MENTAL HEALTH SERVICES — the type of the specialized help including prevention of mental diseases and complex treatment of mentally sick.
Organization of mental health services. From first years of existence of the Soviet health care the nation-wide system of Pct — one of the integral links of the general organization of medical aid by the patient was created. In activity of mental health facilities philosophy and methods of the Soviet health care (see) and first of all the free help, its general availability, a preventive orientation were realized. The basis of Pct is made by widely extensive network of the institutions which are carrying out extra hospital psikhonevrol. help. In it its fundamental difference from Pct, existing before revolution when fundamental units of psychiatric service would be psychiatric (territorial, the Ministries of Internal Affairs, etc.), as a rule, located far from the residence of patients (see. Insane hospital ). The extra hospital help was absent. Posemeyny patronage (see) was the only form of the device mentally sick (see) out of hospitals.
In the years of formation of the Soviet health care the first-priority attention was paid to development extra hospital by Pct. In 1923 at the II All-Russian meeting on psychiatry and neurology the issue of the organization city psikhonevrol was resolved. clinics (see the Clinic), their main objectives and structure are defined. It was for the first time created state psikhonevrol. help to children and teenagers. The organizations of Items in the USSR
are the cornerstone three philosophy: differentiation (specialization) of the help to various contingents of patients, gradualness and succession of the help in system of various mental health facilities. Differentiation of the help to patients, is reflected by mental diseases in creation of several types of mental health services. Special departments for patients with acute and borderline cases, with age psychoses, children's, teenage, etc. are created. Bodies of social security create houses for disabled people (psychiatric nursing homes), for hron, patients, education authorities — nursing homes and schools for mentally retarded children and teenagers.
Gradualness of the organization of Pct is expressed available as close as possible to the population of the extra hospital, semiportable and stationary help. The extra hospital step includes psikhonevrol. clinics, dispensary departments of BC, psychiatric, psychotherapeutic and narcological offices at policlinics, MSCh, and also medical and production, labor workshops (see). The day hospitals in the regular relation belonging psikhonevrol enter a semiportable step. to clinics; in stationary — psychiatric-tsy and psychiatric departments in others-tsakh.
Succession of Pct is provided with a close functional linkage of mental health facilities of different steps that is regulated by provisions and instructions of M3 of the USSR. It allows to carry out continuous overseeing by the patient and his treatment upon transition from one to lay down. institutions in another.
In the USSR the special account mentally sick is established, it is carried out regional, city and regional psikhonevrol. clinics, psikhonevrol. offices of district clinics and central regional-tsy in which bodies of health care oblige to have complete lists mentally of the patients living in the territory serviced by them. The system of the account allows with sufficient degree of reliance to reveal prevalence over the country of the main forms of the mental diseases including which are easily proceeding and especially so-called borderline cases. Establishment of prevalence of mental diseases is promoted by availability and nearness of network psikhonevrol. institutions to the population and their contact with neurologic and other medical institutions. For implementation of a research of prevalence of mental diseases of M3 of the USSR the wedge, criteria of the account are developed and approved. The relevant documents are adapted to the International classification of diseases made by WHO. On the basis of registration yielded and results of the kliniko-statistical researches conducted by scientific and practical institutions receive authentic data on indicators of prevalence of mental diseases, their structure and dynamics.
Fundamental units of Pct are psikhonevrol. a clinic and an insane hospital (see), as a rule, attached to a clinic on a territorial sign. They render Pct to the population living in a certain district. At the same time would service patients of several clinics. Activity of clinics is constructed by local territorially principle (the local psychiatrist and his assistants render Pct to inhabitants of a certain territory — the site).
Psychoneurological clinic carries out the medical and diagnostic, advisory and psychoprophylactic help mentally sick and sick with borderline cases, and also to persons with alalias. On the basis of the account and statistical development the clinic makes tactical reviews of dynamics of incidence and the operating plan to lay down. - professional, the help mentally sick; carries out the social and patronage help to the patients who are under his observation and also psychogienic and scheduled maintenance both within the clinic, and out of it (e.g., at the industrial enterprises, in educational institutions, in hostels, in rural areas — in collective farms, state farms); carries out forensic-psychiatric, medical labor and other types of examinations. Psikhonevrol. the clinic together with institutions of social security is engaged in employment mentally sick with limited working capacity; takes part at the request of bodies of health care in the solution of questions of guardianship over the incapacitated insane; carries out daily communication with corresponding psikhonevrol. hospitals concerning hospitalization, receives the information about the written-out patients for further observation and succession in treatment etc.; provides advice to the patients who are in-tsakh and policlinics; carries out the accounting of patients and dynamic overseeing by them.
In structure of a clinic there are local psychiatric offices, a day hospital (semi-hospital), medical and production, labor workshops and crew of emergency mental health services. Since 1981 the local psychiatric office works on system of local psychiatric crew. In addition to local psychiatrists for adult population as a part of a clinic the children's psychiatric office and an office for teenagers are provided. Average medics of the social help enter into staff of a clinic. An important link of a regional clinic is the specialized ambulance crew. Such crews will be organized for rendering urgent (emergency) by Pct mentally sick and preventions of possible socially dangerous actions from their party. Depending on local conditions psychiatric medical ambulance crews can form not as a part of a clinic, and at psychiatric-tse or the city station of ambulance. Regular standards of divisions psikhonevrol. a clinic are provided by special orders and other normative documents of M3 of the USSR.
Psikhonevrol. the clinic along with to lay down. work holds events of preventive character, and also gives necessary social help to patients. Scheduled maintenance of a clinic consists in employment of the patient according to his opportunities, in the solution of questions of temporary or permanent loss of working capacity by it, about providing additional issues to the patient, the direction in sanatorium, etc. All this demands acquaintance of the doctor with living conditions and an office situation of the patient, contact with his relatives, and if necessary and with colleagues. The district doctor and the sister of the social help help to settle the household and office conflicts, are engaged in improvement of living conditions of patients, their transfer into other work, etc. In this activity help to the psychiatrist is given by the lawyer attached to a clinic.
In close connection with clinics work medical assistant's psychiatric points, taken out on industrial and page - x. the enterprises where they can be in structure of all-health services. The role of these points in rural areas with small population density where psikhonevrol is especially big. clinics or psychiatric offices all-medical to lay down. institutions (-tsy, policlinics) can appear at considerable distance from certain settlements.
Day hospital — the intermediate link between extra hospital and stationary psychiatric links intended for assistance mentally sick at the corresponding stages of complex recovery treatment. In some cases day hospitals will be organized in structure to lay down. - professional, the institutions having psychiatric department or an office. Some of them work in two changes, i.e. combine functions of a day hospital p a night dispensary. The day hospital was offered at the II All-Russian meeting on psychiatry and neurology and is organized in 1933 at the initiative of V. A. Gilyarovsky and M. A. Dzhagarov.
Problems of a day hospital include treatment and return to work mentally sick with temporary disability; treatment mentally sick with permanent decrease in working capacity and preparation them to employment at other work with partial use of a former art; treatment of patients with the expressed mental degradation and social disadaptation and their familiarizing with life of collective, training in labor skills (disabled people of the I—II groups, disabled from childhood) with the subsequent transfer for continuation of work therapy in medical and production, labor workshops and preparation them to employment out of system psikhonevrol. institutions; an aftercare and gradual adaptation to a usual vital situation of the patients who received medical treatment in psychiatric-tse; in some cases specification of the diagnosis, studying of extent of disability and definition of suitability to professional work; rendering social legal aid by the patient, settlement of labor and household questions etc.
The day hospital intends for patients whose further stay in psychiatric would not be necessary, and the extract in usual conditions of life is premature. It is intended also for patients at whom the phenomena of a decompensation, but not so that there was a need to hospitalize them in psychiatric-tsu are noted. Sometimes day hospitals will be organized directly in rooms or in the territory of the industrial enterprises that allows to apply more actively and widely industrial work in complex recovery treatment.
The important place among extra hospital divisions is taken by medical and production, labor workshops at psikhonevrol. clinics in which special workshops with different types of work will be organized. Medical and production, labor workshops provide patients with recovery treatment using work. The following tasks are set for such workshops: to apply work in to lay down. purposes; to apply it when the patient owing to the disease lost labor skills; to train it in a new type of work after recovery or considerable improvement of a condition of the patient found a job on new specialty. In operating time in medical and production, labor workshops of the patient earns a reward. Work has also great psychotherapeutic value. And the patient does not bear any liability for substandard products, do not set a task to implement the production schedule for it. Medical and production, labor workshops will organize work therapy (see. Labor therapy) both for the coming patients, and for the patients who are in house conditions under observation of a clinic or on patronage (home work). In some cases work therapy, a trudoobucheniye or employment in mental health and psychoneurological facilities will be organized by the industrial enterprises at themselves on a contract basis. At the same time the particular sparing treatment for patients and constant medical observation is provided.
Big achievement of the Soviet health care is free issue of pharmaceuticals for out-patient treatment of patients with schizophrenia and epilepsy, and also disabled people of I and II groups on a mental disease.
Insane hospital it is intended for hospitalization mentally of the patients directed to hospitalization by doctors of extra hospital services. It has specialized departments. Accepts the patients living in the territory serviced by it (according to the local and territorial principle of service).
For mentally sick with long, chronic, quite often for years country would be available the proceeding diseases in some cases. In them, along with all other methods to lay down. influences, work therapy is widely used, it is preferential in the form of various pages - x. works. The great value in such would be attached to recovery at sick skills of self-service and to their return to socially useful work.
At-tsakh and some psikhonevrol. clinics the new type of departments for the patients who lost family relations and the permanent residence is created, but capable at the minimum medical observation completely to service itself and to work in usual working conditions or at the specialized enterprises for employment of disabled people — mentally sick. The mode of such departments approaches the mode of hostels (them it is possible to call medical hostels for mentally sick).
In psychiatric there would be also medical and production, labor workshops which represent well equipped workshops intended for carrying out the corresponding types of work therapy and a trudoobucheniye. On the basis of such workshops function taken out on the territory-tsy of the workshop of the industrial enterprises which provide conditions for labor retraining and employment of disabled people — mentally sick.
Stationary psychiatric service of patients the BC is carried out also in the psychiatric departments organized as a part of large (regional, city). Such departments perform functions of a psychiatric hospital (in rural areas and sparsely populated districts) or serve as an auxiliary view of the stationary help, existing along with usual psychiatric-tsami, and carry out treatment of patients with sharply arising psychoses (especially somatogenic) and short-term aggravations of mental diseases.
For patients with hron, the psychiatric nursing homes entering a social security system are available forms of diseases. Also the group of special facilities, first of all special workshops at the industrial enterprises for employment of disabled people — mentally sick treats department of the Ministries of Social Welfare. Taking into account the contingent employed in workshops the facilitated conditions for the employed disabled people — mentally sick are created. At the same time psikhonevrol. the clinic gives them necessary methodical and advisory help.
To the persons who made socially dangerous acts and recognized legally deranged on decision of the courts compulsory treatment in the general psychiatric would be appointed (see. Compulsory treatment ), or in special psychiatric-tsakh systems of the Ministry of Internal Affairs of the USSR.
The pct to mentally sick children is carried out as independent to lay down. institutions (children's psychiatric hospitals). and departments in large psychiatric-tsakh. Feature of children's psychiatric hospitals is the combination of medical and pedagogical processes. Classes with children are given in programs of mass and auxiliary schools. Some children's hospitals incorporate semi-hospitals and dispensary departments which function as the centers which are carrying out organizational and methodical and advisory work. Special schools of the Ministry of Public Education of the USSR provide necessary level, educations to mentally retarded children and children with other defects of mentality if at usual schools these children by the mental opportunities cannot study.
Big development was gained by the narcological help — rather independent system of extra medical, stationary and other medical institutions intended for prevention and treatment of alcoholism, toxicomanias and drug addiction (see. Narcological service).
Along with the described types of Pct in some large cities at psychiatric and territorial to lay down. institutions of other profile offices on sexual pathology, services of the emergency help (including telephone) in crisis situations, and also psychiatric medicogenetic consultations are created.
Acute mental health services — a complex to lay down. died, pursuing the aim of the emergency therapeutic influence and protection of both the most sick, and surrounding his faces from the possible dangerous actions caused by a mental disorder. The concept «acute mental health services» in a broad sense includes all actions promoting isolation of the patient, performing treatment, the organization of care of it. In narrower sense urgent hospitalization in a psychiatric hospital (urgent hospitalization) is meant. Legal aspects of urgent hospitalization of mentally sick are regulated by Bases of the legislation of USSR and federal republics about health care, and also laws on health care of federal republics. So, article 56 of the Law on health care of RSFSR states: «... With explicit danger of actions mentally sick for people around or the most sick bodies and healthcare institutions have the right as acute mental health services to place the patient in mental health (psychoneurological) facility without its consent and without the consent of the spouse, relatives, the trustee or the trustee. In this case the patient shall be within a day examined by the commission of psychiatrists which considers a question of correctness of hospitalization and defines need of further stay of the patient for mental health (psychoneurological) facility...» Similar articles are available in laws on health care and other federal republics.
Urgent hospitalization it is carried out according to «The instruction for the urgent hospitalization mentally the patients constituting public danger» developed by M3 of the USSR and coordinated with Prosecutor's office of the USSR and the Ministry of Internal Affairs of the USSR. The indication to urgent hospitalization is the danger of the patient to itself and people around caused by the following features of his mental state: the wrong behavior owing to acute psychosis (psychomotor excitement with tendency to aggressive actions, a hallucination, nonsense, a syndrome of mental automatism, syndromes of the upset consciousness, patol. impulsiveness, heavy dysphorias); the systematized nonsense if it defines socially dangerous behavior of patients; the crazy states causing the wrong aggressive attitude of patients towards individuals, the organizations, institutions; depressions if they are followed by suicide tendencies; the maniacal and hypomaniacal states causing disorderly conduct or aggressive manifestations concerning people around; acute psychoses at psychopathic persons, patients with inborn weak-mindedness (oligophrenia) and with the residual phenomena of organic lesions of a brain, followed by the excitement, aggression and other actions dangerous for themselves and for people around.
Conditions of alcoholic and drug intoxication (excepting intoksikatsionny psychoses), and also affective reactions and antisocial forms of behavior of the persons with borderline cases who are not suffering from actually mental diseases are not the indication to urgent Pct. Suppression of dangerous behavior of such persons is within the competence of appropriate authorities of protection of law and order.
The issue of indications to urgent hospitalization is resolved by the psychiatrist. Bodies of militia at the address of medics are obliged to render them assistance. If the mental disease at the person finding dangerous behavior is not obvious, it is not subject to urgent hospitalization. Bodies of protection of law and order, having detained such person, direct it in the presence of the bases to expert and psychiatric survey according to the law. For ensuring control of validity of use of measures urgent the Pct of the person placed in a hospital as urgent hospitalization are subject to monthly obligatory survey by the special commission as a part of three psychiatrists, edges considers a question of need of further stay of the patient in a hospital. At improvement of a mental condition of the patient or at change a wedge, pictures of a disease when public danger of the patient is eliminated, the commission draws the written conclusion about a possibility of an extract of the patient on care of the family or the trustee. The arrangement with them shall be previously provided.
Urgent the Pct is of great importance during the rendering stopping of psychomotor excitement, the main role is played at the same time by early prescription of medicines. During the stopping of excitement in somatic hospitals where it is impossible to create conditions for keeping of the excited patients, the grid (hammock) sometimes is for a short time applied, a cut cover a bed.
For rendering urgent Pct in the republican, regional, regional centers and the large cities are created specialized crews of emergency medical service, at the rate of 1 crew on 300 thousand population, but not less than one crew in the cities with the population from 100 thousand to 300 thousand people. The crew consists of the doctor and two paramedics; it is equipped with necessary pharmaceuticals for stopping of acute conditions of excitement, and also rendering in case of need other types of the emergency medical aid. For hospitalization of the patient according to the permit of the psychiatrist who examined the patient earlier the crew without doctor goes. In districts. where crews of the ambulance of Pct are not created, their functions can carry out crews of the general (unspecialized) emergency medical service. In considerable volume (hl. about river, in the afternoon) urgent the Pct are carried out also by doctors psikhonevrol. clinics and dispensary departments of psychiatric BCs. In districts where there are no mental health facilities, those doctors of all-medical network who usually carry out assistance to mentally sick there can carry out urgent hospitalization. At the same time the patient would be sent immediately to the next psychiatric.
If mentally the patient needing in urgent Pct is brought to mental health facility not by medical staff, the doctor on duty of this establishment is obliged to examine the patient and in the presence of the bases to accept it on hospitalization. In the areas having more than one psychiatric hospital, reception of the patients directed as urgent hospitalization quite often it is carried out only by one of them, as a rule, located in the regional center. In the large cities with several psychiatric one of them sometimes entirely would specialize in reception of the patients sent as urgent to Pct, performing thus functions-tsy of ambulance or the central accident ward.
Methods of identification and accounting of mentally sick. The leading role in identification and the accounting of mentally sick belongs psikhonevrol. to a clinic. Identification of mentally sick is made by various methods: at active negotiability mentally patients or their family to the local psychiatrist, at detection of a mental disease during medical examination, by the direction of patients on consultation to the psychiatrist doctors of territorial policlinic or-tsy, MSCh, doctors of policlinics of educational institutions at suspicion on existence of any mental disease. In the same way doctors of a children's day nursery or gardens, schools, nursing homes direct to consultation to the psychiatrist of children or teenagers. Very important method of studying of prevalence of mental diseases in various groups of the population are epidemiol. researches (see. Mental diseases). The accounting of mentally sick is made by hl. about river by the territorial principle.
The research at suspicion on existence at the person of this or that mental disease is conducted first of all by the special psychiatric inspection by all means including detailed inquiry of the patient, collecting by the doctor subjective (personal) and objective (from the family) the anamnesis (see), data of medical observation (the doctor, the sister, junior medical staff) with the subsequent characteristic of a mental state in general (kliniko-descriptive method), and also results nevrol, researches. At the same time the somatic research is surely conducted. At inspection mentally sick it is necessary to remember dissimulation quite often inherent to them (see).
Major importance for establishment of the diagnosis has a wedge, inspection of the patient, the anamnesis, a catamnesis. For specification a wedge, the diagnosis or the solution of questions of differential diagnosis laboratory and tool methods of a research use.
Medical labor examination (VTEK) — a necessary link in system of the treatment-and-prophylactic, rehabilitation and social help to mentally sick. The questions connected with expert assessment of working capacity (see) and also development of actions for the labor device and professional rehabilitation of disabled people are within the competence of medical labor examination (see. Rehabilitation ).
Methodical and organizational bases of medical labor examination of persons with mental diseases began to develop in the 30th 20 century. They formed as a result of systematically carried out special scientific research and developed in close unity with clinical and social psychiatry. Medical labor examination of mentally sick is based also on the general principles of the Soviet examination of working capacity and is regulated by the operating statute (see. Medical labor commission of experts). Working capacity at the same time is treated as a concept the biosocial, and principal value is attached to safety of the identity of the patient. At expert assessment the wedge, factors are considered in a complex with social and psychological, professional opportunities of the patient matter.
At mental diseases with the favorable clinical and labor forecast at patients temporary disability is established. At long aggravations (attacks) of mental diseases the maximum duration of temporary disability usually does not exceed 6 — 7 months. Lack of positive effect for the specified period assumes, as a rule, disability of a pas a long term. The patient, the Crimea established the corresponding group of disability, along with social security (see) the conditions allowing them to participate in socially useful work are created.
At assessment of working ability of the patient it is not enough to establish nozol. the diagnosis and to qualify features of a state. The special role at the same time belongs to the functional diagnosis reflecting character, disease severity, degree of its progrediyentnost, type and a stage of a current, depth of changes of the personality. The expert opinion is based on carefully collected anamnesis, materials complex a wedge, inspections, data of psychological, production and household inspection. All this combined allows to specify features not only the available pathology, but also that is more essential, the reasons and the nature of the occurred permanent social and labor disadaptation, and also to estimate defect of working capacity. to reveal the socially important qualities remaining with the patient safe.
At a considerable part of disabled people with mental diseases at rehabilitation actions and existence of necessary conditions it is possible to recover (to keep) ability to work. Patients, restrictedly the able-bodied, recognized by disabled people III groups, as a rule, can work in the specialty with reduced by loading and the volume of duties, shortened in working afternoon, part-time working week and so forth or to perform work of lower qualification. Much of them training, retraining is available to the prof. Labor processes at home, in special workshops are available to the disabled people of the II group unsuitable to work in usual working conditions, individual conditions on production are created to them. Disabled people of the I group need permanent care and supervision.
Lead to disability generally such diseases as schizophrenia, epilepsy, an oligophrenia and organic diseases of c. N of page. Criteria for evaluation of a condition of working capacity and the labor forecast, proceeding from a wedge, features and the rehabilitation potential which is available for patients, resources of the personality, the gained professional experience, compensatory opportunities, efficiency of medical and recovery actions and so forth are developed for each of them.
In the USSR much attention is paid to further researches of diverse aspects of working capacity mentally sick and to improvement on their basis of medical labor examination. For conducting the qualified labor examination of mentally sick the network of the specialized medical labor commissions of experts (MLCE) is created, training of medical experts of this profile is carried out. The large organizational actions concerning involvement in labor process of disabled people with mental diseases are solved in the state scale.
Rehabilitation. The priority of domestic psychiatry in development scientific and organizational * and kliniko-theoretical bases of social rehabilitation mentally of patients is conventional (S. S. Korsakov, V. A. Gilyarovsky, etc.). The social orientation was inherent still in territorial psychiatry. However as the complete system rehabilitation could be implemented only in 20 — the 30th there are 20 century at the organization of essentially new mental health services in the USSR.
In relation to psychiatry those aspects of rehabilitation (see) which concern recovery (formation) of socially important qualities of the personality, stimulation of its social activity are especially important. The purpose of rehabilitation — to make mentally sick with the most capable to life in about-ve. At mental diseases rehabilitation actions possess especially important role. Carrying out them demands special long efforts as these diseases cause damage to those parties of the identity of the patient on which the social value of the person, the level of its family, household and professional adaptation depends.
The importance and possibilities of medical and social rehabilitation steadily increase in psychiatry in connection with the increasing efficiency of psychopharmacotherapy and the occurring pathomorphism of mental diseases.
Rehabilitation, i.e. a complex of recovery actions, steadily accompanies to lay down. to process. Rehabilitation in psychiatry is considered as consecutive, continuous step-by-step process which assumes use along with all types of therapy of special methods and forms of work with patients.
Conditionally distinguish medical, professional and social stages of rehabilitation. At a stage of medical rehabilitation the main role is assigned intensive biol, therapies (see. Mental diseases, treatment). It falls usually on the period of an exacerbation of a disease, stay of the patient in a hospital, in a day hospital, medical and production, labor workshops in which special significance of the organization of the activating mode is attached, to carrying out leisure, different types of cultural and mass work are used, educational and correctional measures are applied. An important role is played by labor therapy, psychotherapy (see). All combined allows to avoid the phenomena of a hospitalism (see), disintegration of family and public relations, loss of a labor orientation, ability of the patient to social and labor adaptation in general keeps.
At a stage of professional rehabilitation the measures promoting a training of professionally significant functions, fixing of the forms of behavior necessary under production conditions, to formation of skills of the public relations are important. At the same time such types of work which on the organization, difficulties of labor operations, to a metabolic cost approach work under production conditions are effective. At this stage medicamentous therapy, psychotherapy continues, correctional and recovery actions are carried out, a lot of work with relatives of the patient is carried out. Actually labor and vocational education can be implemented in medical and production, labor masterful clinics, on special sites, in special workshops and the enterprises of various profile. Adequate vocational guidance of the patient is of particular importance.
At a stage of social rehabilitation recovery of the social status of the patient at that level which corresponds to its condition, interests, features of the personality, and also professional knowledge and experience is carried out. At the same time particularly important recommendations become. concerning choice of profession, forms of the labor device, vocational education, retraining, etc. Experience of so-called industrial psychiatry showed efficiency of involvement of patients in labor process in the conditions of the large industrial enterprises allowing to carry out their individual labor device, to create special sites and to organize medical observation of MSCh, etc. At this Pct it is carried out as dispensary observation.
The purpose, forms and methods of rehabilitation work, its efficiency depend on character of a mental disease, its stage and option of a current. At schizophrenia, epilepsy, organic diseases of c. the N of page many patient is possible to gain professional experience that facilitates their rehabilitation. At an oligophrenia it is necessary to create initially skills of self-service, behavior in work, performance of simple labor operations.
Implementation of recovery actions demands specially prepared shots and unity of actions of all links of Pct. Interfering with permanent social disadaptation, measures of Pct gain also great social and economic value. Possibilities of rehabilitation in the different countries and during the separate historical periods are defined by the level of development a wedge, psychiatry and the organization of psychiatric service, and also social and economic structure about-in and. In the USSR the problem of rehabilitation of mentally sick is solved in the state scales by joint efforts of bodies of health care, social security, education, with attraction industrial and page - x. enterprises.
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E. A. Babayan; M. V. Korkina (methods of identification and accounting of mentally sick), V.P. Kotov, 3. N. Serebryakova (acute mental health services), M. S. Rozova (medical labor examination, rehabilitation).