Talk:Psychiatric rehabilitation

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There's three similar pages - Psychosocial rehabilitation, Psychiatric rehabilitation and Recovery model. I think they should either form one page, describing a range of approaches from the psychatric and a focus on function despite illness, through to a full psychosocial recovery goal that isn't necessarily psychiatric. Alternatively maybe two pages would be needed for the psychiatric medical usage separately from the broader, more user-led recovery usage. EverSince 21:45, 22 December 2006 (UTC)

Given no objections or alternative suggestions, I'm going to move most of the content of psychosocial rehabilitation to this page, some of it to psychosocial recovery. It could always be changed back of course EverSince 19:43, 5 January 2007 (UTC)

Response:

Psychosocial Rehabilitation is a unique rehabilitation model. Although there may be overlap with other approaches to psychiatric rehabilitation, I believe that it merits a page of its own. I suggest that the topic be expanded, and that the principles of Psychosocial Rehabilitation be clearly identified.

January 11

Could you clarify in what sense it is a unique model, as opposed to a variant or subset of psychiatric rehabilitation or psychosocial recovery? Even if a merge went ahead, a separate page could still be split off, if the topic was built up enough (currently virtually nothing specific on it). It would be helpful if you could reply, and perhaps make a username for yourself so it's easy to see who's talking. EverSince 13:40, 12 January 2007 (UTC)

Contents

[edit] unique model?

Although the three terms may have become homogenised into having similar meanings, the "recovery model" is based on the psychiatric, mental health, behavioral health workers, or social workers etc. believing in the capacity of the person suffering from a mental illness to recovery. Recovery does not neccesarily mean "cured", anymore than a diabetic recovers from a pancreas infection, but is diabetic for life. This belief or concept is based on psychosocial principles,i.e. Burdening a person in to believing that they are a misfit or outcast cuases what kind of behavior? versus actually valuing a person as a person. -One may refer to the following concerning more similar concepts: Rogerian Psychology, Psychosocial, Person-Centered Therapy and "Positive" Psychology. Psychiatric Rehabilitation and Psychosocial Rehabilitation are only similar if the staff puts these psychosocial principles in to consideration in the treatment of mental illness. The "medical model" as opposed to the "recovery model", would be that cut and dry medical treatment or so-called psychiatric treatment that prescribes almost exclusively only medication and is bureaucratic at best, in its "care" of persons of mental illness.02:17, 16 January 2007 (UTC) Psychologyofrecovery

I agree about the unique meaning of the recovery model, although would add that its usage stems not just from professionals but from consumers/survivors/ex-patients, as described on the psychosocial recovery page - and in that context does more usually refer to the idea and ideal of "full" recovery rather than just remission or improved functioning.
Were you the author of the unsigned comments above or was that someone else? I'm still not sure what was being claimed about the difference between between the terms "psychiatric rehabilitation" and "psychosocial rehabilitation". They appear to be used interchangeably, and to both differ from "recovery" by based on a more medical concept of rehabilitation. EverSince 18:56, 17 January 2007 (UTC)

[edit] Fact about Recovery Re: PSR & PsyR

Mental illnesses or mental disorders such as "schizophrenia" have a better recovery rates than "heart disease, cancer, or diabetes", however persons suffering from the latter suffer from far less social stigma, prejudice and or discrimination.Psychologyofrecovery 02:31, 16 January 2007 (UTC)psychologyofrecovery

[edit] USPRAs and the CPRP

If you look at the USPRAs webpage [www.uspra.org] you might find where Recovery, Psychosocial Rehabilitation, and Psychiatric Rehabilitation come together. Looking at the CPRP certification, you will notice that Paraproffessionals, Behaviorial Health Techs, Psychiatrists, Psychologists, Casemanagers, Direct Service Workers, Psychiatric Nurses and a wide array of various levels of workers in the Mental Health profession are seeking this certification. CPRP (Certified Psychiatric Rehabilitation Practioner)gives the impression that the person certified is a licensed Psychiatrist or similar to; or so it has such a connotation. However it meant, I believe more to denote that the certified person is direct service worker for persons of mental illness, if the "P" in CPRP were replaced with the word "Psychosocial" then it would steer such connotation towards something more suitable for being a high school counselor, which would be a rather differint work proffession. However a CPRP working in behavioral health, would be a person who feels that the "psychosocial elements" of mental illness are most important for treating, such as stigma of mental illness being the psychosocial ailment which is co-morbid to the mental illness. The concept of "recovery" being important to the treatment of the client since it returns the client to feeling of being a human being. The opposition to this being the stigma, imposed mostly by the media. If you will notice, the main stars of most television programs and movies are okay but they see counselors or therapists; which are far and removed from the characters in storyline who are protrayed as "crazy lunatics". In a Drama series such as "ER" there was at least one episode per season making a public service announcement out of the series, where they invoke a "social consciousness" about real issues that the writers feel need be addressed; but then when the psych ward has an escapee it is always a murderer...this is stigma, prejudice and anti-recovery. The protrayal of persons suffering from mental illness as damned for all eternity as villians since of course they will just always be that way, and abandon all hope for them...If you believe in "recovery" you believe there is hope for the client, this hope and faith is 100% readable to the clients, they know if you believe in it or not...and it directly effects the frequency, duration, intensity and latency of the clients symptoms.(Psychologyofrecovery 03:30, 21 January 2007 (UTC))Psychologyofrecovery

That interesting USPRA website seems to use the terms "psychiatric rehabilitation" and "psychosocial rehabilitation" interchangeably. And they recently changed their name to use the former rather than latter term. So I still don't see the need for two separate pages, even if the different wording can sometimes imply a different emphasis on medical worker vs social worker (and I agree that even if termed psychiatric rehab, it involves both types of worker). Do you feel there must be a page for each term?
On the other hand, I do feel that the concept of full recovery should have a separate page. Think we basically agree about its meaning, including the importance of fighting stigma (good point about ER!..sad...). While rehab professionals can (increasingly) talk about full recovery (often seemingly in a PR-type way reflecting its popularity among users, as on that homepage), rehab is still based on a focus on services and "readjustment" (as in their underlying mission statement) and on "managing the symptoms of their mental illness." (homepage). By contrast, the concept of recovery also has a usage derived from addiction circles such as Alcoholics Anonymous and from the consumer/survivor movement, which can have little to do with, and sometimes be opposed to, being a "client", having an "illness" or being "rehabilitated" EverSince 16:31, 21 January 2007 (UTC)

I agree in the concept of "Full Recovery" The problem is in the "controversy" I would call this "intra-stigma" within those who fight stigma,at best those who wave the Recovery banner refer to Mental Illness as 'most likely a permanent condition'...The group "Recovery, Inc" established by Abraham A.Low, M.D. had various similarities to A.A.; although for a time period A.A. rejected SMI persons,for using medications since A.A. was an abstinence organization and psych meds require compliance, the rift was fortunately later resolved. As for a "full recovery" I can use depression as an example, I have some knowledge in "positive psychology" and/or cognitive-behaviorial psychology...basically negative thoughts for a long period of time can cause an inertia in the nuerotransmitters produced in the CNS, as the mind thinks negative, the brain is required to produce "x" amount of Serotonin for an example( as the function of performing the chosen task)this inertia or unwillingness to stop producing chemicals thus creating chemical imbalance; gains momementum from the depression resulting from amplification of negative thinking; and so a vicious cycle. However, six months (as per Dx in ICD & DSMIV lingo) is what is required and as Biological Psych Profs teach is sufficient for chemicals to go into imbalance...So should not the reversal being mood stablizers, anti-depressants, MAO inhibitors, SSRI's and etc. having been administered for six months, while a "positive thinking" program along with a big move out of any 'psychosocial environments' that foster negativity lead to a good prognosis of "full recovery" ... Prehaps PSR(Psychosocial Rehabilitation) and PsyR (Psychiatric Rehabilitation) should be explained on the same page, for their similarities and differinces but show up as differint when searched for and of course directly linked to Recovery. I am combing through the books "Best Practices in Psychosocial Rehabilitation" and "Psychiatric Rehabilitation" and writing notes, the problem being to wiki them is a copyright issue.

...Sorry, the terms "positive" and "negative" used here above was meant in laymans terms not scientific [[[User:Psychologyofrecovery|Psychologyofrecovery]] 04:58, 22 January 2007 (UTC)]

That sounds good to me. It sounds like you might be best placed to organize the article on psychiatric/psychosocial rehabilitation. No doubt you could use brief-ish quotes from, and paraphrase, those books without breaching copyright. If the term psychosocial rehabilitation is redirected to psychiatric rehabilitation I think it would show up separately on a search. I'll go ahead and merge the two pages shortly unless you want to suggest something else or do something else yourself. EverSince 18:47, 25 January 2007 (UTC)

[edit] Merged

I've now merged psychosocial rehabilitation into this page, keeping virtually all of both. Psychologyofrecovery - having discussed this as above, I actually would be happy whether this page was called psychosocial rehab or psychiatric rehab, if you did want to change around. Also if you did feel that enough separate kinds of content developed for two pages, I don't imagine I'd have a prob with splitting back in to two. I guess the main thing now is to concentrate on improving this and the psychosocial recovery pages. Thanks. EverSince 16:28, 30 January 2007 (UTC)

"Note: PSR and PsyR are different terms for the same practice" p108 Psychiatric Rehabilitation Carlos W. Pratt, Kenneth J. Gill, Nora M. Barett, Melissa M. Roberts Copyright 2002

I had not even noticed that statement in my previous reading of the material --Psychologyofrecovery 02:06, 9 February 2007 (UTC)

Cool I've added that source to support that point in the article. I formatted those external links; I think the desriptions could be clarified still so it's clear what they're linking to (with the actual webpage link also being as direct to the content as possible) EverSince 16:46, 17 February 2007 (UTC)

[edit] opening summary section

I don't think this summary is quite right (although it is very close to being right): "Rehabilitation work undertaken by psychiatrists, social workers and other mental health professionals seeks to effect changes in a person's environment and in a person's ability to deal with their environment, so as to factiliate improvement in symptoms or personal distress." The part I question is the last phrase "so as to facilitate improvement in symptoms or personal distress." I don't think that this is the ultimate goal of psychiatric rehabilitation professionals, although they may measure for these outcomes, in addition to others (like improved sense of personal satisfaction, reduced hospitalization periods, reduced disability benefits, retention of housing, retention of competitive employment, etc.) The ultimate goal is really more in line with what is written in the opening sentence: "restoration of [independent] community functioning". "Improvement in symptoms or personal distress" is ultimately a treatment goal, but psychiatric rehabilitation is only indirectly related to treatment (i.e. unlike psychiatric medication and psychotherapy--forms of psychiatric treatment--it isn't directly aimed at reducing symptoms). Psychiatric rehabilitation aims to enable and to empower individuals to manage and control their symptoms so that they can attain the social roles of their choice in the community.PeasantScribbler 18:59, 27 March 2007 (UTC)

I agree with PeasantScribbler on this point. Psychiatric rehabilitation is primarily concerned with community functioning, as opposed to symptom severity. Symptom reduction is essentially instrumental: one means of assisting individuals to achieve their functional goals. Aaronjlevitt 17:21, 11 April 2007 (UTC)

Meant to agree to this also, I think the text should be revised to clarify as above. I would suppose that the improvement of reported life satisfaction and quality of life can be seen as central goals (and in that sense so is the reduction of distress?) but not only or directly through symptom reduction as you say. EverSince 17:39, 11 April 2007 (UTC)