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Medical and social (labor) examination of mentally ill patients. Features of medical and social examination in schizophrenia and bipolar affective disorder

It is impossible to say anything definite about disability in schizophrenia, since schizophrenia is a general designation for a number of syndromes. It all depends on the severity of the disorder, the nature of progression, and the inclusion of certain defects in the overall structure. It will not be possible to answer the question of what kind of pension people with schizophrenia have. They can belong to any group, if the patient is given a disability at all. Representatives of medical and social expertise do not think about a specific amount of money at all. They assign a group, and the amount is calculated by the Pension Fund employees. The social pension for disabled people of the 2nd group in 2017 in Russia is 4959.85 rubles. Labor is calculated according to certain formulas, since it takes into account length of service. It doesn’t matter at all that schizophrenia led to group 2 disability. As much money as all other disabled people receive, so does a psychiatric patient.

It is possible for a person with a mental disorder to become disabled

The schizophrenia group is not automatically given. You can end up in the hospital at least every month, but this in itself does not mean anything. In practice, most often the conversation about prescribing MSA can only be started after the second episode, which ended in hospitalization. Or rather, a conversation can be started at any time, even if a person has never been to public hospitals. Then he will be sent for examination to a hospital, which will last about a month. But if there are some compelling reasons, of course. If the patient was hospitalized for the first time and his condition is severe, malignant, then they can give a group immediately, after the first episode and undergoing an emergency medical examination. They may not give, or even refuse, a referral to an emergency medical examination. Everything is individual, it all depends on the situation. Is there any disability for schizophrenia? Not everyone, but everyone can get it. These are the features...

The most common options for starting the process

  1. The patient was treated in a state psychiatric clinical hospital. He learns that he will soon be discharged. If the patient considers himself a person with limited vitality, he can write an application to the ITU, which will confirm or deny this. In this case, the examination period may be less than standard if the examination is carried out on the basis of the same institution.
  2. The patient was treated in a private clinic, or in some state clinic, but outside the Russian Federation. Here he decided to get a group. Then he can simply come to the local psychiatrist and initiate the process. He should be sent to a hospital and examined there within the framework of the ITU. The psychiatrist will need to hand over a package of documents.

What is psychiatric MSE?

This is a council of specialists who assess the patient’s condition in terms of the degree of limitation of his life activity. There are three of them, as well as disability groups. The third is the heaviest, and the first is the lightest. The degree of disability should not be confused with legal capacity. The incapacity of a group 1 disabled person due to schizophrenia can only be established by a court. With such a group this almost always happens, but still the court must first meet and begin the hearing. At the same moment, the court determines who will be the guardian and official representative of the patient. Loss of legal capacity means the inability to make legally significant decisions. This is making transactions and making decisions on important issues regarding one’s destiny. In this case, a person can temporarily or permanently maintain his sanity. Insanity is another way of expressing a state. Recognition of insanity is a legal reason for a person not to be subject to legal liability for any actions he has committed.

Based on the medical history, characteristics, examination results and other examination data, ITU members determine the degree of disability.

  • Third degree. Patients, in principle, cannot perform self-care activities, and the course of the disorder proceeds without clear intervals at all. This degree is often assigned to patients with catatonic schizophrenia. The main criterion is the maximum level of separation from reality, and not just some disturbances in thinking. This degree entails 1 disability group.
  • Second degree. The most common phenomenon. The main criterion for establishing this group is high progression, clearly expressed malignancy of the course, increased incidence of hospitalization and decreased quality of remission. If a patient has schizophrenia this way, then group 2 disability is quite possible.
  • First degree. Attacks are rare and symptoms are not intense. It is understood that the patient remains able to work, but receives some restrictions. Corresponds to disability group 3.

If the ITU refuses to assign a group, and the patient or his relatives consider this to be incorrect, they can go to court or write a complaint to the central bureau of the ITU. It must be borne in mind that the court will most likely order a new examination, which will take place in a different place and will assess what kind of schizophrenia is and what disability group follows it.

So, the disability group for schizophrenia depends on what restrictions the mental defect imposes on the patient’s ability to provide for his life. Only disabled people with group 1 will receive a relatively normal pension in Russia, although they are unlikely to be able to fully appreciate this. The life of a group 2 disabled person cannot be called rich.

Doctors distinguish several degrees of disability

Schizophrenia: disability group and pitfalls when assigning it

What should those who are looking for an answer to the question of how to obtain disability for schizophrenia understand? The medical examination is not a medical examination, but primarily a social one. Therefore, the stories of patients about how they received disability and the opinion of the EMS participants themselves in different institutions may be different. Everyone knows that there are certain regulations, but everyone understands something different by it.

Disability is determined not on the basis of a diagnosis, but by analyzing various indicators. Data must be collected from all possible sources. These include characteristics from the place of work or study, ordinary stories from relatives, extracts from the medical history that was recorded in another medical institution. As they say, any sources not prohibited by law. And here we are faced with the first absurdity. For example, a doctor may not accept a reference from a place of work or may not take its data into account because, from his point of view, it was compiled somehow incorrectly. However, no one at the patient’s place of work owes the doctor anything, and they write as they see fit. They can write that the person is lazy and did not want to work, but they need some kind of confirmation that the patient cannot perform his duties, and is not just lazy.

The assessment is made on the basis of the following indicators of ability to:

  • self-service;
  • movement;
  • orientation;
  • communication;
  • training;
  • labor activity;
  • control over your behavior.

As a result of assessing the degree of influence of the defect on the social characteristics of the patient, indicators of his viability are derived. Therefore, in the characteristics, the members of the examination want to see data on the dynamics of the development of the disorder’s reflection on a person’s abilities, which will allow them to identify an integral indicator of the condition. However, the phrase “cannot work” may also be perceived negatively, since it is an indication of a third-degree restriction.

One patient was advised to take any negative reference from his place of work, transfer to a less qualified position, and then take another negative reference about his performance of the duties of a loader or laborer. And then even unsightly lines will show that over time there is no improvement.

Here it is not the patients who are detached from reality, but the representatives of semi-medical and semi-social expertise.

The second absurdity is that the presence of regulations does not provide any clarity in answering the question of when a disability is given with a diagnosis of schizophrenia. The presence of criteria, methods of scoring, etc. create the appearance of adequate ways to objectively assess the condition. Below are two real examples that to uninitiated people will seem like slander and malice.

Disability is given not on the basis of diagnosis, but by analyzing various indicators

Assessment of the ability to move and navigate in space. The patient tells how he once got lost in his own city. I boarded one bus while deep in thought. I realized that I was going to the wrong place. He came out and didn’t understand where to go. I drove like this for several hours. I realized that this was not the right route, I got out and went somewhere again. The specialist's assessment showed that the patient is well oriented in space and does not experience difficulties with movement. Why? Well, he understood that this was not the right route, he got out and got on another bus. And he walked calmly with his feet, and did not hide under the seat. And he didn’t know where he was going - this can happen to anyone.

Assessment of the level of self-service. The patient says that she has obvious signs of anorexia nervosa. Only in our case it is better to call it psychotic. The patient has F20.1, and heaps of anorexia. She doesn't cook anything for herself. Eats tea. Sometimes a piece of bread, an apple. Cooking soup, chicken, potatoes is something fantastic for her. At the same time, he does not feel hungry. Wear clean clothes outside the HDPE walls only because there is a washing machine. She does laundry, but sometimes she even forgets her clothes and linen there. He remembers, but everything is rotten there. Self-care ability is assessed as high. You guessed it - remission is evident. He does the laundry, makes tea, breaks off some bread. Well, that means he will live.

And this is how we do not find any threats to life and activity in patients who walk the streets with their eyes closed or talk to their own teeth, even during the period of remission. The main thing is that they don’t bite...

There are two reasons for this state of affairs. There are disagreements about the need to reduce the number of disabled people who go beyond the limits of the IPA. It won’t be shown to the general public, but there are such demands. The second is the desire of psychiatrists themselves to receive some kind of bonus. Not everything, the industry is motley. Someone himself offers a disability to the patient simply out of the kindness of his heart. And someone will become a wall and will stand until the last.

There can only be one way out of this situation. A pension for schizophrenia should be assigned on the basis of a diagnosis, and diagnoses should be strictly regulated. No one will ever say that a patient who constantly hears voices will be able to be 100% functional. Let’s also take into account that any manifestation makes the general state of health worse than that of lovely ladies during the PMS period. Do you know why women with schizophrenia very rarely think about PMS? But because, compared to the problems of even one pseudohallucination and a state when thoughts seem to be alien and stretch through the head with a creak, which “makes you feel sick” (c) - these are mere nonsense.

The disability must be based on an accurate diagnosis made and confirmed by a qualified physician

All this social nonsense with criteria then comes up against an expert assessment, which is made on the basis of the kindness of the heart or lack thereof. Point to the sky, nose to the reference from the place of work. Who wrote it, what state he was in is a big question. As well as the question, where do unemployed people actually get characteristics? However, for a country where the entire pension reform has failed, financing patients with schizophrenia is not the most important problem. So the answer to the question of whether schizophrenia is a disability or not depends on the budget. Hold on! Good mental health to you!..

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

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

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

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

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

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

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

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

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

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

Task 3. Determination of the disability group

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

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

Task 4.

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

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

Examination deadlines:

Task 5. Determining the causes of death of disabled people

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

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

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

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

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

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

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

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

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

Step 1. Getting directions

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

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

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

Example

Vladimir had health problems sufficient to qualify for disability. But he didn’t go to the doctor, and he didn’t keep an outpatient card. When Vladimir wanted to receive the social status of a disabled person, he was refused.

After the refusal, he had to register and undergo regular medical examinations. A year later, during a re-examination, he was given the status of disabled person.

To obtain the status, you need to regularly visit your local doctor and have notes about this in your medical record. Inpatient treatment and examination will follow only after a long outpatient visit to a medical facility. If there are no regular requests for an outpatient treatment card, the status will be denied.

It is the lack of success in outpatient treatment and then inpatient treatment that is proof of persistent pathology. Extracts from the hospital must be certified by department seals. The referral is certified with the seal of the institution. The signatures of at least three doctors are also required.

Step 2. Compose an application for examination

A citizen can submit an application independently or entrust this to his representative. It indicates the name of the institution to which the application is being submitted, information about the applicant, formulates the request for an ITU, its goals, and sets the date for filing the application.

The recipient must sign the received application, thereby confirming its receipt.

A statement is also written when a referral to medical examination in a hospital is refused.

Documents for ITU are prepared by the clinic at the place of residence. The chairman of the medical commission is responsible for this aspect of the work. You need to contact him when preparing documents to obtain disability.

Step 3. Receive an invitation from the ITU Bureau

After submitting your application, you must wait until you receive an invitation. It can be compiled both in written and electronic form, including by publishing it on a specialized Internet portal.

Step 4. Collect the necessary documents

It is better to prepare the necessary documents before receiving the invitation. This way you will definitely have time to collect the entire package. You will need a passport, a referral to an ITU, and medical documents that confirm your health status.

If you did not have all the documents when submitting your application, you must submit them within 10 days.

Step 5. We are waiting for an assessment of the body’s condition

The study is carried out in the office at the place of residence or, if there is a conclusion, then at home. Also, MSE can be carried out on a permanent basis or in absentia. The subject expert may invite a specialist who will have the right to vote to perform the examination.

The specialists’ task is to study the documents, conduct an examination and decide whether to grant disabled status.

Step 6. We receive a medical and social examination report

The decision is made within 30 days from the date of registration. If the examination was carried out in absentia, then the decision and explanations for it are drawn up on paper or electronically. Based on the results, a report is drawn up, it is signed by specialists and the head of the bureau, and certified with a seal.

All documents, including the report, as well as the protocol and rehabilitation program, are entered into the personal file of the subject. You will receive certified copies of these documents if you write an application.

4. Where to get advice on solving ITU issues - review of the TOP 3 companies

When obtaining the status of a disabled person, legislative and bureaucratic obstacles may arise.

For this reason, we recommend that you obtain legal advice before completing the necessary paperwork. This will help reduce the processing time, simplify the procedure, and save you from multiple trips to government agencies.

1) Lawyer

“Pravoved.ru” provides legal advice and services for document preparation in various areas. From almost 17 thousand qualified and experienced lawyers from all over the country, you can always choose the right specialist for your situation.

The company offers both free and paid services. But even paid services have prices below the market average. After all, Pravoveda’s lawyers do not need an office to provide advice to clients.

You can get advice without leaving your apartment. When submitting a question on the website, you will receive the opinion of several experts, which is equivalent to a collegial meeting and eliminates the possibility of errors.

The site operates 24 hours a day, without days off or breaks. If necessary, you can meet with specialists offline if the case requires the direct presence of a lawyer.

2) Legal consultation “Your personal lawyer”

Experts from the legal consultation “Your Personal Lawyer” provide advice on legal issues. You can contact the company for help by leaving a request on the website or by calling. Responses to requests are sent within five minutes.

Experts also prepare articles on topics of their profile - real estate, social security, property, family and labor, civil, tax corporate law and others.

The Docexpress company provides advice on legal issues around the clock, using a 24-hour hotline. Legal assistance is provided to both individuals and legal entities.

The company also provides a free newsletter, and the website has a forum where you can see expert answers to questions already asked. The list of the main advantages of the organization includes the reliability of the information provided, speed, and quality.

5. What to do if you are refused an examination - 3 useful tips

It may happen that the assignment of disability is denied. This can happen for many different reasons.

If you are sure that the refusal is illegal, then let's look at what needs to be done to protest it.

If you receive a refusal, be sure to request a certificate of this in writing. You will be able to contact the bureau yourself for an examination if you have it in your hands.

If the examination shows that all signs of disability are present, then they will issue a certificate with which you need to go to the clinic and receive a referral form.

Tip 2. Use the services of a professional lawyer

A professional specialized lawyer will help with the procedure for challenging the refusal. The lawyer must have experience in such cases and the necessary level of qualifications.

Medical and social examination and disability in mental illness (general issues)

In mental disorders (diseases), the most complex integrative level of human activity suffers, which leads to the loss of the unity of the organism as a whole, disrupts correct orientation and adaptation to changing living and working conditions.
Mental illnesses particularly 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. Finally, not only individual mental qualities are often violated, but the personality as a whole changes, social and psychological ties with society, work orientation, and the ability to set certain goals and objectives are destroyed or weakened, as the motives, aspirations and attitudes of the individual change.
At the same time, an inverse relationship is also characteristic of mental illness. For mentally ill people, work is not only the most important social, but also a therapeutic factor. After the acute stage of the disease has passed, the employment of mentally ill patients plays a special role, since the course of the disease itself to a certain extent depends on this.
Timely inclusion of the patient in work activity is a powerful compensatory factor that levels out mental defects. The work activity of mentally ill people contributes to the formation of new or preservation of old labor stereotypes, increases the self-esteem of the individual, the level of his social significance, etc. on the contrary, separation from activity leads to a deepening of the degradation of the patient’s mental life. This determines the great preventive value of medical labor examination and employment of mentally ill patients.
The work of specialized psychiatric ITUs should be closely connected with all social and preventive activities of dispensaries, labor treatment workshops, special workshops and day hospitals, and the decision of the ITU, its labor recommendations have the force of a legal document, binding on institutions that provide employment.
The organization of specialized psychiatric medical examinations on the basis of psychiatric hospitals and psychoneurological dispensaries provides the opportunity for a qualified assessment of the degree of disability and making work recommendations.
Psychiatric ITUs should be staffed in such a way that the chairman and one of the commission members are qualified psychiatrists, and the third member of the commission can be a therapist or neurologist.
Psychiatric MSEs carry out an examination of the ability to work of patients with mental illnesses who are under the supervision of psychiatric institutions, and only VCs of psychiatric hospitals and dispensaries can refer patients to MSEs, and if there are none, VCs of medical institutions with the participation of a psychiatrist (or a neurologist at a polyclinic - in the absence of a psychiatrist).

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 Institution of Institutions and must be convincingly justified.
It is unacceptable for medical institutions to refer patients for medical examination if the diagnosis has not been clarified and the necessary treatment has not been carried out in an inpatient or outpatient setting.
It is not necessary to establish a disability group 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. 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.

It should be noted that in the initial stages of mental illness, when clinical symptoms develop or in acute painful conditions, patients should be considered temporarily disabled and should not be referred to MSE until the effectiveness of therapy is determined.

Particular care and caution must be taken when determining the disability group for mental illnesses such as manic-depressive psychosis, post-infectious asthenic conditions, prolonged reactive depression and neuroses. In these cases, premature establishment of a disability group worsens the course of the disease and complicates the implementation of rehabilitation measures. As a rule, patients with this pathology, with sufficiently active therapy, and, in necessary cases, with release from work due to temporary disability for 2 - 4 months, return to work. The question of referral to an ITU to establish a disability group in such cases arises when the disease takes on a protracted or continuously relapsing course with short clear intervals.

The correct expert decision is based on observational materials from medical institutions. In accordance with this, when referring a mentally ill patient to medical examination, the history of the disease, clinical picture, course, volume and effectiveness of therapy should be covered in detail; a detailed clinical diagnosis, dynamics of the disease, frequency, duration and cause of temporary disability over the last 12 months are indicated, as well as information about transfer to easier and more accessible work in accordance with the decision of the Institution’s Institution’s Institution.

Medical information sent to the medical examination must reflect, in addition to the mental, the somatic state of the patient, as well as the functional characteristics of the existing disorders (detailed conclusion of a neurologist, ophthalmologist, surgeon, etc.).

To make an expert decision, the ITU must have a production characteristic that contains information about the behavior of a mentally ill person at work, his labor productivity, relationships with the team, etc. Along with this, data is needed on the patient’s behavior in occupational therapy workshops, day hospitals and especially in everyday life. The most complete information about the behavior of patients at work and at home can be obtained through nurse examiners who are available in hospitals, psychoneurological dispensaries or specialized medical centers, as well as through the inspectorate and public activists of district and city social security departments.

In order to improve the quality of documents sent, MSEs should conduct systematic training of doctors in medical institutions on MSE for mental illnesses.
Despite the fact that the Referral to MSE (form No. 88) contains data from dynamic observation of a medical institution, when examining patients, MSE must also reflect in their documentation the clinical and work history, professional route, results of a study of the patient’s mental state, and make a clinical diagnosis of the underlying condition. 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.

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.

Errors in nosological diagnosis are relatively rare, but the leading syndrome, features of psychopathological disorders, the nature of the course and stage of the disease, the type of remission or defect, the degree of compensation are formulated in ITU acts in the most general terms or are not even indicated at all.

The clinical diagnosis should reflect not only the nosological affiliation and morphological essence of the disease, but also the main psychoneurological disorders and functional capabilities of the patient.
A correct functional diagnosis is possible with an objective assessment of the manifestations of the disease and the state of the body’s protective properties, preserved personality traits, and the possibilities of compensating for impaired functions. In each specific case, the diagnosis must indicate the nature and severity of the leading clinical syndromes, the stage of the process and features of the course of the disease.

Based on the dynamics of the pathological process and the similarity of labor prognosis criteria, all mental illnesses can be divided into 5 main groups:
1) diseases with a progressive course (schizophrenia, epilepsy, vascular, presenile and senile psychoses, organic diseases of the central nervous system with mental disorders, for example various neuroinfections, syphilis, encephalitis);
2) psychoses occurring according to the type of phase states (manic-depressive psychosis, decompensation in psychopathic individuals, periodic organic psychoses);
3) congenital character abnormalities (psychopathy);
4) congenital or early acquired irreversible mental defects (oligophrenia);
5) diseases that have the nature of transient reactions (reactive states, neuroses).

Analysis of the course of the disease allows us to make a judgment about the clinical and work prognosis, and the degree of possible social recovery.
Objective information about the patient greatly contributes to correct diagnosis and adequate expert decision.
Among them, an important role is played by extracts from the medical history, data from social examinations at work and at home, and full-fledged referrals to medical examination. However, in the ITU materials there are few acts of everyday examination, or they are of a formal nature and do not reveal the characteristics of the patient’s mental state, which, in essence, determine his position in society and should be the basis of an expert decision. Referrals to MSE often do not reflect the entire psychopathological picture of the disease.

A thorough analysis of objective data, characteristics of the patient’s condition and functional capabilities of the psyche gives grounds to judge the labor prognosis and ability to work, measures to prevent disability, ways and possibilities of social and labor rehabilitation of disabled people with mental illnesses.