Improving the legal and regulatory framework for rehabilitation in psycho-neurological residential facilities: from a custodial care to a psychosocial model

Objective. To analyze the current legal and regulatory framework of the Republic of Belarus governing the rehabilitation of individuals residing in psycho-neurological social boarding houses, to identify systemic barriers to rehabilitation, and to scientifically substantiate the need for improving the conceptual apparatus to enhance the effectiveness of the rehabilitation process.
Materials and methods. A systematic analysis of legal acts of the Republic of Belarus, international guiding documents, and scientific publications on rehabilitation, long-term care, and the rights of persons with mental disorders was conducted using methods of comparative legal analysis, a systemic approach, and conceptual modeling.
Results. It was established that the Republic of Belarus has a progressive legislative framework guaranteeing the right to rehabilitation for persons with functional limitations. However, in the specific conditions of psycho-neurological social boarding houses, a systemic “implementation gap” is observed between the declared rights and their practical application. This gap is due to institutional barriers, interdepartmental fragmentation, and the absence in legislation of concepts that account for the complexity of the rehabilitation process in institutional setting. It is substantiated that the existing concept of “psychological assistance” is insufficient to describe the comprehensive process of rehabilitation and requires the introduction and legislative consolidation of the term “psychosocial rehabilitation”, implemented through an intersectoral approach and the activities of an intersectoral rehabilitation team.
Conclusion. Rehabilitation in the setting of a psycho-neurological social boarding house has its own specific features and requires a paradigm shift from a custodial model to a rehabilitation-oriented model. Overcoming existing barriers to rehabilitation is impossible without improving the conceptual and regulatory apparatus. The introduction of the concepts of “psychosocial rehabilitation” and “ntersectoral rehabilitation team” into scientific discourse will create a basis for developing modern standards and protocols, integrating disparate types of assistance into a single, person-centered, iterative process, and as a consequence, enhancing the quality of the rehabilitation process in the setting of a psycho-neurological social boarding house.

1. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990—2019 : a systematic analysis for the global burden of disease study 2019 / GBD 2019 Risk Factors Collaborators [et al.] // The Lancet. — 2020. — Vol. 396 (10258). — Р. 1223—1249. — DOI: 10.1016/S0140-6736(20)30752-2.

2. Hong, C. Response of global health towards the challenges presented by population aging / C. Hong, L. Sun, G. Liu [et al.] // China CDC Weekly. — 2023. — Vol. 5 (39). — Р. 884—887. — DOI: 10.46234/ccdcw2023.168.

3. Cookson, C. The changing picture of disease: living longer may not mean living healthier / C. Cookson // Financial Times. — 2024. — URL: https://www.ft.com/content/18aec512-1036-4a9e-8dcb-605890c6ae2a (date of access: 18.08.2025).

4. Zhang, X. Barriers and facilitators to dementia care in long-term care facilities : protocol for a qualitative systematic review and meta-synthesis / X. Zhang, C. Guan, J. He [et al.] // BMJ Open. — 2023. — Vol. 13 (11). — URL: https://bmjopen.bmj.com/content/13/11/e076058.info (date of access: 11.08.2025).

5. Custodero, C. Editorial: challenges in dementia care: a global perspective / C. Custodero // Frontiers in Psychiatry. — 2024. — Vol. 15. — URL: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1450368/full (date of access: 11.08.2025).

6. Ye, B. Why are people with dementia overlooked in long-term care insurance policy in Guangzhou, China? / B. Ye, Y. Xu, W. K. Chan [et al.] // BMC Health Services Research. — 2024. — Vol. 24 (1). — URL: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-12126-1 (date of access: 11.08.2025).

7. Chamberlain, S. A. Characteristics of socially isolated residents in long-term care : a retrospective cohort study / S. A. Chamberlain, W. Duggleby, P. B. Teaster [et al.] // Journal of Gerontology & Geriatric Medicin. — 2020. — Vol. 6. — URL: https://pubmed.ncbi.nlm.nih.gov/33283023/ (date of access: 11.08.2025).

8. Boamah, S. A. Social isolation among older adults in long-term care : a scoping review / S. A. Boamah, R. Weldrick, T. J. Lee [et al.] // Journal of Aging and Health. — 2021. — Vol. 33 (7—8). — Р. 618—632. — DOI: 10.1177/08982643211004174.

9. Rehabilitation 2030: a call for action / WHO. — URL: https://www.who.int/initiatives/rehabilitation-2030 (date of access: 24.04.2023).

10. Примачонак, Г. А. Управление социальной реабилитацией, абилитацией инвалидов в новых условиях: проблемы и решения / Г. А. Примачонак, О. А. Лабейко // Проблемы социальной гигиены, здравоохранения и истории медицины. — 2021. — Т. 29, № S1. — URL: https://journal-nriph.ru/journal/article/view/630 (дата обращения: 11.08.2025).

11. Funk, M. K. Mental health legislation / M. K. Funk, N. J. Drew // The Eastern Mediterranean Health Journal. — 2015. — Vol. 21 (7). — Р. 527—530. — DOI: 10.26719/2015.21.7.527.

12. Конституция Республики Беларусь 1994 года : с изм. и доп., принятыми на респ. референдумах 24 нояб. 1996 г., 17 окт. 2004 г. и 27 февр. 2022 г. // ilex : информ.-правовая система (дата обращения: 18.08.2025).

13. Byrne, G. J. Implementation science in the nursing home / G. J. Byrne // International Psychogeriatrics. — 2021. — Vol. 33 (9). — Р. 865—866. — DOI: 10.1017/S104161022000383X.

14. Lekovitch, C. Implementation in nursing homes: describing early and late adopters of an evidence-based dementia care program / C. Lekovitch, P. Toto, F. Chew [et al.] // Innovation in Aging. — 2021. — Vol. 5 (1). — Р. 547. — DOI: 10.1093/geroni/igab046.2102.

15. О ратификации Конвенции о правах инвалидов : Закон Респ. Беларусь, 18 октября 2016 г., № 424-З // Национальный правовой интернет-портал Республики Беларусь — URL: https://pravo.by/document/?guid=12551&p0=H11600424 (дата обращения: 11.08.2025).

16. Chiu, T. Y. From fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country / T. Y. Chiu, H. W. Yu, R. Goto [et al.] // BMC Geriatrics. — 2019. — Vol. 19 (1). — Р. 159. — DOI: 10.1186/s12877-019-1172-5.

17. Mortensen, A. H. Residents' experiences of paternalism in nursing homes / A. H. Mortensen, D. Nåden, D. Karterud Goto [et al.] // Nursing Ethics. — 2024. — Vol. 31 (2—3). — Р. 176—188. — DOI: 10.1177/09697330231166085.

18. Ogletree, A. M. Omissions of care in nursing home settings : a narrative review / А. М. Ogletree, R. Mangrum, Y. Harris [et al.] // The Journal of the American Medical Directors. — 2020. — Vol. 21 (5). — URL: https://www.jamda.com/article/S1525-8610(20)30212-7/abstract (date of access: 11.08.2025).

19. Rasmus, P. The Influence of a Psychosocial Rehabilitation Program in a Community Health Setting for Patients with Chronic Mental Disorders / P. Rasmus, A. Lipert, K. Pękala [et al.] // International Journal of Environmental Research and Public Health. — 2021. — Vol. 18 (8). — URL: https://www.mdpi.com/1660-4601/18/8/4319 (date of access: 18.08.2025).

20. О правах инвалидов и их социальной интеграции : Закон Респ. Беларусь, 30 июня 2022 г., № 183-З // Национальный правовой интернет-портал Республики Беларусь — URL: https://pravo.by/document/?guid=3871&p0=H12200183 (дата обращения: 18.08.2025).

21. О здравоохранении : Закон Респ. Беларусь, 18 июня 1993 г., № 2435-XII // Национальный правовой интернет-портал Республики Беларусь. — URL: https://pravo.by/document/?guid=3871&p0=v19302435 (дата обращения: 18.08.2025).

22. Об оказании психиатрической помощи : Закон Респ. Беларусь, 2 января 2012 г. № 349-З // Национальный правовой интернет-портал Республики Беларусь. — URL: https://pravo.by/document/?guid=3961&p0=H11200349 (дата обращения: 18.08.2025).

23. Об оказании психологической помощи : Закон Респ. Беларусь, 1 июля 2010 г. № 153-З // Национальный правовой интернет-портал Республики Беларусь. — URL: https://pravo.by/document/?guid=3961&p0=H11000153 (дата обращения: 18.08.2025).

24. О порядке организации и проведения медицинской реабилитации, медицинской абилитации : приказ Министерства здравоохранения Респ. Беларусь, 1 сентября 2022 г., № 1141 // Национальный правовой интернет-портал Республики Беларусь. — URL: https://etalonline.by/document/?regnum=u622e2877&q_id=0 (дата обращения: 18.08.2025).

25. Всемирная организация здравоохранения (WHO) : Psychosocial rehabilitation : a review of the concept and its implications. — Geneva : WHO; 2010. — 52 p.

26. International Classification of Functioning, Disability and Health (ICF) / World Health Organization. — Geneva : WHO, 2001. — 303 р.

27. Williams, C. The Psychosocial Impact of Neurobehavioral Disability / C. Williams, R. L. Wood, N. Alderman [et al.] // Front Neurol. — 2020. — Vol. 11. — Р. 119. — DOI: 10.3389/fneur.2020.00119.

28. The national imperative to improve nursing home quality: honoring our commitment to residents, families, and staff / National Academies of Sciences, Engineering, and Medicine. — Washington, DC : The National Academies Press, 2022. — 604 р.— DOI: 10.17226/26526.

29. Корзун, В. А. Специфика реабилитации лиц с когнитивными расстройствами, проживающих в психоневрологическом доме-интернате для престарелых и инвалидов / В. А. Корзун, Т. А. Емельянцева, А. А. Лакутин // Медицина. Социология. Философия. Прикладные исследования. — 2024. — № 2. — С. 102—108.

30. Шмонин, А. А. Базовые принципы медицинской реабилитации, реабилитационный диагноз в категориях МКФ и реабилитационный план / А. А. Шмонин, М. Н. Мальцева, Е. В. Мельникова // Вестник восстановительной медицины. — 2017. — № 2 (78). — С. 16—22.