Psychiatric Rehabilitation

Research substantially supports the view that consumers with SMI can, with the right type of support, pursue successful normal adult roles in the community.  Mental health services should aim not just to keep the consumers stable and out of the hospital but to help them to pursue their own goals, independence, management of their illnesses, and self-fulfillment— which is what psychiatric rehabilitation (PSR) is all about.  The fundamental concepts of PSR include, but are not limited to, the following:

* Sense of Hope…PSR aims to actively reach out to consumers to engage them in the program, focusing on consumer strengths, building their self-confidence, and instilling hope for recovery through a rehabilitation relationship that appreciates gradual and small successful experiences.  

* Pragmatism…PSR has a focus on helping consumers with the practical problems in daily life, including education, work, welfare payments, housing, family and social relationships, and stress management.  Closely related to this pragmatism is an outcome orientation, wherein services are organized around specific, tangible goals.

* Skills Training…PSR emphasizes helping consumers acquire and apply practical interpersonal and illness management skills needed to achieve community adjustment.

* Integration of Treatment and Rehabilitation…The treatment of psychiatric disorders was revolutionized during the last century by the discovery and development of psychotropic medications.  While medication has become the mainstay of treatment for SMI to reduce symptoms and vulnerability to relapse, many experts agree that it work best in conjunction with practical psychosocial interventions.

* Continuity of Care…The chronic nature of SMI warrants provision of flexible, timely, and long-term support.  For continuity of treatment efforts, it is also incumbent upon community providers and hospitals to work together.

* Community Integration…PSR embraces the principle of normalization, helping consumers exit patient roles, treatment centers, segregated housing arrangements, and sheltered work, and enabling them to pursue normal adult roles in the communities with ongoing support.

* Attention to Consumer Preferences…PSR stresses the importance of individualizing assessment, planning and intervention. Consumers, as experts of their own illnesses, are empowered to set their own goals and make informed decisions in their treatment and rehabilitation, and services are shaped to their preferences (e.g., helping consumers find jobs in the occupations they desire).

Individuals with SMI often experience serious functional impairments. These impairments may affect the way people manage aspects of daily living, such as attending to physical health, work, education, financial management, and family and social relationships.

Research has substantially supported the view that persons with SMI can, with the right type of support, pursue successful normal adult roles in the community. Mental health services should aim not just to keep the consumers stable and out of the hospital, but to help them to pursue their own goals, independence, management of their illnesses, and self-fulfillment-which is what rehabilitation is all about. During the last decade, extensive efforts have been made to document the best rehabilitation approaches to help persons with SMI return to high-quality functional lives to the greatest extent possible. In 1998, a national expert panel identified six areas of interventions having strong research support for their use in the rehabilitation of SMI.

6 Areas of Evidence-Based Practice in PSR 

Critical ingredients of each of the 6 areas are listed below, and it is important to note that all the six areas share key principles, such as community integration as the goal, assertive outreach, focus on consumer strengths, emphasis on consumer needs and choices, individualized and flexible services, long-term support, and cultural sensitivity and competence. Evidence-based practices are often delivered in combination and in a coordinated fashion.      

Identification of effective interventions for SMI is an ongoing effort. One of the most exciting developments in the field of rehabilitation is the commitment by researchers, mental health care professionals, state mental health directors, consumers, and their families, to disseminate and implement the evidence-based practices in routine mental health settings that provide services for persons with SMI. Consumers and their families have a right to have access to interventions that are proven to be effective, and provision of services proven to be ineffective is an unethical practice. The empowered, proactive consumers and their families may be one of the best hopes for the rehabilitation of people with SMI.

     Assertive Community Treatment (ACT):
      * Multidisciplinary team sharing responsibility for the consumers they serve
      * Services available 24 hours/day, 7 days/week
      * Small staff-to-consumer ratio
      * Home & community-based services
      * Highly individualized services
      * Uninterrupted care
      * Time-unlimited support

    Illness Management and Recovery:
     * Psychoeducation
     * Social skills training
     * Relapse prevention & coping
     * Cognitive therapy
     * Medication adherence

    Integrated Dual Disorders Treatment:
     * Integration of mental health & substance abuse interventions
     * Comprehensive assessment & interventions
     * Assertive outreach
     * Motivational interventions
     * Staged approach to recovery
     * Social network & family interventions
     * Time-unlimited support

    Medication:
     * Comprehensive & accurate assessment
     * Involving consumers in guiding their medication treatment
     * Medication choices guided by diagnosis(es), symptoms & treatment history
     * Adequate treatment duration & doses
     * Ongoing monitoring of adherence, symptoms, side effects & tolerability
     * Integration of rehabilitation & medication

    Family Intervention:
     * Assessment of family strengths
     * Involving the family as a partner in the planning & delivery of treatment
     * Flexible services to meet the family's needs
     * Ongoing emotional support
     * Education & training on communication skills & problem-solving techniques
     * Referral to social support networks

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Glossary Terms

Illness Management

Illness Self-Management

Motivational Interviewing

Prodromal Phase

Psychiatric Rehabilitation

Relapse Prevention Plan

Supported Employment