Модернизация психиатрической службы г. Москвы: от гуманизации помощи к развитию общественно ориентированной психиатрии

Abstract

Background : the main direction of the psychiatric care organization development is the creation of community-based psychiatry system. The basic principles of community-based psychiatry were formulated in international documents regulating the work and organization of mental health services, and consist in providing comprehensive specialized psychiatric care at the primary health care level integrating psychiatric care into general hospitals, creating rehabilitation and home care services, reduction of the inpatient services, use of evidence-based approaches, continuity between inpatient and outpatient psychiatric services, a multidisciplinary approach and observance of mentally ill people rights. Aim : description of Moscow Psychiatric Service modernization, produced in 2010-2018. Material and methods : data of the Psychiatry Organizational and Methodical Department of the Moscow Health Department Order No. 624 of the Moscow Health Department of September, Order No. 753 of the Moscow Health Department and Order No. 130 of the Moscow Health Department. Results : reorganization of the psychiatric services in Moscow from 2010 have been aimed at optimizing of inpatient and development of outpatient levels. The reform of the psychiatric services was carried out in accordance with the Law of the Russian Federation of 02.07.1992 «On psychiatric care and guarantees of the rights of citizens in its provision» and the principles of community-based psychiatry. The first stage of reforms, implemented in 2010-2016, consists of the psychoneurological dispensaries joining to the psychiatric hospitals, the inpatient level reduction and reprofiling of psychiatric hospitals. The second stage, implemented in 2017, included the reorganization of psychiatric hospitals: a further inpatient level reduction and the pooling of psychiatric hospitals. The third stage, planned for 2017-2020, involves the development of outpatient facilities. Conclusions : due to ongoing reforms, the uneven distribution of resources among psychiatric medical organizations in various districts of Moscow has been minimized, the lack of areas for psychiatric outpatient services has been filled, the duration of inpatient treatment has been approximated to the target indications, the structure of the psychiatric outpatient service has been brought into line with the «Order of providing medical care to persons with mental and behavioral disorders».