Scientific Foundations for the Improvement of the Organization of Psycho-Psychiatric Assistance to the Population during Emergency Situations

The dissertation is dedicated to the development of the scientific foundations for improving the organization of psycho-psychiatric assistance to the population during emergency situations of various natures — technological, social, and terrorist. The study is based on a comparative analysis of existing approaches to the organization of the specified type of assistance, conducted at the National Research Institute of Public Health RAMS in Moscow. The work identifies patterns in the provision of psycho-psychiatric assistance to victims and their relatives, as well as to personnel involved in the elimination of emergency consequences.

The author has developed and implemented a model for the organization of specialized psycho-psychiatric assistance in the system of medical institutions of the Department of Health of Moscow, and has also proposed measures for optimizing inter-agency interaction, including with representatives of EMERCOM, the MVD, and mass media. The results of the study were tested in practice from 2002 to 2004, including in the provision of assistance to victims of terrorist acts, aviation disasters, and other emergency situations.

Relevance of the Study. In recent years, the number of emergency situations (ES), especially technological, social, and specifically terrorist acts (T.B. Dmitrieva, V.N. Krasnov, V.P. Kochanov, 2002; Yu.A. Aleksandrovsky, 2000; B.A. Kazakovtsev, 2000; Yu.P. Boyko, 2003), has been increasing.

Annually, more than 200 million people worldwide suffer from natural disasters, approximately 60 million are involved in armed conflicts, and about 48 million are refugees and internally displaced persons (B.A. Kazantsev et al., 2000; N.G. Politova, 2003; Mainville, 2003; Smith, 2003; Winn, 2003).

These circumstances require territorial bodies and health care institutions to adequately develop services of emergency medical assistance to the population (O.P. Shchepin and V.A. Zhukov, 1992; L.G. Kostomarova, 2003; L.I. Stazhadze, 2004).

Effective resolution of the tasks arising during the elimination of consequences of emergencies is possible only with a corresponding, modern level of organization and strategic planning of the health care system. Especially acute is the resolution of these tasks in the context of the emerging course of reforms of the health care system aimed at increasing the legal and economic independence of medical-preventive institutions (E.P. Kakorina, 1999, 2003; D.I. Kicha, 2004; V.Z. Kucherenko, 1996, 2001; Yu.P. Lisitsyn, 1999, 2002; A.L. Lindenbraten, 2002; T.M. Maksimova, 2003; Yu.V. Mikhaylova, 2001; V.K. Ovcharov, 1998, 2004; V.I. Starodubov, 1999, 2000, 2004; E.A. Tishuk, 2000, 2003; V.B. Filatov, 2000, 2003; V.O. Shchepin, 2000, 2003; O.P. Shchepin, 1999, 2004).

Due to the growing significance of emergency problems worldwide and in our country, the development of principles for the organization of psycho-psychiatric assistance during emergencies has become extremely relevant (V.O. Shchepin, 2004).

This task includes the formation of a service and system for providing psycho-psychiatric assistance during emergencies (Z.I. Kekelidze, 1999; Yu.P. Boyko, 2003). Special attention to the provision of the specified types of assistance during terrorist acts is due to the essence of terrorism as a phenomenon aimed at establishing an atmosphere of fear in society, as an attempt to destabilize public processes (A.I. Appenyansky, 2004; Hovan, 2003; Simeon et al., 2003).

Practical experience of foreign specialists and the results of their scientific research in this direction have a number of features determined by differences in organizational forms and principles of building the work of the corresponding services (Cardena, 2000; Sarpy et al., 2003; Simeon et al., 2003). All this does not allow the full transfer of the results of foreign research to the areas of interest to us.

Despite the sufficient scientific and practical material on the subject devoted to medical aspects of emergencies, it should be recognized that research aimed at studying the organizational aspects of psycho-psychiatric assistance reflect only individual sides of the problem and are "tied" to specific circumstances (G.S. Chovdyrova, 2003; I.A. Nazarova, 2003).

Objective of the Study. Based on a comparative analysis of the organization of psycho-psychiatric assistance to the population during emergencies of different types, by various groups of specialists, to present a scientific justification for improving the organization of psycho-psychiatric assistance to the population during emergencies, and to develop and implement a model for the organization of this type of assistance.

The tasks of the study included:

1. Studying the main stages of development of the problem and the current state of the organization of psycho-psychiatric assistance during emergencies;

2. A comparative analysis of the organization of psycho-psychiatric assistance to the population during emergencies of different types, by separate groups of specialists and by the division providing this type of assistance;

3. Developing, testing, and implementing a model for the organization of psycho-psychiatric assistance to the population during emergencies;

4. Determining ways to optimize inter-agency coordination during the elimination of medical consequences of emergencies, including interaction with mass media (MM).

Scientific Novelty of the Study. For the first time, a comparative characterization of the organization of psycho-psychiatric assistance during emergencies depending on the type of emergency and the area of its occurrence is presented.

A comparative analysis of the performance indicators of individual groups of specialists and the division providing specialized psycho-psychiatric assistance during emergencies has been conducted.

A model for the organization of psycho-psychiatric assistance during emergencies has been developed and implemented in the system of medical institutions of the Department of Health of Moscow.

For the first time, ways of coordinating the psycho-psychiatric service of the health care system with representatives of profile services of other agencies (EMERCOM, MVD, etc.) have been analyzed, and recommendations for interaction of the psycho-psychiatric service with mass media have been developed taking into account existing legal norms.

Main Propositions for Defense.

1. Results of the comparative analysis of the organization of psycho-psychiatric assistance to the population during emergencies of different types, by individual groups of specialists, and the advisability of creating a specialized psycho-psychiatric assistance division during emergencies;

2. Model for the organization of psycho-psychiatric assistance during emergencies;

3. Ways to optimize inter-agency coordination during the elimination of consequences of emergencies, issues of interaction with mass media.

Scientific and Practical Significance. The results of the conducted study made it possible to develop and implement a model for the organization of psycho-psychiatric assistance to victims during emergencies, to optimize the processes of managing the forces and resources of the psycho-psychiatric service; to develop algorithms of specialist actions contributing to improving the quality of providing this type of assistance; to develop ways to optimize inter-agency coordination during the elimination of medical consequences of emergencies, which made it possible to improve the level of coordination in the actions of profile services, contributing to the improvement of the organization of psycho-psychiatric assistance to victims, and create prerequisites for conducting further scientific research in this direction.

Implementation of the Study Results in Practice. The results of the study were used in the preparation and implementation of the Moscow Government Decree of November 19, 2002 No. 955-1Sh "On the Medium-Term City Target Program 'Moscow on the Path to a Culture of Peace: Formation of Tolerant Consciousness, Prevention of Extremism, and Education in the Culture of Peace (2002-2004)'", the Order of the Department of Health of Moscow dated November 20, 2003 No. 67 "On Measures for Improving Specialized Psychotherapeutic and Medical-Psychological Assistance to Victims of Extremism and Terrorism", as well as in the process of organizing psycho-psychiatric assistance to victims during emergencies from 2002 to September 2004, including work with relatives of aviation disaster victims, providing assistance to victims of the explosion at the "Rizhskaya" metro station in Moscow, providing assistance to victims of the hostage-taking in Beslan, Republic of North Ossetia, and their relatives who were admitted for treatment to medical institutions of the Department of Health of Moscow.

Testing of the Work. Materials of the study were reported at:

- the 9th Scientific-Practical Conference of the NNII of Public Health RAMS "The Role of Health Care in Protecting Public Health" (Moscow, 2004);

- annual inter-regional scientific-practical conferences of psychotherapists, medical psychologists, and social workers (Moscow, 2002, 2003, 2004); the all-Russian scientific-practical conference "Psychological Rehabilitation of Participants in Armed Conflicts and Persons Affected by Emergency Situations" (Vologda, 2003);

- the all-Russian scientific-practical conference "Man and Medicine" (Moscow, 2004);

- the inter-departmental scientific conference of the GU NNII of Public Health RAMS (Moscow, 2004).

Publications. The main provisions of the study are reflected in the methodological recommendations "Strategy for the Development of Psychotherapeutic and Medical-Psychological Assistance in Emergency Situations and Their Consequences" (methodological recommendations No. 32, approved by the Committee of Health of Moscow, 2001) and in 10 scientific publications.

Volume and Structure of the Work. The dissertation consists of an introduction, a literature review, a chapter dedicated to the program and methods of the study, two chapters containing the main results of the author's research, a conclusion, conclusions and practical recommendations, a bibliography list comprising 195 sources, including 54 foreign ones, appendices, and documents confirming the implementation of the study results in practice. The work is presented across 198 pages, including 6 schemes, 4 tables, and 1 diagram.