Psychiatric Rehabilitation: Its Principles and Practices

1
Psychiatric Rehabilitation Its Principles and
Practices

• The Challenges of Communicating these Through
  Training and Education
• Kenneth J. Gill, Ph.D., CPRP

2
Challenge Defining Psychiatric Rehabilitation

• Is it really Psychosocial Rehabilitation?
• Is is only skill training and skill development?
• Is it only a set of values?

3
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?

4
Challenge of Defining (cont.)

• Is Psychiatric Rehabilitation unique to
  community services?
• Is it a set of evidence-based best practices?
• Is it a set of program models?

5
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

6
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

7
Understanding Psychiatric Rehabilitation

• Four Part Model

8
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

9
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)?

10
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)

11
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

12
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

13
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)

14
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

15
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
• Whats the problem with them?
• They take the moral high ground?
• Implies others may not have these values
• Not particularly unique

16
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

17
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

18
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)

19
The Approaches or Settings

• Day services
• Residential/independent living
• Case management/assertive community treatment
• Vocational
• Educational
• Hospitals
• Families
• Consumer-operated

20
Why are the challenges in Psychiatric Rehab
training?

• Trainees attitudes
• Lack of optimism or demoralization
• Wouldnt work with our people
• Wouldnt work in our place
• Organizational Barriers
• Dysfunctional teams
• Unsupportive supervisors,
• Poor leadership
• Sympathetic supervisor, poor leader
• Lack of relevant organizational vehicles or
  structures

21
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