2. Educational and correctional work with persons burdened by mental illness

Identification of persons burdened by mental illness.


Due to the shortcomings of forensic psychiatric and forensic psychology examinations, persons with painful features of the innate and acquired psyche (consequences of traumatic brain injury, epilepsy, reactive psychoses, etc.) also end up in places of social isolation. Our task is not to cover the etiology, clinical manifestations, as well as methods of treatment of these diseases. This is the work of psychiatrists. However, it is not uncommon for educators, through ignorance, to deform any behavior of minors in the form of deliberate rudeness, demonstrative excitement arising as a response to incorrect methods of education (especially during the adaptation period) are perceived as a manifestation of mental illness, which hurts the whole medical and pedagogical work with these people. -sanitary parts of places of social exclusion.

Why is it necessary to identify this category of minors? Firstly, because during the period of acute illness they most often commit offenses, violations of the regime (escapes, self-harm, etc.). Secondly, by their behavior they provoke other minors to such actions. And finally, thirdly, because of their illness and the impossibility of objectively assessing the situation and correctly resolving it, they become victims of criminal abuses by criminal groups of minors. Often, the leaders of criminal groups specifically incite such persons against the administration, complicating the situation in the institution in order to achieve some of their narrow group goals.
However, so far, little attention has been paid to the identification and study of persons with mental abnormalities in a number of institutions of social exclusion. Some educators and staff members believe that, to a certain extent, under the influence of the criminal lifestyle, deviations from the psychic norm have arisen for all minors and therefore special psychodiagnostic work should not be carried out to identify persons suffering from mental illness. Others consider themselves incompetent in dealing with these issues, shifting all worries to doctors. However, without daily observations of educators, workers of the regime, industrial training masters, teachers, their help, the psychiatrist has to spend considerable time to establish an accurate diagnosis of mental illness and the causes of its decompensation (exacerbation), as well as to identify cases of qualified simulation of such diseases. As you know, “mowing under a psycho” (pretending to be mentally ill) is one of the favorite activities of people who are in conditions of social isolation. Minors know in detail the diagnostic signs of certain mental illnesses and simulate them skillfully.
Other medical workers of the special school (special vocational school, VC) can provide substantial help to a psychiatrist in identifying persons with mental disabilities: a) by examining medical documentation received with a minor (health certificates, forensic psychiatric and forensic psychiatric examinations and etc.); b) primary and next (calendar) medical examinations of minors; c) analysis of complaints of persons visiting the medical unit; d) monitoring the relationship of minors (for example, when bathing in a bath, in a canteen, etc., where the presence of a health worker is required) and with educators and other employees of the institution; e) to study the incidence of injuries (domestic and industrial) among minors, to identify the facts of self-harm and to simulate diseases; e) a survey of people who know this teenager or young man.
Success in identifying minors with various mental abnormalities depends largely on the close interaction of employees of the institution of social exclusion (educators, supervising minors in everyday life and communication; teachers, observing them in class; industrial training masters and production workers, observing minors in the process of training and production , etc.), as well as from establishing contacts with relatives of adolescents and young people and medical institutions at the place of residence .
In the study and identification of minors suffering from mental illness, attention is drawn to the following groups of features:
1) external behavior: affective reactions, emotional lability, irritability, tearfulness, nastiness, tendency to aggression, reduced intelligence and memory, seizures and seizures - in epilepsy, conflict or overly conformal behavior;
2) the motives of behavior and the degree of their adequacy to the actions;
3) complaints of headaches, dizziness, exhaustion of the nervous system, fatigue, loss of strength;
4) the appearance of autonomic disorders: pulse lability, arterial pressure asymmetry, shortness of breath;
5) auto-aggressive manifestations in the form of self-harm, as well as the application of awkward tattoos, the continuous application of tattoos that have the opposite meaning and significance.
It is also important for educators and other employees to know the causes and factors causing the state of decompensation, be the first to notice it, take action and inform the doctor. Studies show that most often the occurrence of decompensation is affected by:
- in case of reactive psychosis - getting into a distressing situation, engaging to work without taking into account the mental capabilities of the individual (mainly in monotonous and sedentary work), assigning tasks that require a lot of attention;
- in epilepsy - getting into a traumatic situation; irregular use of anticonvulsant drugs due to poor control of minors by caregivers and health workers (often, adolescents and young men themselves refuse to take medicines for various reasons: tired, not helpful, do not want to go to school and work, etc.); taking alcohol, inhaling vapors of nitrokrasok and acetone, other toxic substances and drugs, etc .;
- with psychopathies - getting into a stressful situation; especially the rudeness and conflictness of those around them, which leads to the deepening of conflicts by excitable psychopaths, violations of the regime, impudent antics, etc .; the delayed warning of excitable psychopaths about responsibility for their behavior and the absence of requirements for them by educators and the collective, inconsistency in the presentation of requirements; the untimely explanation to asthenic psychopaths of the groundlessness of their doubts about something, the lack of timely support and psychological protection; the bad influence of others on unstable psychopaths, under whose influence they begin to resort to the use of alcohol, toxic and narcotic substances, etc.
Thus, the most important factors for the occurrence of states of decompensation are: minor exposure to a traumatic environment, delayed medication, alcohol abuse, intake of toxic substances and drugs, the influence of the surrounding microenvironment, the lack of constant dynamic monitoring and control over their behavior. Teenager R. grew up in his stepfather's family, who did not pay attention to him; his mother was constantly ill. Therefore, R. was left without supervision, wandered, repeatedly participated in thefts. Easily excited at the slightest occasion, behaved unbridled. Psychiatric examination established R. psychopathy excitable type. In order to prevent undesirable consequences during the period of decompensation of the disease, it was necessary, under a specious pretext, to isolate him from the persons hostile to him and ensure that they receive sedatives. However, in a special vocational school, he was uncontrolled. In a conflict with other minors, he grabbed a metal bar and injured a teenager 3.
Otherwise, educators with a student K. who suffered from asthenic psychopathy acted in another special technical school. When he was under the influence of a quick change of the situation upon arrival at the school, decompensation resulted in a painful reaction to the comments, crying, lack of confidence in his abilities, the caregivers reported this to the doctor who had treated and removed the neurotic syndrome. At the same time, the adolescent was created a favorable environment in the team, as a result of which K.'s complaints about the disease ceased. No excesses on his part were allowed.
Our research has shown that mental illnesses in places of social isolation, especially psychopathy, are often observed in a clinically unclean form: the use of alcohol, other intoxicating drugs, and brain injuries, which makes it harder to change their typical traits, change.
As noted above, the presence of persons with mental disabilities can significantly complicate the situation in places of social exclusion, since they themselves are the object of abuse by their inner circle (for example, morons), and their conflicting behavior is contagious for unstable people and dangerously criminal consequences (hooliganism, fights, injuries, self-injury, shoots, sodomy, etc.). To avoid the admission of such persons to a special school, special vocational school or to VC, sometimes the administration does not have the opportunity. It so happens that when taking weak and "erased" types of mental abnormalities simply do not come to light. You can also talk about the careless attitude of forensic psychiatric examiners (especially when they bring them to a special school and vocational school), the desire of employees of local juvenile commissions, law enforcement agencies to get rid of these people who are constantly “bothering” their unlawful forms of behavior.
If there are a significant number of minors with mental disorders, the administration of the institution faces the problem of choosing the principle of recruiting primary teams (departments) and teams of detachments. Due to inexperience and psychological ignorance, they sometimes strive to gather all these people into one primary team or team of a detachment, believing that this supposedly makes it easier to control their treatment and allows them to differentiate educational and preventive work. In practice, this leads to opposite results: a sharp and rapid complication of the operational environment. On the part of adolescents and young men of other groups, a hostile or ironic attitude towards the detachment (department, study group) occurs, where all mentally ill persons are gathered. They are beginning to be called the "detachment of fools," "psychos," "crazy." On the part of the latter, reciprocal hostile actions follow, and a "war" arises between the troops, with all the negative consequences. In the detachment (department), interpersonal and intergroup relations are quickly broken, frequent conflicts, fights between minors arise; pederasty, the use of intoxicants and other violations of the regime are beginning to flourish. Therefore, the most justified principle is the uniform distribution of these persons among the primary groups, with the creation in each of them a "sparing" moral and psychological environment for these adolescents and young people.
Persons with mental disorders along with other minors are involved in social work in the team of the detachment and the primary team. However, significant adjustments should be made to preventive work with them. First of all, one should not allow a psychiatrist to become a center of attraction for them and that they flaunt their illness: "I am mentally ill and everything is permitted to me." They should be explained that they are responsible for their actions, that they will be strictly asked for each offense.
The skillfully organized mode of their study, work and rest is of essential importance in working with them. They must work, taking into account the characteristics of their diseases, which contributes to the correction of behavior, smoothes emotional-volitional disorders, thereby helping them to re-educate. In the distribution of minors by type of activity and training in specialties, a psychiatrist and psychologist take part, who, based on the personality characteristics of the minor, make recommendations on his professional training and application of measures of occupational therapy.
The success of creating a healthy social and psychological climate in the team of minors largely depends on the caregiver, which favors the combination of medical measures with psychological and pedagogical measures in working with adolescents suffering from mental illness. Teenager N. - an executive, disciplined, although painfully reticent, suspicious, was sent to a department on arrival at the institution, which was considered prosperous, but in reality there lived under criminal "laws" and traditions. He headed the department with a young man with criminal installations - the "horn", which with the help of the "sixes" was picking up newcomers, forcing them to work for themselves. Dissatisfied with such orders brutally beaten. Teenager N. did not submit to arbitrariness and was also beaten. After that, he became even more isolated, refused to attend school, for which he was punished. In order to rescue from reprisal from the side of "denial" and to avoid punishment, N. resorted to self-harm, broke his arm, and ended up in the medical unit. In the first days of stay in the medical unit was closed, aggressive. After the removal of stress drugs became available, relaxed and told everything to the doctor. Upon recovery, N. was transferred to another team with a favorable socio-psychological climate, where attention was paid to him, after which no cases of decompensation were observed.
Thus, a decisive suppression of the hostile attitude towards mentally ill adolescents and young men, ridicule, humiliation of them, fixing collective attention on their behavior favors educational and medical work with them. The constancy of the requirements of caregivers and the collective, the stability and certainty of the internal routine of life help them to quickly adapt.
I would like to draw attention to the timely identification of people who have dramatically changed behavior and mood, which are very tense, express a special attitude towards others and persecution (which is typical of reactive psychoses, schizophrenia and other mental illnesses during their exacerbation). In accordance with the law, they are taken timely measures for emergency hospitalization or dismissal from a special school, special vocational school, release from VC in the prescribed manner (after appropriate expertise), which contributes to the improvement of the situation in the team and among the minors of the whole institution.
Persons who have undergone inpatient treatment in a hospital are given dynamic observation. They are carried out preventive and supportive treatment in accordance with the recommendations contained in the history of the disease. The teacher, the master of industrial training, the class teacher must know these people, observe their behavior, place them in a favorable microenvironment, promptly send them to the medical unit for taking the drugs, inform the doctor about any changes in their behavior and mental states.
Along with the ongoing educational work, the creation of favorable conditions for study, work and rest, hypnotic psychotherapy is useful for achieving long-term remission (improving the general condition of the patient) and preventing decompensation1. The caregivers are required to ensure the attendance of minors for sessions of hypnotic psychotherapy, conducted by a doctor, to create the necessary conditions for adolescents and young men before and after such sessions to ensure the effectiveness of this treatment method.

Findings:
1. Due to a number of objective and subjective reasons, a significant contingent of minors suffering from mental illness accumulates in places of social isolation. Social isolation and its attendant factors exacerbate the course of these diseases, causing a state of decompensation. Such persons significantly complicate the situation in the institution, provoking some to commit offenses and showing different types of deviant behavior.
2. The success of educational and preventive work with minors suffering from mental illness depends on the coordinated actions of all the staff of the institution, their close cooperation. Re-education of persons with mental abnormalities is a complex matter, requiring educators and other employees not only a minimum of psychological and pedagogical knowledge, but also the ability to navigate in the field of psychiatry, for which their study should be adjusted.
3. Timely identification of persons with mental disabilities, their registration, follow-up dynamic follow-up and preventive treatment in conjunction with clear and definite regime activities and the organization of psychological, psychotherapeutic and pedagogical influence, the creation of a benevolent moral and psychological atmosphere among minors make it possible not only to prevent decompensation and excesses on their part, but also to achieve significant shifts in their re-education and adaptation to the conditions of working life situ.
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1 For more details, see: PI Boule. Basics of psychotherapy. M .: 1974, Ch. III; Guide to psychotherapy. Coll. authors. Tashkent, 1979, p. 70-76.
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