From Big Medical Encyclopedia

INSANE HOSPITAL — the treatment and prevention facility intended for rendering stationary mental health services and conducting psychiatric examination.

The first institutions for mentally sick arose in 4 century in Byzantium. In 4 — 6 centuries in some countries of the East would appear monastic for mentally sick. In 9 century in Cairo the first psychiatric department would be created at the general. From 13 — 14 centuries in the countries of Europe shelters («shelters», dollgauza) for mad open. In England, e.g., at the end of 14 century would function London psychiatric Bedlam. Not treatment, but contempt and isolation mentally sick to prevent their possible actions dangerous for about-va was their main function. Patients were quite often supported in insanitary conditions, cruelly treated them. In Paris, e.g., even in 18 century mentally sick women accommodated in casemates of an insane hospital Salpetriyer. And only in the second half of 18 century in Western Europe began to create medical mental health facilities. In Russia the first P. it was founded in 1776 in Riga; the same year in Moscow psychiatric department in Ekaterina's, and in 1808 — Preobrazhenskiy-tsa would be open. In 1779 in St. Petersburg the special facility «for use of mentally ill people» was created (afterwards department Obukhovsk-tsy). Network P. in Russia gained further development after territorial reform of 1864 when a row well-planned was constructed to lay down. institutions of this appointment (the famous territorial psychiatrists of P. P. Kashchenko, V. I. Yakovenko, etc. took part in development of projects of BC) and necessary conditions for humane contents in them mentally sick with wide use of a restrictive and bed rest (fig.) were created. Besides time declaration as the advanced domestic and foreign psychiatrists of the idea of labor therapy belongs.

Psychiatric to lay down. institutions traditionally were divided into hospitals for sharply sick and for hron, patients. For patients with hron, the course of a disease created special psychiatric colonies, is preferential in rural areas which task was patient care and the organization of work therapy, usually in agriculture. Large P.' creation. promoted development of psychiatry as sciences and to training of psychiatrists, however did not solve a problem of the organization of public mental health services.

The organization of such help became possible only after Great October socialist revolution when to lay down. - professional, P.'s activity. and colonies it was considerably expanded. Colonies began to create special laboratories and offices for providing to lay down. process. Along with large P. the small hospitals servicing the population of the adjacent territory functioned. Widely developed network of psychoneurological clinics (see the Clinic) and other specialized institutions was gradually created.

The subsequent achievements of psychiatry would cause a new stage in P.'s development., connected with implementation in their practice of methods of recovery treatment and medico-social rehabilitation of patients (see. Mentally sick). In the 50th the idea of liquidation of psychiatric colonies was put forward, in 1963 according to the task set by the IV All-Union congress of neuropathologists and psychiatrists, the order M3 USSR these colonies would be reorganized into P. The structure and power of such institutions were significantly changed as their main task began active to lay down. - professional, work in combination with social actions.

By 1981 the most part of psychiatric beds in the USSR would be concentrated in large P. with number of beds not less than 500, and in some cases St. 2000. As a rule, such would render all types of stationary mental health services to the population of the territory serviced by it corresponding to several medical sites of a psychoneurological clinic. The territorial principle of hospitalization of patients provides the fullest succession in treatment of patients with an out-patient and stationary link of mental health services. Along with it the nomenclature announced in the order M3 USSR No. 236 from 3/5/1981 in addition to P. would be entered psychoneurological an expanded profile (not only for alcoholics, but also with so-called borderline cases — neurosises, etc.), and also narcological-tsy for patients hron, alcoholism, drug addiction, toxicomanias, asylums for the migrating insane, etc.

Main structural division of P. the wedge, department is. In P. there can be from 2 to 30 and more such departments. They are, as a rule, differentiated on age of patients (children's, teenage, gerontological). In the majority it is all-psychiatric departments. Except them in P. narcological departments can be allocated (see. Narcological service), departments for borderline cases, epileptologichesky, tubercular, somatic, departments for recovering (sanatorium), etc. Depending on the prevailing type of the medical help given to patients allocate in some cases departments of unloading and dietary therapy, psychotherapy, an intensive care, neurosurgical, forensic-psychiatric; there are also departments of labor examination.

the Model of the Moscow insane hospital No. 5 constructed in 1907. On the similar project at the end of 19 — the beginning of 20 centuries in Russia it was constructed 6 district (servicing several provinces) psychiatric clinics.

Along with divisions, usual for hospitals of other profile (reception, a wedge, and biochemical, laboratories, physiotherapeutic department or an office, x-ray and dental surgery offices, pathoanatomical department, medical office, archive, an economic part, etc.). in P. there are divisions, specific to them, such, e.g., as medical and production, labor workshops (see), psychological and elektrofizpologichesky laboratories, etc. At a row P. the dispensary departments and day hospitals which are carrying out extra hospital mental health services are created; in large P. there are organizational and methodical offices (or departments) for the management of psychiatric service in the territory fixed for-tsey. As a part of some hospitals the special departments functioning in the mode of the hostel and intended for mentally patients who lost family and social touches, not having a certain residence will be organized.

Opening of departments of P. is provided. at MSCh of some industrial enterprises, and also workshops of the industrial enterprises in the territory of P., what is an important factor in implementation of a comprehensive approach to recovery treatment mentally sick.

Item. occupy, as a rule, the big planted trees and shrubs territories, with an orchard and flower beds, gardens for walks and rest of patients; in a row P. there are clubs with a film projector and library.

Detention regime of mentally sick would demand development of special projects P. Traditionally developed requirements to P.'s design. (providing generally continuous overseeing by patients, the prevention of actions of the patients dangerous to them or for people around. an exception of a possibility of their unauthorized leaving department), playing very essential role in the past, lose the paramount value in connection with achievements of pharmacotherapy of psychoses and development of the differentiated rehabilitation modes now. Restriction of personal liberty is more and more replaced with organized work with group of patients, elements of amateur performance and self-government are entered, work therapy and therapy will be organized by employment. Value of rational accommodation of patients increases in department, taking into account the differentiated (individual) modes of observation and contents. Duties of the manager and doctors of departments of BC include creation of a certain psychotherapeutic and psychogienic atmosphere that is reached by the relevant organization of work of an average and junior medical staff. At the correct organization of work perhaps simultaneous use in one department of various modes — from restrictive in its extreme degree (bed contents at continuous observation) to the mode of open doors with free escaping of department and even leaving from the territory-tsy.

In 1974. The m3 of the USSR is approved the standard project P. on 500 beds with medical and production workshops, the wedge meeting the modern requirements, psychiatry. It provides special rooms for labor therapy, cultural actions, exercises, reception of visitors, for some specific types of treatment (gipnotariya, an office of conditioned-reflex therapy, etc.)? chambers at the rate of 7 sq.m on one patient (see Chamber medical).

Standards of medical staff in P. are established depending on a profile of departments and are connected with the average duration of stay of the patient in-tse. As a rule, in department 1 doctor conducts 35 adults or 25 children; 1 round-the-clock post of the nurse is provided on 30 patients (except positions of procedural sisters); 1 round-the-clock post of junior medical staff — on 15 — 20 patients. For the organization of labor therapy and therapy employment in the state a wedge, departments provided positions of instructors on labor therapy. In children's departments there are positions of teachers (1 on 15 studying children) and logopedists (1 on 40 children).

Children's P. (children's department of P.) it is intended for treatment of children aged up to 14 years inclusive; for teenagers of 15 — 18 years departments would be created at for adults. Generally age and sex principle (separate keeping of girls and boys, children of preschool and school age) is the basis for a profiling of children's departments. There are also departments of sanatorium type. Departments for children with the expressed defect of mentality and needing prolonged treatment are created. Rehabilitation work among children has generally teaching and educational character in this connection in departments also classrooms are provided game; for these purposes enter additional states of personnel.

At assessment of activity of P. the following main indicators are considered: annual average employment of one bed (points out load of a hospital), average duration of stay in-tse one patient (reflects a condition of therapeutic and rehabilitation work), the frequency of repeated hospitalization (points out efficiency carried out in-tse treatments and completeness of succession of treatment in an out-patient and polyclinic and hospital link), frequency of an exit of patients to disability, mortality. These indicators shall be considered in a nosological section, on age groups, on departments, etc.

Besides, of P. is a source of the data necessary for assessment of activity of psychiatric service in general, in particular for calculation of such indicators as the attitude of number of the hospitalized patients towards number of inhabitants in the territory attached to-tse, and also to number of the patients staying on the registry in a psychoneurological clinic, and some other.

See also Mental health services , organization of mental health services.

Bibliography: M. M boars. Rehabilitation mentally sick, L, 1978; Kannabikh 10. V. Istoriya of psychiatry, page 82, etc., M., 1929; Krasike. D. Organization of the psychoneurological help during broad use of psychopharmacological therapy, Ryazan, 1966; Rokhlin L. L. Sketches of psychiatry, M., 1967; Fedotov D. D. Sketches on stories of domestic psychiatry, M., 1957.

V. P. Kotov.