Psychiatric Rehabilitation: Its Principles and Practices

The Challenges of Communicating these Through

Training and Education

Kenneth J. Gill, Ph.D., CPRP

Challenge –Defining Psychiatric Rehabilitation

Is it really Psychosocial Rehabilitation?

Is is only skill training and skill development?

Is it only a set of values?

Challenge of Defining Continued

Is it about unique goals ?

Is it a delineated professional role?

Is it a specialty within other professions?

Is it a unique discipline?

Challenge of Defining (con’t.)

Is Psychiatric Rehabilitation unique to community services?

Is it a set of evidence-based best practices?

Is it a set of program models?

Why is it not implemented?

If psychiatric rehabilitation is so great then: Why is it not implemented ? When it is attempted, why is it done poorly?

Unskilled, unprepared staff Dysfunctional teams Poor supervisor support Poor organizational support, lack of “vehicles”

and/or funding

Psychiatric Rehabilitation is:(Pratt, Gill, Barrett, & Roberts, 1999)

Not a simple question William Anthony and colleagues definition

that appeared in their 1990 book Cnaan (1989, 1990) definitions of

principles IAPSRS definitions (1996) for RPRP Our own arguments, rationality and

irrationality

Understanding Psychiatric Rehabilitation

Four Part Model

Four Part Model

Understanding severe and persistent mental illness

Goals, Values, & Principles of PSR Basic Methods of PSR Settings and Approaches where the

principles and methods are applied

The Four Part Model

The Features of Severe and Persistent Mental Illness Understanding the nature of severe and

persistent mental illness and why these disorders make PSR necessary?

Goals Values and Guiding Principles What are the goals, values and principles of

PSR (and why does the illness make them particularly relevant)?

The Four Part Model

The Basic Methods of PSR and its best practices Common to all approaches (explicit or not) Overall and specific goal setting Assessment of functions strengths, skills, and

environments that are relevant Resource development (to support goals) Skill development and practice (not just

explicit skills training)

What does everyone need to know about Psychiatric Rehab ?

The nature of severe and persistent mental illness makes it necessary Long-term Recurrent Difficult courses and history Disruption of may life domains Interruption of skill, support, and experience Many functional deficits

The nature of severe and persistent mental illness That is why there is a focus on:

Long-term recovery ( is there any other kind with severe & persistent mental illness)

Community integration: the illnesses and their associated features and segregate people from their communities

Improving quality of life: the illness and associated problems harm the quality of life

Psychiatric Rehabilitation is about:

Goals Recovery Quality of life Community Integration

Distinguishing it from other helping approaches which are primarily symptom reduction or relief (although these are not contradictory goals)

Values of Psychiatric Rehabilitation

Self-determination Dignity and worth of the individual Optimism or hopefulness for progress of

improvement Belief in the capacity of individuals to

improve self, learn, and grow Sensitivity/understanding to the culture of

others

Values of Psychiatric Rehabilitation

They are important, but are hardly unique. Other helping professions consider them critical They are the values of humanism and the

enlightenment, the best of western civilization What’s the problem with them? They take the moral “high ground”?

Implies others may not have these values Not particularly unique

Values

Nonetheless they are critical to psychiatric rehabilitation?

Why? Due primarily to stigma and discrimination,

people with mental illness have not been able to fully participate in or receive the benefits of these values

The reason PSR must emphasize them is that this remains true, even with its own field

Guiding Principles

Individualize services Maximize client preference and choice Ensure normalized, community basis Focus on strengths Use situational assessments Integrate efforts with treatment holistically Coordinate services, make them accessible

Guiding Principles

Focus on vocational outcomes Employ skills training approaches Consider environmental modifications Partner with families Focus on practical outcomes

(source Pratt et al (1999), p. 94)

The Approaches or Settings Day services Residential/independent living Case management/assertive community treatment Vocational Educational Hospitals Families Consumer-operated

Why are the challenges in Psychiatric Rehab training? Trainee’s attitudes

Lack of optimism or demoralization “Wouldn’t work with our people” “Wouldn’t work in our place”

Organizational Barriers Dysfunctional teams Unsupportive supervisors, Poor leadership Sympathetic supervisor, poor leader Lack of relevant organizational vehicles or structures

More barriers

Training format Consumes time, competes with other

demands Usually a short period of time Often a “one shot” or couple of shots deal Too much content to assimilate Too little directly practical content