What is Psychosocial Rehabilitation?
Psychosocial rehabilitation (also known as psychiatric rehabilitation) is a constellation of services designed for persons with serious mental illnesses and severe functional deficits. The goal of psychosocial rehabilitation is to enable individuals to compensate for, or eliminate the functional deficits, and to restore ability for independent living. Psychosocial rehabilitation represents a revolution in the treatment of serious mental illnesses, and was developed in the same era as medications. Medications primarily address the positive symptoms, like delusions, hallucinations, and depression or mood swings. Psychosocial rehabilitation counteracts the negative symptoms of the illness, like difficulty staying on task, concentrating, and being assertive. It does this by teaching skills and coping techniques, and helping the individual develop a supportive environment, and restore a sense of mastery over his or her life. Psychosocial rehabilitation providers build on the strengths of each individual, by emphasizing wellness and by including families and the community in the recovery process. (IAPSRS, 1995)
Serious mental illnesses include Schizophrenia, Bipolar Disorder, Major Depression and many of the personality and organic mental disorders that historically often resulted in institutionalization. Psychiatric medications and the practice of psychosocial rehabilitation developed as alternatives to state psychiatric institutions in the 1940's and 1950's. The development of community-based day support, residential and vocational services (the places where psychosocial rehabilitation is practiced) made it possible for men and women with serious mental illness to leave the "patient" role behind them and get on with their lives in decent housing, with good jobs, and lasting friendships. The era of deinstitutionalization accelerated as government funding became available in many countries to support community treatments, and major court decisions supported patients’ right to treatment in the least restrictive and most facilitative environments. (IAPSRS, 1999)tablish contacts around the world to help IAPSRS share its knowledge and learn new ideas.
What is the International Association for Psychosocial Rehabilitation (IAPSRS)?
The International Association for Psychosocial Rehabilitation (IAPSRS) is the pre-eminent professional association for the development of, support for, and information about the practice of psychosocial rehabilitation. Many of the founders of the field of psychosocial rehabilitation served as the founding members of IAPSRS, which was established in 1975. The membership of IAPSRS consists of practitioners, academicians, consumers and family members, who represent a diverse array of treatment settings and academic backgrounds, but are united in their support and practice orientation to enabling consumers to build upon their inherent strengths in developing and enhancing the skills needed for optimal living in today’s world. (IAPSRS, 1999)
Core Principles and Values of IAPSRS
IAPSRS subscribes to a set of core principles and values which drive the practice of psychosocial rehabilitation. A commitment to the development of these values was endorsed by the IAPSRS Board of Directors in 1992 and has evolved over the past decade as they have been tested and refined. The core principles and values are currently incorporated into the application process for the Registry of Psychiatric Rehabilitation Practitioners. Each applicant must meet rigorous standards, possess appropriate qualifications, provide references attesting to their expertise, and meet with the approval of peer reviewers who independently review work samples describing interventions which embody selected values.
* Recovery is the ultimate goal of psychiatric rehabilitation. Interventions must facilitate the process of recovery.
* Psychiatric rehabilitation practices help people re-establish normal roles in the community and their reintegration into community life.
* Psychiatric rehabilitation practices facilitate the development of personal support networks.
* Psychiatric rehabilitation practices facilitate an enhanced quality of life for each person receiving services.
* All people have the capacity to learn and grow.
* People receiving services have the right to direct their own affairs, including those that are related to their psychiatric disability.
* All people are to be treated with respect and dignity.
* Psychiatric rehabilitation practitioners make conscious and consistent efforts to eliminate labeling and discrimination, particularly discrimination based upon a disabling condition.
* Culture and/or ethnicity plan an important role in recovery. They are sources of strength and enrichment for the person and the services.
* Psychiatric rehabilitation interventions build on the strengths of each person.
* Psychiatric rehabilitation services are to be coordinated, accessible, and available as long as needed.
* All services are to be designed to address the unique needs of each individual, consistent with the individual’s cultural values and norms.
* Psychiatric rehabilitation practices actively encourage and support the involvement of persons in normal community activities, such as school and work, throughout the rehabilitation process.
* The involvement and partnership of persons receiving services, and family members is an essential ingredient of the process of rehabilitation and recovery.
* Psychiatric rehabilitation practitioners should constantly strive to improve the services they provide.
Multicultural Principles
In 1996, the Board of Directors of IAPSRS adopted Principles of Multicultural Psychiatric Rehabilitation Services which follow. IAPSRS accepts the concept of multiculturalism as consistent with a basic holistic orientation. Multiculturalism denotes the full inclusion of the individual with his or her culture and differences. Diversity is a limited concept that allows for physical representation of differences but not necessarily accommodation to them.
Multicultural professionals are students of their own ethnicities and cultures. They have learned to understand and accept their heritage both personally and as objectively as possible. Professionals have also studied other cultures and developed an appreciation and understanding of them. Professionals have developed the ability to change perspectives and view situations through the lens of a specific ethnic/cultural group in order to refine and modify interventions to increase compatibility with the cultural/ethnic group’s values and expectations. Professionals are aware of their own and others’ biases, stereotypes and prejudices. This awareness can reduce, eliminate or set aside attitudes interfering with the development of a positive (therapeutic) working relationship with clients.
Multicultural professionals can walk in the shoes of others without tripping. They can see the world through many cultural perspectives. Each of us lives in a cultural bubble; a multiculturalist can enter another cultural bubble without bursting it (Pernell-Arnold, 1995).
* Psychosocial rehabilitation practitioners accept that every individual has an ethnicity, as well as a gender, sexual orientation, level of ability/disability, age, and socio-economic status; therefore, they view every human encounter as a cross-cultural encounter.
* Practitioners study, understand, accept, and appreciate their own cultures as a basis for relating to the cultures of others.
* PSR professionals recognized that differences, discrimination, and isolation continue to create unique situations in which culture may emerge. The cultures of gender, disability, or sexual orientation may also provide support, security, a sense of belonging and identity, similar to the cultures of ethnic heritage. The condition of stigmatization, rejection, and discrimination are addressed as rights violations as well as barriers to the attainment of health.
* Practitioners recognize that thought patterns and our behaviors are influenced by one’s world view, of which there are many. Each world view is valid and influences how clients perceive and define problems, perceive and judge the nature of help given and solutions developed.
* Professionals show respect toward clients by accepting cultural preferences which value process or product, as well as harmony or achievement, within one’s life.
* Practitioners also demonstrate respect by appreciating cultural preferences which value relationships and interdependence, in addition to individuation and independence.
* PSR practitioners accept that the solution to problems are to be sought within consumers, their families, and their cultures. Alternatives identified by practitioners are to be offered as supplementary or educational.
* Practitioners apply the strengths/wellness approach to all cultures.
* Interventions are culturally syntonic and accommodate culturally determined needs, beliefs, and behaviors. Modalities are modified in order to be compatible with family/group patterns and structures; communication, cognitive, behavioral, and learning styles; identity development; perceptions of illness; and help-seeking behaviors.
* Professionals recognize that discrimination and oppression exists within our society; These take many forms, including race, ethnicity, gender, sexual orientation, class, disability, age, and religion discrimination/oppression. PSR professionals have a role and responsibility in mitigating the effects of these "isms," advocating not only for access to the opportunity and resource structure, but for the elimination of all "isms."
* PSR practitioners are responsible for actively promoting positive intergroup relations, particularly between the consumers in their programs and the larger community.
* Practitioners engage in ongoing cultural competence training in order to increase their knowledge and skills of appropriate effective cross-cultural interventions.
* Professionals are committed to learning about problems and issues that adversely and disproportionately affect the various cultural groups with whom they work.
What are Psychosocial Rehabilitation Services?
As the field has grown from the late 1940's, a continuum of services were developed to meet the specific needs of adults with severe and persistent mental illness. Not all of these services are strictly health services. Because of the pervasive effects of a psychiatric disability, many aspects of an individual’s life are adversely affected. The use of health services can be reduced by providing these other support services. They include:
Clubhouses facilitate the development of coping mechanisms, skills and environmental supports to offset the effect of a psychiatric disability. The services integrate normal community and daily life activities into the rehabilitation process. Frequently, the rehabilitation focuses on management of the psychiatric disability, including medication management and relapse prevention, training in instrumental activities of daily living, social skills training and problem solving.
Intensive Case Management includes the coordination and delivery of services. Not only is the case manager responsible for coordinating and facilitating a wide array of services, but the case manager also provides rehabilitation and treatment services as needed. These services are usually delivered in the community directly and many consumers refer to them as "clubhouses without walls."
Crisis Residential Services are alternatives to hospital care and are growing quickly. A crisis residential program keeps the individual in a home like setting, but still provides the medical treatment necessary and is not as institutionalizing as a hospital. The individual continues to be responsible for self and others and may continue at some level of community involvement.
Housing (supported housing, supervised apartments and group homes) is safe, reasonable in cost, and provides the level of support needed by the residents and is a crucial ingredient of community supports. Consultation provided by psychosocial rehabilitation staff enhances the quality of life in private settings.
Social Rehabilitation addresses the area of community life which is most difficult for someone with a severe and persistent mental illness – social integration. Withdrawal, difficulty with subtle and nonverbal communications, cognitive deficits and anhedonia (lack of enjoyment of normal activities) are all common deficits. Social rehabilitation helps people to learn social coping skills to counteract these effects and assists them in developing natural social networks in the community.
Vocational Rehabilitation services may take the form of supported employment, transitional employment and consumer run businesses. Between 75% and 90% of people with severe and persistent mental illness do not have jobs. An emphasis is needed which provides services and supports designed to help people get and keep real jobs.
Substance Abuse Treatment is also needed for approximately 50% of individuals who have a serious and persistent mental illness and is most effectively provided at a single location in an atmosphere that builds on trust, provides empathy, and builds on an increasing understanding of the reasons for abuse as well as the effects of abuse on the individual’s overall recovery.
Supported Education provides special supports to students both in the classroom and on campus. Since serious mental illness often interrupts the individual’s education and ability to set and meet career goals, a number of programs across the country are now available to help students with a mental illness return to school and complete degrees.
Dual Disability Services address the impact of other disabilities. While substance abuse is the most common, other problems include HIV/AIDS, mental retardation, physical illnesses, homelessness and deafness. Specialized services have been developed to work with each of these populations, recognizing the importance of integrating the rehabilitation and treatment of the mental illness with services for other disabilities.
Peer Support Services are offered by a rapidly growing body of individuals who have a mental illness themselves. This self-help movement has provided an important level of support by others who have experienced the same problems and have developed the skills to cope with the symptoms of a mental illness successfully.
Family Support Services provide information, education and support to family members, particularly those who remain the major care-givers for sons, daughters, siblings or spouses. The support offered is practical and educational in nature, to give family members the skills to cope with a loved one’s mental illness and to maintain a normal family environment. Often, family members become involved in advocacy activities designed to improve the recovery outcomes of a well functioning mental health system.
Psychosocial rehabilitation providers help people re-establish normal roles in the community. The goal for recovery of men and women with a serious mental illness is met through good jobs, decent housing, trustworthy friends and money to spend. Through an informal approach, psychiatric rehabilitation providers are able to develop relationships with members of clubhouses, clients in programs for assertive community treatment, family members in support groups, tenants in supportive housing programs and employees in job clubs that build on strengths. The point is to help clients and their families to get on with their lives, leaving the "patient" role behind.
Nothing is taken for granted regarded the skills that clients and their families may need in order to achieve positive outcomes. In fact, many agencies address the "four S’s" in all interventions. These include helping clients and families to understand their primary SYMPTOMS and recognize the early warning SIGNS of relapse; it also includes helping clients and their families learn how to decrease their STRESSORS, and to increase their SUPPORTS.
This process works well when each person’s strengths and needs are addressed jointly with his family and his community. And successes must always be highlighted with commendations and celebrations. The empowerment of this approach is shared by consumers, families, communities and providers together with such testimonials as those reported in psychiatric rehabilitation programs over the years:
* I know I earned by paycheck. . .this is not a token job for the disabled.
* Because of my job, I just bought my very own red pick-up truck.
* Now that I have my own place, I can eat my favorite foods whenever I want.
* Every year I used to go back to the hospital in July; now that I have the clubhouse, I don’t do that; it’s like a family.
* Since I got involved with NAMI, I’ve been able to let my son make his own choices, and guess what? He’s in nursing school now! (Peterson, 1999)
What is the International Committee of IAPSRS?
The purpose of the International Committee of IAPSRS. is to make available the principles, Values and Technology of psychosocial rehabilitation to mental health practitioners around the world.
Our work to date has focused on developing a web accessible package of information in four languages, English, French, Portuguese, and Spanish.
A second area of work is to raise the profile of IAPSRS. at international conferences through attendance and presentations.
People interested in the work of the committee should contact the committee chairs for more information. We would appreciate your ideas about how we could achieve our goal and in particular, we need help in translating our website based information into more languages. |
