagnosis of the main and concomitant diseases. Along with the study of mental functions, a neurological and somatic examination of those being examined is necessary, and in the presence of concomitant ophthalmic, surgical, gynecological and other diseases, psychiatric medical expert doctors must have an authoritative opinion from the relevant specialists.

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