Psychiatric rehabilitation

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Psychiatric rehabilitation, also known as psychosocial rehabilitation, and sometimes simplified to psych rehab, is the process of restoration of community functioning and well-being of an individual diagnosed with a mental disorder and who may be considered to have a psychiatric disability. Rehabilitation work is undertaken by rehabilitation counselors, licensed professional counselors, psych rehab consultants or specialists, psychiatrists, social workers, psychologists, occupational therapists and community support workers seeks to effect changes in a person's environment and in a person's ability to deal with his/her environment, so as to facilitate improvement in symptoms or personal distress. These services often "combine pharmacologic treatment, independent living and social skills training, psychological support to clients and their families, housing, vocational rehabilitation, social support and network enhancement and access to leisure activities."[1] There is often a focus on challenging stigma and prejudice to enable social inclusion, on working collaboratively in order to empower clients, and sometimes on a goal of full recovery. The latter is now widely known as a recovery approach or model.

The Board of Directors of the United States Psychiatric Rehabilitation Association (USPRA) approved and adopted the following standard definition of psychiatric rehabilitation: Psychiatric rehabilitation promotes recovery, full community integration and improved quality of life for persons who have been diagnosed with any mental health condition that seriously impairs their ability to lead meaningful lives. Psychiatric rehabilitation services are collaborative, person directed and individualized. These services are an essential element of the health care and human services spectrum, and must be evidence-based. They focus on helping individuals develop skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning, and social environments of their choice.

In Canada, Psychosocial Rehabilitation/Réadaptation Psychosociale (PSR/RPS) Canada promotes education, research and knowledge exchange in relation to evidence-based psychosocial rehabilitation and recovery-oriented practices for service-providers and those receiving services for mental health challenges. A framework of competencies for service providers (individuals and organizations)was developed and announced at the 2013 Annual National Conference in Winnipeg, Manitoba.[2]

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History

From the 1960s and 1970s, the process of de-institutionalization meant that many more individuals with mental health problems were able to live in their communities rather than being confined to mental institutions. Medication and psychotherapy were the two major treatment approaches, with little attention given to supporting and facilitating daily functioning and social interaction. Therapeutic interventions often had little impact on daily living, socialization and work opportunities. There were often barriers to social inclusion in the form of stigma and prejudice. Psychiatric rehabilitation work emerged with the aim of helping the community integration and independence of individuals with mental health problems. "Psychiatric rehabilitation" and "psychosocial rehabilitation" became used interchangeably, as terms for the same practice.[3] These approaches may merge with or conflict with approaches based in the Psychiatric survivors movement, including the concept of user-controlled personal assistance services.[4]

Although current literature in the United States uses the names psychosocial rehabilitation and psychiatric rehabilitation interchangeably, around 2005 the professional organization IAPSRS (International Association of Psychosocial Rehabilitation Services) changed its name to USPRA (United States Psychiatric Rehabilitation Association) and the trend is toward the use of "psychiatric rehabilitation."[5]

Theory

The concept of psychiatric rehabilitation is associated with social psychiatry and is not based on a medical model of disability or the concept of mental illness which is often associated with the words "mental health". However, it can also incorporate elements of a social model of disability. A sometimes similar but sometimes alternative approach employs the concept of psychosocial recovery rather than rehabilitation, and is less centered around professional services.

Psychiatric rehabilitation was promulgated in the US through Boston University's Rehabilitation Research and Training Center on Psychiatric Rehabilitation led by Dr. William Anthony. The concept has been integrated with a community support approach, including supported housing/housing and support, recreation, employment and support, culture/gender and class, families and survivors, family support, and community and systems change. [6] [7][8] [9]

Problems experienced by people with psychiatric disabilities are thought to include difficulties understanding or dealing with interpersonal situations (e.g., misinterpreting social cues, not knowing how to respond), prejudice or bullying from others because they may seem different, problems coping with stress (including daily hassles such as travel or shopping), difficulty concentrating and finding energy and motivation.

Psychiatric rehabilitation is distinct from the concept of independent living and consumer-controlled services which have been written about and promoted by psychiatric survivors.[10][11][12][13] The psychiatric rehabilitation concept is separated from the psychiatric survivor concept, in education and training of individuals with psychiatric disorders, in that psychiatric survivors tend to operate services and control funding.

Services

Psychiatric rehabilitation services may include: workplace accommodations, supported employment or education, social firms, assertive community (or outreach) teams assisting with social service agencies, medication management, housing, employment, family issues, coping skills and activities of daily living and socialising.

Psychiatric rehabilitation is illustrated by community models (e.g., Fountain House Model, MHA Village in Long Beach, CA), cross-field best practices (e.g., supported work), consumer voices (e.g., Rae Unzicker), multiple disabilities (e.g., chemical dependency), training of community residential, employment, education and support service professionals, rehabilitation outcomes, and management and evaluation of services. [14]

Core principles of effective psychiatric rehabilitation (how services are delivered) must include:

  • providing hope when the client lacks it,
  • respect for the client wherever they are in the recovery process,
  • empowering the client,
  • teaching the client wellness planning, and
  • emphasizing the importance for the client to develop social support networks.[15]

Psychiatric rehabilitation (what services are delivered) consists of eight main areas:

  • Psychiatric (symptom management)
  • Health and Medical (maintaining consistency of care)
  • Housing (safe environments)
  • Basic Living Skills (hygiene, meals, safety, planning, chores)
  • Social (relationships, family, boundaries, communications & community integration)
  • Vocational and/or Educational (coping skills, motivation)
  • Financial (personal budget)
  • Community and Legal (resources)

References

  1. ↑ "Psychosocial Rehabilitation Services". Mental Health: A Report of the Surgeon General. Washington, D.C.: United States Department of Health and Human Services. ISBN 978-0-16-050300-9. OCLC 166315877. 
  2. ↑ PSR/RPS Canada, ["http://www.psrrpscanada.ca/index.php"], "PSR/RPS Canada"
  3. ↑ Pratt, Carlos W.; Kenneth J. Gill, Nora M. Barrett and Melissa M. Roberts (2002). Psychiatric rehabilitation. San Diego: Academic Press. ISBN 978-0-12-564431-0. OCLC 64627515. 
  4. ↑ Racino, J. (1995). "Personal Assistance Services: Psychiatric Survivors and People with Psychiatric Disabilities." Syracuse, NY and Boston, MA: Community and Policy Studies. Prepared for the World Institute on Disability. ED 405705 Link label
  5. ↑ Salzer, Mark (2006). Psychiatric Rehabilitation Skills in Practice: A CPRP Preparation and Skills Workbook. Linthicum, Maryland: United States Psychiatric Rehabilitation Association. ISBN 978-0-9655843-6-4. OCLC 168391421. 
  6. ↑ Racino, J. (2000)."Personnel Preparation in Disability and Community Life: Toward Universal Approaches to Support." Springfield, IL: Charles C. Thomas Publishing co. Link label
  7. ↑ Stroul, B. (1994). "Community Support Systems for Persons with Long-Term Mental Illness; A Conceptual Framework." In: L. Spaniol, et al, "An Introduction to Psychiatric Rehabilitation." Columbia, MD: International Association of Psychosocial Rehabilitation Services.
  8. ↑ Murphy, S., Racino, J. & Shoultz, B. (1991). "Rehabilitation of Persons with Psychiatric Disabilities: Course Curriculum." Syracuse, NY; Syracuse University, Division of Special Education and Rehabilitation.
  9. ↑ Shoultz, B. (1988). My home, not theirs: Promising approaches in mental health and developmental disabilities. In: Friedman, S. & Terkelsen, K., Issues in Community Mental Health: Housing". Canton, MA: PRODIST>
  10. ↑ Chamberlin, J. (1978). "On Our Own." New York, NY: McGraw Hill.
  11. ↑ Deegan, P. (1992). The independent living movement and people with psychiatric disabilities: Taking back control of our lives. "Psychosocial Rehabilitation Journal", 15(3), 3-19.
  12. ↑ Harp, H. (1993). Taking a new approach to independent living. "Hospital and Community Psychiatry", 44(5), 413.
  13. ↑ Stewart, L. (1991). "Personal Assistance Services for People with Psychiatric Disabilities." In: Weissman, J., Kennedy, J. & Litvak, S. (Eds.). "Personal Perspectives on Personal Assistance Services and Independent Living." (pp. 67-71). Oakland, CA: World Institute on Disability.
  14. ↑ Spaniol, L., Brown, M.A., Blanlartz, L., Burnhau, D., Dincin, J., Furlong-Norman, K., Nesbitt, N., Ottenstein, P., Prieve, K., Rutman, I., & Zipple, A. (1994). "An Introduction to Psychiatric Rehabilitation." Columbia, MD: International Association of Psychosocial Providers.
  15. ↑ PSR/RPS Canada, , "PSR/RPS Canada Core Principles and Values"

External links

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