Rehabilitation
Development trends in modern society are aimed at perceiving all groups of people with disabilities as full-fledged members of society. Patients with schizophrenia are no exception. They have some features, but they also have their own rights and responsibilities. Psychiatrists believe that this position contributes to the successful healing of patients, while excessive care and exclusion of patients from society become the main reasons contributing to disability.
One of the main goals of a doctor treating patients with schizophrenia is to return the carrier of the disorder to society. The psychiatrist places the main emphasis in his work on learning to live in new conditions. This part of the doctor's work is called psychosocial rehabilitation.
It includes learning to interact, restoring motivational resources, and forming abilities and functions lost as a result of illness. During rehabilitation activities, the patient is given the opportunity to find a new profession for himself, taking into account his existing characteristics.
Currently, there are a wide variety of methods that allow mentally ill people to undergo rehabilitation. These include trainings:
- self-respect,
- independent living,
- communication,
- confident behavior
- family therapy,
- learning to cope with residual symptoms of psychosis.
Practice shows that the earlier rehabilitation work begins, the more successful the restoration of social skills is, which means the fewer consequences the disease leaves.
When choosing the type of professional activity, it is necessary to take into account the new characteristics of the patient’s personality and his abilities. Properly selected work helps the carrier of the disorder to realize themselves, provide for their financial needs, promotes socialization and, as a result, helps to cope with the disease and prevent its relapse.
Labor rehabilitation involves three stages:
- Depending on whether the sick person studied or worked, the existing symptoms of the disorder, loss of work skills, and the wishes of the carrier of the disorder, the patient can continue to perform the type of activity that he was engaged in before the illness. In case of loss of existing work skills, the patient is recommended to undergo training with the development of actions aimed at their restoration. At first, in such cases, protected employment is used - the patient works under the supervision of a social worker or doctor in a simplified mode.
- Then, “transitional” employment is provided, in which patients work under normal conditions at enterprises, but under the supervision of occupational rehabilitation specialists.
- The next stage is employment on a general basis. In modern conditions, it is customary to omit the first two stages of labor rehabilitation and immediately move on to the last with on-the-job training. However, despite this simplification of the procedure, at first the patient works under the supervision of social workers.
There is no universal advice regarding employment and choosing a new profession for patients with schizophrenic disorder: some are able to achieve high results by performing research activities, creative professions are suitable for some, and others can only perform simple physical manipulations.
Is it possible to work with a diagnosis of schizophrenia?
I am disabled, my insurance pension has been assigned since 2012, the diagnosis is sad and lifelong, although a number of doctors could challenge it and thus I would lose my pension altogether.
According to existing legislation, the procedure for increasing the retirement age and the presence at that time (I was unfortunately born in 1967) of experience that I could not accumulate should not apply to me; I had to work unofficially during the perestroika years and there was also a break between the last job and the granting of a pension, during which I actually and physically could not get a job in the village.
Thus, if you count the years of my experience, I did not accumulate the necessary experience.
The situation is twofold:
With such a diagnosis, I cannot get a job (schizophrenia), in our area everyone knows about it, but in the city in some places it is required to obtain a medical record and they wrap me up with my diagnosis, although, I emphasize, it is possible to remove it.
If the diagnosis remains in force, then this year I will be assigned a lifetime pension of the second, but working, disability group.
I studied the legislation and realized that if by the time I reach retirement age, and I repeat, increasing the age is not applicable to disabled people, within 10 years I will have been retired for 6 years, then no increase in length of service will apply to me (as of today I have one) enough, but I’m only 50 years old), nor increasing age.
There is a dilemma:
Or remove the diagnosis that prevents me from living in society and lose my lifelong pension, or this year go on a lifelong pension and, to the extent possible, still earn money through creativity, which I am not forbidden to do.
Am I right that in any case, having endured these 6 years out of ten, or more, before retirement, I will have the right to access old-age insurance without increasing the retirement age and length of service.
In addition to this diagnosis, there are other serious health limitations, but they do not give the right to a lifetime pension.
This fall it will be 5 years since I was diagnosed with disability, which means I need, with the support of compassionate doctors, to maintain the diagnosis for at least another year or two in order to acquire the right to retire at 55 years old with my experience.
True, I am a member of the Russian Union of Writers, and it is possible that in the coming years I will earn the right to join another of the unions.
The pension fund reluctantly recognized my certificates for professional activity, it seems that it is possible to count my experience in this way, but at the same time I have to pay such an insurance premium that my pension will not be enough, and as a result the pension will still be almost the minimum wage.
I correctly understood the provisions of the laws that it is better for me to remain disabled for as long as possible, but at least until these 6 years out of ten.
Of course, I would like to remove this disgusting social stigma from myself, but as the specialist who can do this told me, “do you need it?”
Indeed, such a diagnosis gives me the right to a lifetime pension, but I emphasize once again whether I cannot challenge it after a certain period of time, based on the totality of my pension rights.
Yes, it’s good that I pay only half the fare for transport between cities and villages, there are some other benefits, but they are tiny compared to public censure and intolerance.
Not recommended activities for schizophrenia
There are a number of professions associated with special occupational hazards that can cause harm to a healthy person, not to mention those who already have problems. The list of professions not recommended for people with schizophrenia includes the following:
- Professions involving work activities associated with disruption of cyclic biorhythms. Frequent night shifts may worsen the patient's condition.
- Work that involves severe psycho-emotional stress is not recommended for a carrier of a schizophrenic disorder. Excessive demands and conflicts can negatively affect the patient’s condition and provoke a relapse of the disorder.
- You will also have to refuse work that is associated with the delusional symptoms of the patient or with someone specific from the team.
- Work associated with danger - electricity, fire, gas - is not recommended for mentally ill people.
- All types of activities related to contact with weapons are prohibited for people suffering from mental disorders: armed guards, military personnel. In this regard, when purchasing weapons or applying for a job related to weapons, a medical examination is required.
How to identify mental illness in an employee
Mental illnesses are identified during a specialized psychiatric examination. It can be either mandatory or voluntary.
Mandatory psychiatric examination (hereinafter referred to as OPE) at least once every five years is established by labor legislation for workers engaged in certain types of activities, including those associated with sources of increased danger (with the influence of harmful substances and unfavorable production factors), as well as working in conditions increased danger. The rules governing the procedure for passing OPO are established by Decree of the Government of the Russian Federation of September 23, 2002 N 695.
As a rule, employers enter into agreements with medical organizations for their employees to undergo vocational training. When concluding contracts, business entities should pay attention to the following.
- Firstly, the doctor conducting a psychiatric examination is obliged to introduce himself to the subject and his legal representative as a psychiatrist (Article 23 of the Law of the Russian Federation of July 2, 1992 N 3185-1 “On psychiatric care and guarantees of the rights of citizens during its provision”).
- Secondly, all doctors from the medical commission conducting OPO must have specialist accreditation. Otherwise, the conclusion of the medical commission may subsequently be challenged.
It should be noted that the presence of professional medical education and accreditation of a specialist are comprehensive conditions confirming the competence and qualifications of the members of the medical commission examining the mental state of the employee.
They are not required, for example, to have academic degrees. Thus, in one of the cases, rejecting claims for reinstatement at work on the basis that the members of the medical commission conducting the general professional training are not candidates and doctors of science, the court indicated the following.
The plaintiff’s disagreement with the conclusion of the medical commission with reference to the examination by doctors who do not have academic degrees of candidates of sciences and doctors of sciences does not refute the commission’s conclusions that the plaintiff has <data taken> that prevents him from working in his previous position.
The specified requirements for doctors of the commission conducting psychiatric examinations of workers, the law (in particular, the Rules for undergoing mandatory psychiatric examinations by workers engaged in certain types of activities, including activities associated with sources of increased danger (with the influence of harmful substances and adverse production factors), and also working in conditions of increased danger, approved by Decree of the Government of the Russian Federation of September 23, 2002 N 695) is not provided for (Appeal ruling of the Supreme Court of the Republic of Tatarstan dated 07/11/2016 in case N 33-10726/2016).
A psychiatric examination can be carried out without the employee’s consent in “emergency situations”, the list of which is defined in the Law on Psychiatric Care mentioned above, when he, as it is now fashionable to say, behaves “inappropriately”.
In this case, his actions:
- - create an immediate danger to him or others;
- - show his helplessness, that is, his inability to independently satisfy the basic needs of life;
- - cause significant harm to his health due to deterioration of his mental state.
If a psychiatric illness is detected by the OPO, the employee is suspended from work by order of the employer.
Employment difficulties
Modern reality is particularly harsh. Excessive demands on people and unemployment do not allow healthy people to find decent, interesting work; what then can we say about patients with such a terrible diagnosis as schizophrenia. Getting a good job or keeping an existing one is almost impossible.
Despite the fact that it is now not customary to indicate the type of specific disease, the presence of a mental disorder in an applicant will sooner or later become known. Any self-respecting head of the HR department, before accepting a person into his team, will “make inquiries about him.” And not all employers and employees will agree to work with a sick person. In some cases, the employer does not need to find out anything; oddities in behavior are clearly visible in patients.
Despite this bleak state of affairs, there is still no need to despair. First, not all people avoid contact with mentally ill people; secondly, the situation, thanks to universal psychoeducation, promises to improve over time; and thirdly, there are a number of activities that do not require employment: creativity, work from home, entrepreneurship.
Work for schizophrenics at home
No matter how severe the illness is, in no case should you completely limit the patient from housework. Most often, a schizophrenic can cope with simple physical labor, such as cleaning, washing dishes, cooking, and working in the garden. He may not be doing something very well, but that doesn't matter. The task of his relatives is to support him so that he tries, feels needed and useful. If a person, after falling ill, was unable to keep his previous job, it is especially valuable that he be fulfilled in household chores.
In our age of information technology, the Internet and the possibility of working from home open up great prospects for patients.
This is useful for those who had certain skills before diagnosis. Programmers, architects, engineers can try themselves in the field of freelancing. Remote work is simply an excellent solution for people with social disabilities. Abilities and skills are realized, while communication with strangers is minimized. There are a lot of resources on the Internet that deal with contacting employers with performers in very different fields of activity.
Where can a person with schizophrenic disorder work?
Patients with schizophrenic disorder who do not have a disability can work in ordinary enterprises, disabled people of group II - in workshops at dispensaries, disabled people of group III - in enterprises and organizations, taking into account the recommendations of the attending physician.
As for specific types of activities, patients diagnosed with schizophrenia without a group can work in libraries, scientific laboratories, in production, in the field of education and culture. In the absence of restrictions and positive symptoms, maintaining skills and knowledge, they can perform the work of an elevator operator, mechanic, engineer, accountant, assistant secretary, editor, university teacher, doctor, mid-level manager.
Police officer
As mentioned above, the Ministry of Internal Affairs believes that psychopaths could make good law enforcement officers.
Kevin Dutton feels the same way. The scientist says that their inherent ability to perform dangerous work and maintain an intense pace of life while maintaining calm is a unique gift.
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Jobs for the mentally ill
The forensic medical examination could not be completed due to the loss by the hospital of medical documents that recorded the fact of the injury almost immediately after the victim received it. As is known, if the Bureau of Medical Examinations is not provided with a medical document, which would record in black and white the fact that the victim applied to a medical institution immediately (or almost immediately) after he received injuries as a result of violent acts committed against him and in which the findings would be recorded he was beaten by the doctors of this medical institution - then the Bureau of Medical Examinations refuses, in connection with this, to the district police officer or investigator who appointed this forensic medical examination to conduct an entire forensic medical examination in relation to this victim, even if there are other medical documents confirming the grave harm of the injuries suffered by the victim. All other medical documents indicating the health of the victim of grievous harm have been preserved (results of magnetic resonance imaging with photos, medical history from the neurology hospital where I was admitted two years after the traumatic brain injuries I received due to the loss of the ability to speak, read and write as a result the loss of part of my brain as a result of an injury, medical history from the psychoneurological dispensary where I first went to a year after the robbery committed against me due to the mental health problems I developed as a result of the injuries, discharge from the hospital, surgeon’s report, etc. .). Without the results of a forensic medical examination, a criminal case cannot be initiated, because there is no point in it - without a forensic medical examination, it will not be completed anyway. The question is, can I, without a forensic medical examination conducted on me, count on at least financial compensation for the serious harm caused to my health by filing a civil claim against the attacker? I hope the district police officer will still collect testimony (now he is working extremely slowly and reluctantly, but there were witnesses to the incident. If I can, then without a forensic medical examination carried out on me, what kind of compensation can I count on? After all, a criminal case was not even initiated from - because, as is known since March last year, even a district police officer can now order forensic medical examinations before initiating a criminal case, and if it is not completed, then the criminal case will not be initiated - not to mention the trial, which for this reason also did not take place. The attacker has already been convicted of a similar crime, as a result of which two more children received traumatic brain injuries, was caught on drugs and other offenses. Is there any point in wasting time preparing a civil lawsuit? Or the compensation will be, but extremely reduced, because it was not certified by the court medical examination, because a criminal case was not initiated, because a trial did not take place? For example, for heavy damage I will receive the same as for light damage. Does it make sense to file a claim against the enterprise while working at which the crime occurred (the crime occurred far in the taiga at a drilling rig. The management of the enterprise where I worked not only did not provide me with a vehicle to leave the taiga to provide me with full medical care, but also insisted that I stay for one more shift, since at that time they had an acute shortage of qualified personnel and there was no one to work in. In addition, I was not provided with medical assistance - there was no employee/employees in the brigade officially obliged to provide medical care assistance, although the drilling site belonged to a state mining and geological enterprise. Perhaps they were formally there, but no one provided me with any medical assistance. I did not have access to a first aid kit. There was a first aid kit in the team, but it was used exclusively to relieve hangovers among workers this brigade (I remember a geologist complaining to the head of the site that during the shift the entire supply of painkillers from the first aid kit was always used up. “It’s as if they are all seriously ill with something”). Due to the lack of medical assistance provided to me in a timely manner, all the fractures of my face and skull healed incorrectly, which is why I was left with injuries for the rest of my life. The doctor did not advise me to correct them, since in doing so there was a possibility of damage to the brain and eyes, next to which there are fractures of the face and skull. A forensic medical examination could also be carried out if witness statements from the employee(s) officially responsible for providing medical care were obtained.) How do the courts treat such civil suits? By the way, where should such a claim be filed - in the magistrates' court or the city court? Although the claim is civil, it is a serious crime and a criminal case was not brought only because of the negligence of the hospital doctors.
Thanks in advance for your answer.
Salesman
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In general, Kevin Dutton believes that the sales field is ideal for psychopathic qualities to flourish.
