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 emotional disorder and who may be considered to have a psychiatric disability.
Society affects the psychology of an individual by setting a number of rules, expectations and laws. 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 (
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
Yet, new in these fields is a person-centered approach to recovery
Definition
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Psychiatric rehabilitation is not a practice but a field of academic study or discipline, similar to social work or political science; other definitions may place it as a specialty of community rehabilitation or physical medicine and rehabilitation. It is aligned with the community support development of the National Institute on Mental Health begun in the 1970s, and is marked by a rigorous tradition of research, training and technical assistance, and information dissemination regarding a critical population group (e.g., psychiatric disability) in the US and worldwide.[6] The field is responsible for developing and testing new models of community service for this population group.[7][8][page needed][9][page needed][10][page needed][11][page needed]
The Psychiatric Rehabilitation Association provides this 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 should 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.[12]
The term was added to the U.S. National Library of Medicine's Medical Subject Headings in 2016. There, psychiatric rehabilitation is defined as a:
Specialty field that promotes recovery, community functioning, and increased well-being of individuals diagnosed with mental disorders that impair their ability to live meaningful lives.[13]
History
From the 1960s and 1970s, the process of
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.[14][page needed] These approaches may merge with or conflict with approaches based in the psychiatric survivors movement, including the concept of user-controlled personal assistance services.[15]
In the 1980s, the US Department of Education, National Institute on Disability Research and Rehabilitation, revised a Rehabilitation Research and Training Center program to meet the new needs in the community of special population groups. A priority center, published in the Federal Register, was the Rehabilitation Research and Training Center in Psychiatric Disabilities (awarded to William Anthony's Boston University Center). As of 2015,[update] it remains a priority center, providing nationwide assistance and serving as flagship center internationally.[citation needed]
With the founding of Psychosocial Rehabilitation Canada in 2004, the professional organization International Association of Psychosocial Rehabilitation Services (IAPSRS) changed its name to
Academic discipline
In 2012,
Theory
The theoretical base for psychosocial then psychiatric rehabilitation is community support theory as the foundational theory; it is aligned with integration and community integration theories, psychosocial theories, and the rehabilitation and educational paradigms. Its fluid nature is due to variability in development and integration into other essential fields such as family support theories (for this population group) which has already developed its own evidence-based parent education models.[citation needed]
The concept of psychiatric rehabilitation is associated with the field of community rehabilitation and later on
The Journal of Psychosocial Rehabilitation, then renamed the Journal of Psychiatric Rehabilitation,[full citation needed] traces the development of the field over a period of several decades. The academic discipline psychiatric rehabilitation has contributed new models of services such as supported education, has cross-validated models from other fields (e.g., supported employment), has developed the first university-based community living models for populations with "severe mental illness", developed institutional to community training and technical assistance, developed the degree programs at the university levels, offers leadership institutes, and worked collaboratively to expand and upgrade older models such as clubhouses and transitional employment services, among others.[citation needed]
Psychiatric rehabilitation was developed and formulated as a new profession of community workers (not medical psychiatry which is an MD awarded by a Medical School) which could assist both in deinstitutionalization (e.g., systems conversion) and in community development in the US. It represents the first Master's and Ph.D. classes in the US to specialize in a rehabilitation discipline focused on community versus institutions or campuses. In the US, it also represents a movement toward evidence-based practices, critical for the development of viable community support services.[citation needed]
Psychosocial services, in contrast, have been associated with the term "mental health" as part of community support movement nationwide since the 1970s which has an academic and political base. 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. Mental health service agencies or multi-service agencies in the non-profit and voluntary sectors form a critical delivery system for psychosocial services. In the 2000s, a sometime similar but sometimes alternative approach (variability and fidelity of provider implementation in the field) employs the concept of psychosocial recovery.[citation needed]
Psychiatric rehabilitation was promulgated in the US through Boston University's Rehabilitation Research and Training Center on Psychiatric Rehabilitation led by Dr. William Anthony[18] and Marianne D. Farkas,[19][page needed] as well as 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.[20][page needed][ISBN missing] 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.[21][page needed][22][page needed][23][24][page needed][25][26]
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.[27][page needed][28][29][30] 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.
Principles
The mission of psychiatric rehabilitation is to enable with best practices of illness management, psychosocial functioning, and personal satisfaction. Treatments and practices towards this is guided by principles. There are seven strategic principles:[31]
- Enabling a normal life.
- Advocating structural changes for improved accessibility to pharmacological services and availability of psycho-social services.
- Person-centered treatment.
- Actively involving support systems.
- Coordination of efficient services.
- Strength-based approach.
- Rehabilitation is not time specific but goal specific in succeeding.
The peer-provider approach is among the psychosocial rehabilitation practices guided by these principles. Recovery through rehabilitation is defined possible without complete remission of their illness, it is geared towards aiding the individual in attaining optimum mental health and well-being.[32]
Services
Psychiatric rehabilitation services may include: community residential services, workplace accommodations,
Psychiatric rehabilitation is illustrated by agency models which are offered by traditional and non-traditional service providers, and may be considered to be integrated (e.g. dispersed sites in the community) or segregated (e.g., campus-based facilities or villages). (e.g.
Agencies may deliver cross-field best practices (e.g., supported work), consumer voices (e.g., Rae Unzicker), multiple disabilities (e.g., chemical dependency), training of its own community residential, employment, education and support service professionals, rehabilitation outcomes, and management and evaluation of its own services.[33]
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 recoveryprocess,
- empowering the client,
- teaching the client wellness planning, and
- emphasizing the importance for the client to develop social support networks.[34]
Psychiatric rehabilitation (what services are delivered) varies by provider and may consist of eight main areas:
- Psychiatric (symptom management; relaxation, meditation and massage; support groups and in-home assistance)
- Health and Medical (maintaining consistency of care; family physician and mental health counseling)
- Housing (safe environments; supported housing; community residential services; group homes; apartment living)
- Basic Living Skills (personal care, preparing and sharing meals, home and travel safety and skills, goal and life planning,
chores and group decision-making, shopping and appointments)
- Social (relationships, recreational and hobby, family and friends, housemates and boundaries, communications and community integration)
- Vocational and/or Educational (vocational planning, transportation assistance to employment, preparation programs (e.g., calculators), GED classes, televised education, coping skills, motivation)
- Financial (personal budget), planning for own apartment (startup funds, security deposit), household grocery; social security disability; banking accounts (savings or travel)
- Community and Legal (resources; health insurance, community recreation, memberships, legal aid society, homeownership agencies, community colleges, houses of worship, ethnic activities and clubs; employment presentations; hobby clubs; special interest stores; summer city schedules)
As of 2013[update], 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 (LTSS) in the community[35][page needed] including post secondary education as supported education.[36][37][38][full citation needed][39]
Educational and professional organizations
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Canada
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.[40]
United States
- Boston University, Center for Psychiatric Rehabilitation
- Psychiatric Rehabilitation Association, formerly the United States Psychiatric Rehabilitation Association and International Association for Psychosocial Rehabilitation; a professional organization founded in 1975.[12][17]
- Rutgers School of Health Related Professions, Department of Psychiatric Rehabilitation and Counseling Professions
References
- OCLC 166315877.
- ^ "Social inclusion and recovery" (PDF). Australian Department of Health and Ageing.
- ^ King, R. et al., 2007
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- ISBN 978-1-878512-32-1.
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- OCLC 26313717.
- ^ a b "About PRA". Psychiatric Rehabilitation Association. Archived from the original on 15 February 2015. Retrieved 15 February 2015.
- ^ "Psychiatric Rehabilitation". MeSH. National Center for Biotechnology Information, U.S. National Library of Medicine. Archived from the original on 17 November 2016. Retrieved 17 November 2016.
- OCLC 64627515.
- ^ Racino, Julie Ann (May 1995), "Personal Assistance Services in the Field of Psychiatric Disabilities" (PDF), Personal Assistance Services (PAS): Toward Universal Access to Support (Annotated Bibliography), Washington, DC: National Institute on Disability and Rehabilitation Research (U.S. Department of Education/OSERS), pp. 48–67 (PDF 53–72), ERIC ED405705
- OCLC 168391421.
- ^ a b c "Our History". Psychiatric Rehabilitation Association. Archived from the original on 7 November 2016. Retrieved 17 November 2016.
- PMID 19592373.
- OCLC 48958329.
- ^ Racino (1999). "Psychiatric survivors and the international self-help movement". In Racino, J.A. (ed.). Policy, Program Evaluation and Research in Disability: Community Support for All. London: Haworth Press.
- OCLC 30979396.
- OCLC 43913226.
- doi:10.1037/h0099536.
- ^ Murphy, S.; Racino, J.; Shoultz, B. (1991). Rehabilitation of Persons with Psychiatric Disabilities: Course Curriculum (Report). Syracuse, NY: Syracuse University, Division of Special Education and Rehabilitation.
- OCLC 18625648.
- PMID 8509074.
- OCLC 3688638.
- doi:10.1037/h0095769.
- PMID 8509069.
- ^ Stewart, Loralee (1992). "PAS for People with Psychiatric Disabilities" (PDF). In Weissman, Julie; Kennedy, Jae; Litvak, Simi (eds.). Personal Perspectives on Personal Assistance Services. Oakland, CA: World Institute on Disability. pp. 67–71 (PDF 75–79).
- OCLC 672234137.
- OCLC 865475177– via Google Books.
- OCLC 32406183.
- ^ "Principles of Psychosocial Rehabilitation (PSR)". PSR/RPS Canada.
- OCLC 898155148.
- doi:10.1037/h0095637.
- ^ Mowbray, C.T., Brown, K.S., Furlong-Norman, K. & Soydan, A.S. (2002). Supported Education and Psychiatric Rehabilitation. Linthicum (Columbia), MD: International Association of Psychosocial Rehabilitation Resources.
- ^ Unger, 2002.
- doi:10.1037/h0095633.
- ^ "Psychosocial Rehabilitation Association of Canada". PSR/RPS Canada.
Further reading
- Anthony, William A.; Farkas, Marianne D. (2009). "A Primer on the Psychiatric Rehabilitation Process" (PDF). Boston, MA: Center for Psychiatric Rehabilitation, Boston University.
- Chronister, Julie A.; Johnson, Erica K.; Berven, Norman L. (2006). "Measuring social support in rehabilitation". Disability and Rehabilitation. 28 (2): 75–84. S2CID 26281073.
- Cnaan, Ram A.; Blankertz, Laura; Messinger, Karlyn W.; Gardner, Jerome R. (January 1990). "Experts' assessment of psychosocial rehabilitation principles". Psychosocial Rehabilitation Journal. 13 (3): 59–73. doi:10.1037/h0099488.
- Cook, Judith A.; Hoffschmidt, Sara J. (1993). "Comprehensive Models of Psychosocial Rehabilitation". In Flexer, Robert W.; Solomon, Phyllis L. (eds.). Psychiatric Rehabilitation in Practice. Boston: Andover Medical Publishers. pp. 81–97. OCLC 26313717.
- OCLC 147477213.
- Nemec, Patricia B.; Norman, Kathleen F. (2014). Best Practices in Psychiatric Rehabilitation. Psychiatric Rehabilitation Association. ISBN 978-0-615-96265-8.
- OCLC 148726600.