Psychiatric rehabilitation

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Psychiatric rehabilitation, also known as psychosocial rehabilitation, and sometimes simplified to psych rehab by providers, is the process of restoration of community functioning and well-being of an individual diagnosed in mental health or mental or emotional disorder and who may be considered to have a psychiatric disability. Psychiatric rehabilitation work is undertaken by rehabilitation counselors (especially the individuals educated in psychiatric rehabilitation), licensed professional counselors (who work in the mental health field), psych rehab consultants or specialists (in private businesses), university level Masters and PhD levels, classes of related disciplines in mental health (psychiatrists, social workers, psychologists, occupational therapists) and community support or allied health workers represented in the new Direct Support Professional Workforce in the US (e.g., psychiatric aides).

These workers seek 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 and life outcomes. These services often "combine pharmacologic treatment (often required for program admission), independent living and social skills training, psychological support to clients and their families, housing, vocational rehabilitation and employment, 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.

Yet, new in these fields is a person-centered approach to recovery(Rudnick & Roe, 2011) [2] and client-centered therapy based upon Carl Rogers (Raskin, 2004).[3] and user-service direction (as approved by the Centers for Medicaid and Medicare).

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, and generally evidence-based practices for "adult services". These services are an essential element of the health care and human services spectrum, and are evidence-based for the population groups, but not tested, for example on children with disabilities. 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.

Psychiatric rehabilitation leaders in the university sector are Dr. William Anthony and Dr. Marianne Farkas of Boston University,[4] among other professors and teachers such as Julie Ann Racino, Steve Murphy and Bonnie Shoultz of Syracuse University(1989-1991) who also support a generic community approach to education (Racino, 1999). In 2012, Temple University also is funded in the field of psychiatric disabilities at a national center with the National Institute on Disability Rehabilitation Research (NIDRR), US Department of Education, having this population group as a priority.

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.[5]

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History[edit]

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.[6] These approaches may merge with or conflict with approaches based in the Psychiatric survivors movement, including the concept of user-controlled personal assistance services.[7]

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."[8]

Theory[edit]

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.

Psychosocial services, in contrast, have been associated with the term "mental health" as part of community support movement nationwide since the 1970s. These services, which have roots in education, psychology and mental health (and community services)administration, were basic funded services of new community mental health agencies offering community living and professionalized community support since the 1970s.

Psychiatric rehabilitation was promulgated in the US through Boston University's Rehabilitation Research and Training Center on Psychiatric Rehabilitation led by Dr. William Anthony.[9] 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.[10][11][12][13][14][15]

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. People leaving psychiatric centers after long-term hospitalizations, an outdated practice, may also have need to assist with injuries that may have occurred and Community integration.

Psychiatric rehabilitation is distinct from the concept of independent living and consumer-controlled services which have been written about and promoted by psychiatric survivors.[16][17][18][19] 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[edit]

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. Traditionally, "24-hour" service programs (supervised and regulated options) were based upon the concept of instrumental and daily living skills as formulated in the World Health Organization (WHO)definition.

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.[20]

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.[21]

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)

In 2013, it is expected that areas such as supported housing, household management, quality medical plans, advocacy for rights, counseling, and community participation be part of the available package of options for services. Modernization in these fields includes better health care, such as women and men's health (e.g., heart disease), public and private counseling services in mental health, integrated services (for dual and multiple diagnoses), new specialized treatments (e.g., eating disorders), and understanding of trauma services and mental health. Psychiatric rehabilitation is typically associated with long term services and supports in the community, and are described in "Public Administration and Disability: Community Services Administration in the US" (Racino, in press, 2014).[22]

References[edit]

  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. ^ Rudnick, A. & Roe, D. (2011). "Serious Mental Illness: Person-Centered Approaches". London: Radcliffe Publishing Co.
  3. ^ Raskin, N. (2004). "Client-Centered Therapy and the Person-Centered Approach". UK: PCCS Books.
  4. ^ Anthony, W., Cohen, M., Farkas, M. & Gagne, D. (2002). "Psychiatric Rehabilitation." Boston, MA: Center for Psychiatric Rehabilitation, Sargent College of Health and Rehabilitation Sciences. Boston, MA: Boston University.
  5. ^ PSR/RPS Canada, [1], "PSR/RPS Canada"
  6. ^ 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.  [page needed]
  7. ^ 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
  8. ^ 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. [page needed]
  9. ^ Anthony, W. (2009). Psychiatric rehabilitation leadership. "Psychiatric Rehabilitation Journal", 24(2): 150-159.
  10. ^ Carling, P. (1995). Return to Community: Building Support Systems for People with Psychiatric Disabilities". NY: Guilford Press.
  11. ^ Racino, J. (2000)."Personnel Preparation in Disability and Community Life: Toward Universal Approaches to Support." Springfield, IL: Charles C. Thomas Publishing Co. Link label
  12. ^ 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.
  13. ^ 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.
  14. ^ 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>
  15. ^ Carling, P.(1993). Housing and supports for persons with mental illness: Emerging approaches to research and practice. "Hospital and Community Psychiatry", 44(5): 439-449.
  16. ^ Chamberlin, J. (1978). "On Our Own." New York, NY: McGraw Hill.
  17. ^ 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.
  18. ^ Harp, H. (1993). Taking a new approach to independent living. "Hospital and Community Psychiatry", 44(5), 413.
  19. ^ 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.
  20. ^ 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.
  21. ^ PSR/RPS Canada, [2], "PSR/RPS Canada Core Principles and Values"
  22. ^ Racino, J. (2014, in press). "Public Administration and Disability: Community Services Administration in the US". NY, NY: CRC Press, Francis and Taylor.

External links[edit]

  • Anthony, W. A., & Farkas, M. D."Primer on the Psychiatric Rehabilitation Process", Boston University.
  • PSR/RPS Canada [3]
  • Association for Community Living, New York State [4]
  • National Institute on Disability Research and Rehabilitation [5]
  • National Institute on Mental Health [6]
  • Commission on Rehabilitation Counselor Education [7]
  • National Rehabilitation Counseling Association [8]
  • American Rehabilitation Counseling Association [9]
  • Conard House
  • Recovery-Focused Psychoeducational Articles by Psychiatric Librarian Will Jiang, MLS [10]