By Georgine Verano (December, 2020)
Table of Contents
Introduction
Psychosocial Rehabilitation, a definition
History of Psychosocial Rehabilitation
Impact on Society and Critical Factors
Principles of Psychosocial Rehabilitation
Approaches and stages
Bibliography
Introduction
It is often said that the measure of a society is in what it does for its disadvantaged members, and in this day and age with the fast pace of life, it is hard to remember to that not everyone can keep up. Psychosocial Rehabilitation offers the opportunity for those who are disabled to be able to develop the necessary skills (including social and emotional skills) needed to function and thrive in society with the least professional assistance. It aims to provide them independence and dignity, and their own place in the community. There are several approaches to Psychosocial Rehabilitation – including approaches targeted at each individual and honing their abilities to navigate their surroundings especially when under stress, as well as ecological approaches that aim to minimize the stress factors by improving environmental resources. Enabling disabled people to live a normal life like everyone else also creates a model of functional disability within the community.
In order to function the best we can as a society and to progress everyone in the community, more spotlight, education and funds should be invested in psychosocial rehabilitation. Psychosocial Rehabilitation should be accessible to every disabled person, and a priority in every society with the technology and knowledge to make it happen.
Keywords: Psychosocial, rehabilitation, Nonviolence, organization, society, disabled, community
Psychosocial Rehabilitation, a definition
Psychosocial Rehabilitation, was initially developed by Dr Robert Liberman at UCLA and Dr William Anthony at Boston University to treat severe chronic psychiatric conditions such as schizophrenia. Today it is usually defined as the process of restoration of community functioning and the well-being of persons with mental health or emotional disorder diagnoses, and who are considered to have psychiatric disabilities. It was originally termed Psychiatric Rehabilitation – but Psychosocial Rehabilitation (or PSR) became the more popular term as it became used to treat other diagnoses such as drug addiction as well as dual diagnoses.
PSR works to promote a combination of individual recovery, community integration and improvement of quality of life for people who have mental health issues. The services and support provided by psychosocial rehabilitation are collaborative, person-directed and customized for each individual, and is considered an essential element to the human services spectrum. The main goal of PSR is to assist each individual in developing skills as well as providing accessible resources which are necessary to boost their capacity to succeed and improve their living, working, learning and social environments as well as including a wide continuum of services and support systems. [1] What makes it so akin to the beliefs of those in the peacekeeping and peace building community is the strong emphasis on both assisting those in need and creating an environment of inclusion.
History of Psychosocial Rehabilitation
Psychosocial Rehabilitation, as a field of its own, has its roots in several historical developments:
The moral therapy era
The inclusion of the psychiatrically disabled into publicly supported vocational rehabilitation programs
The development of community mental health ideology
The Psychosocial Rehabilitation center movement
The development of skills training techniques as an effective mental health intervention
(Include more detailed information on these seven development sections)
Dr Robert Liberman in Dartmouth Medicine Magazine
Impact on Society and Critical Factors
There is a strong correlation between long-lasting peace in a community and the accessibility to psychological intervention and support for people with disabilities and mental illnesses, or other traumas. PSR provides such a solution to this issue through its singular attitude in treating each individual with respect and acceptance, keeping with the rehabilitation approach. It follows several of the ideas in Peacebuilding and Peacekeeping as well as seen below:
Both place a strong focus on respect and acceptance, celebration and inclusion of the patient and local culture and history
Both require conflict management, problem solving and communication skills training
Both have a strong educational component in order to inform participants, patients and other members of the community – which increases motivation and cooperation, and enables patients to help with the management of their symptoms which helps prevent severe relapses.
Both promote democratic participation – which could include politicization – in order to increase cooperation and motivation
Both also highlight economic and financial health, and independence
Like in peacebuilding and peacekeeping, such measures are intended to avoid conflict escalation, out of control symptoms as well as violence. It also aims to create long lasting changes so that conflict management is possible in the future and aforementioned symptoms will be under better control. Like conflict, relapse is part of being human. What makes the difference is the skilled management of both.
Principles of Psychosocial Rehabilitation
According to Dr Liberman’s Principles and Practice of Psychiatric Rehabilitation, the main goal of Psychosocial Rehabilitation is to “enable with the most effective practices of illness management, personal satisfaction and psychosocial functioning”. Such treatments and practices under this approach are guided by seven strategic principles:
Enable a normal life
Advocate 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 isn’t time specific but goal specific in succeeding
Approaches of Psychosocial Rehabilitation
There are several approaches with individual stages depending on the individual – each has to be customized for them (see Table 1). One such way is the peer-provider approach, which is guided by the seven strategic principles listed by Dr Liberman. Recovery in rehabilitation is defined as possible without complete remission of their illness, it is targeted at assisting the individual in attaining their optimum mental health and well-being. (Davis, 2013)
Organizations like PSR Advanced Practice (https://www.psrrpscanada.ca/what-psychosocial-rehabilitation) note that Psychosocial Rehabilitation’s approaches are evidence-based best and promising practices in the essential parts of life such as work, education, and basic living skills as much as family involvement and peer support. Their proven effectiveness and recovery orientation are proof that such approaches and methods should be widely accessible to those who have long term mental illness and/or substance use issues. These approaches encompass programs and practices that are proven effective in the facilitation of recovery of individuals who have lived with serious mental illnesses, concurrent disorders or substance use problems. Programs like PSR Advanced Practice, provide a service framework which also review any evidence and make recommendations in emerging areas of peer support and family involvement literature – in order to develop and implement the best practices in each of these areas.
Recovery has been emerging as a dominant philosophy in mental health – and PSR approaches are recovery oriented. This has occurred largely as the result of major longitudinal studies, for example in Harding, Brooks et al, (1987a, b) which have shown that recovery is possible for most people who live with serious mental illnesses, and in the writings of William Anthony and Patricia Deegan. [3]
A custom modular approach [2] would approximately cover the following stages:
Medical Intervention - mainly medication to manage delusions and hallucinations, stabilize emotions and support clear thinking.
Psychoeducation - to incorporate patient into treatment and increase motivation and cooperation.
Info about personal diagnosis
Treatment Management Skills Training (TMST)
Symptom Management
Medication Management
Stress Management
Cognitive Therapy
Info about psychology in general
Therapeutic Clubhouse Program
Provides socialization
Increases motivation and cooperation
Milieu for practicing life skills
Provides sense of community
Insight Therapy
Emotional support
Supervision for TMST
Trauma Management
Life Skills Training
Social Skills
Household Management
Conflict Management
Personal Hygiene
Time Management
General Education
Vocational Skills Training
Interview
Job Training
Reporting Skills
Independent Living Program
Group Therapy Maintenance Program
Services under Psychosocial Rehabilitation may include: community residential services, workplace accommodations, supported employment or education, therapeutic social clubs, assertive community treatment (or outreach) teams assisting with social service agencies, medication management (e.g., self-medication training and support), housing, programs, employment, family issues, coping skills and activities of daily living and socializing. 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. [4]
Conclusion
As of late, with the growing agreement that several major psychiatric disorders are stress related biomedical ones, rehabilitation approaches have outgrown traditional methods of treatments and now emphasize the development of the individual’s skills as well as creation of a supportive environment for those with ongoing disabilities, handicaps and affective disorders amongst others. Like in other nonviolence initiatives – peacekeeping and peace building amongst others – the entire community needs to partake in the process. This means that the disabled individual must be as involved as possible in setting the goals of the rehabilitation. This creates a mutually respectful and trusting relationship with service providers as well. In the ideal situation, the training would be supplemented by interventions at the individual’s immediate environment, as well as at a community and societal level. (Liberman, Anthony, 2014)
Bibliography
Davis, Simon (2013). “Community Mental Health in Canada: Theory, Policy, and Practice (revised and expanded ed.)”. Vancouver: UBC Press. p. 90 ISBN 978-0-7748-2701-0. OCLC 865475177 - via Google Books.
Liberman, R. P. (2008). “Principles and Practice of Psychiatric Rehabilitation”. Recovery from Disability: Manual of Psychiatric Rehabilitation. Washington, DC: American Psychiatric Publishing. ISBN 978-1-58562-205-4 OCLC 672234137.
Liberman, R. P., Anthony, W. A., (2014). “The Practice of Psychiatric Rehabilitation: Historical, Conceptual, and Research Base”. Oxford Journals: Schizophrenia Bulletin. Vol. 12 No. 4 p. 547 (accessed via: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.626.481&rep=rep1&type=pdf)
(Need to complete bibliography and put in all other links I have)
Last Name, F. M. (Year). Article Title. Journal Title, Pages From - To.
Last Name, F. M. (Year). Book Title. City Name: Publisher Name.
Footnotes
1“What is Psychosocial Rehabilitation?” PSR Advanced Practice, accessed December 1, 2020 https://www.psyrehab.ca/pages/what-is-psr
2“Psychosocial Rehabilitation” Nonviolence NY, accessed November 30, 2020 https://docs.google.com/document/d/1HgIULOqTQxj9rYxoOn_xFBU3YbuqIPbYojmm6uEORAw/edit
3“The B.C. Psychosocial Rehabilitation Advanced Practice” PSR Advanced Practice, accessed December 1, 2020 https://www.psyrehab.ca
4“Principles of Psychosocial Rehabilitation” PSR/RPS Canada, accessed December 1, 2020 https://www.psrrpscanada.ca/?submenu=_about&src=gendocs&ref=Core%20Principals&category=Main
2“What is Psychosocial Rehabilitation?” PSR Advanced Practice, accessed December 1, 2020
Tables
Table 1
Stages in a rehabilitation of chronic mental patients, with examples of the elements in each stage
Stage:PathologyImpairmentDisabilityHandicapDefinition:Lesions or abnormalities in the central nervous system caused by agents or processes responsible for the etiology and maintenance of the biobehavioral disorder Any loss or abnormality of psychosocial, physiological or anatomical structure or function (resulting from underlying pathology)Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human beingA disadvantage for a given individual (resulting from an impairment or a disability) that limits or prevents the fulfillment of a role that is normal (depending on age, sex, social, cultural factors) for that individual Example:Brain tumors or infections etiologically linked to psychotic symptomsPositive and negative symptoms of schizophrenia (delusions, anhedonia)Deficient social skillsUnemployment, homelessnessInterventions:Laboratory and radio-graphic testsSyndromal diagnosis, pharmacotherapy, hospitalizationFunctional assessment, skills training, social supportNational and State vocational rehabilitation policies; community support programs
Note: “The Practice of Psychiatric Rehabilitation: Historical, Conceptual, and Research Base”. Oxford Journals: Schizophrenia Bulletin. Vol. 12 No. 4 p. 547 (accessed via: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.626.481&rep=rep1&type=pdf)Schizophrenia Bulletin, Oxford Journal, accessed Nov 27, 2020
Figures
Figure 1. Vulnerability, stress, coping and competence model of mental disorders
Liberman, R. P., Anthony, W. A., (1986). “The Practice of Psychiatric Rehabilitation: Historical, Conceptual, and Research Base. Oxford Journals: Schizophrenia Bulletin. Vol. 12 No. 4 p. 547