Psychosocial rehabilitation

Mental Health Nursing

1. r. Ruppamercy m.Sc Nursing ii year Psychosocial rehabilitation

2. content Introduction Definition Psychosocial rehabilitation services History Vision and mission Objectives Psychosocial rehabilitation team Indications Approaches Principles Aims Steps Role of nurse

3. introduction Rehabilitation is the process of enabling the individuals to return to his highest possible level of functioning. Psychosocial rehabilitation promotes personal recovery, successful community integration and satisfactory quality of life for persons who have a mental illness or mental health concern.

4. definition REHABILITATION: Rehabilitation is “an attempt to provide the best possible community role which will enable the patient to achieve the maximum range of activity, interest and of which he is capable Maxwell Jones(1952) PSYCHOSOCIAL REHABILITATION: It is a process that facilitates the opportunity for individuals to reach their optimal level of independent functioning in the community. WHO(1996)

5. Psr services Psychosocial rehabilitation services are programs of two or more consecutive hours per day provided to groups of individuals in anon – residential setting. Services include: assessment, education to teach the patient about the diagnosed mental illness and appropriate medications to avoid complication and relapse opportunities to learn and use independent living skills and to enhance social and interpersonal skills within a supportive and normalizing program structure and environment.

6. history From the 1960s and 1970s, the process of deinstitutionalization meant that many individuals with mental health problems were able to live in their communities rather than being confined to mental institutions medications and psychotherapy were the two major treatment approaches , with little attention given to supporting and facilitating daily functioning and social interaction. With the founding of psychosocial rehabilitation , Canada in 2004, the professional organization International Association of Psychosocial Rehabilitation Services (IAPSRS) changed its name to United States Psychiatric Rehabilitation Association (USPRA) and the trend is toward the use of “psychiatric rehabilitation”

7. VISION AND MISSION VISION The vision of psychiatric rehabilitation is to enable individuals with mental disabilities to recover and to live as normally as possible in the community. MISSION The mission is to engage patients and their families or caregivers in a collaborative treatment process that teaches skills and provides supports for fostering illness management, psychosocial functioning and personal satisfaction.

8. Objectives of psr Symptom reduction Reduction of iatrogenic Social skill improvement Reduction of discrimination and stigma Family support Social support Consumer empowerment

9. REHABILITATION TEAM Psychiatrist Clinical psychologist Medico social worker Psychiatric nurse Counselor Occupational therapist Recreational therapist Other mental health care professionals

10. indications The individual must also meet one of the following criteria listed below. The individual must: Have experienced long – term or repeated psychiatric hospitalization Experience difficulty in activities of daily living and interpersonal skills Have a limited or nonexistent support system Are unable to function in the community without intensive intervention Require long - term services to be maintained in the community.

11. APPROAHES of psr Psychoeducation – includes diagnosing the problem, telling the person what to expect regarding illness and discussing treatment alternatives. Working with families – encouraging family members to get involved in treatment and rehabilitation programs. Group therapy – an opportunity for ongoing contact with others, validation of their perceptions, sharing their views about problems and problem solving abilities. Social skill training – teaching specific living skills that the patient is expected to have in order to survive in the community.

12. principles Hopeful : People may be left feeling demoralized as a result of their condition; rehabilitation focuses on helping clients feel hopeful about the future. Empowered :   Each individual needs to feel that they are able to set their own goals and have the power and autonomy to pursue those aims. Skilled : Rehabilitation aims to teach people skills to help them manage their condition and live the life they want to live. This includes living skills, work skills, social skills, and others. Supported :   Mental health professionals should offer support and help clients build relationships and social connections in their community.

13. Aims Establish a multidisciplinary team , that applies methods, alternative to pharmacological treatment for the inpatients in the hospital and day department Help people with severe end long - lasting mental disturbances to improve life quality. Help to adjust successfully to the environment and feel like satisfaction with the minimal specialists supervision. Help to restore and maintain lost skills and acquire new one’s.

14. steps P sychosocial rehabilitation begins with a comprehensive medical psychiatric diagnosis and functional assessment. The steps of psychosocial rehabilitation includes Reduction of impairment Remediation of disabilities through skill training Remediating disabilities through supportive interventions Remediation of handicaps

15. Reduction of impairments Rehabilitation interventions with psychiatric patients require reduction or elimination of the symptoms and cognitive impairments that interfere with social and vocational performance. These impairments are reduced and eliminated for the greater party by various psychotropic agents .

16. Remediation of disabilities through skill training Skill training is used to remediate disabilities in social, family and vocational functioning. Patients generally require training in self – care skills, interpersonal skills, vocational and employment pursuits, recreational and leisure skills.

17. Remediation of disabilities through supportive interventions When restoration of social and vocational functioning through skill training is limited by continuing deficits, rehabilitation strategies aim at helping the individuals compensate for handicap by learning skills in living and working environments . Adjusting the individual and family expectations to a level of functioning that is realistically attainable.

18. REMEDIATION OF HANDICAPS In addition to clinical rehabilitation interventions, the disabled persons can be helped to overcome their handicaps through social rehabilitation interventions Eg . Community support programs.

19. Role of nurse Assessment of the individual The nurse should assess the areas of symptoms, motivation, strengths, interpersonal skills, self esteem, activities of daily living and long compliance PLANNING AND IMPLEMENTATION Skill training Supportive interventions Community supportive programs Vocational rehabilitation activities

20. CONTD… 2. Assessment of family Family structure including developmental stages, roles, responsibilities, norms and values. Family attitudes towards mentally ill member, emotional climate of the family, social support available to the family and past family experiences with mental health services. FAMILY INTERVENTION Family therapy Group therapy Family counseling Supportive psycho educational programs Crisis intervention Outreach programs

21. CONTD… 3. Assessment of community Assessment of community agencies that provide services to people who have mental illnesses, assessment of attitudes of the people towards the mentally ill, etc. COMMUNITY INTERVENTION Halfway homes It is the transition facility for mental patients who no longer need the full services hospital but are not yet completely ready for an independent living. It is a t ransitional supervised residence assigned to help the patient after discharge from in patient settings. It is temporary residence where various kinds of social skill training are given to this patient, make readjustment to the social life and employment in the community.

22. Activities in halfway homes The duration is maximum of one year which gives sufficient time for them to adjust to the family and to the home environment. Group counseling Recreational activities Home visiting Job placement Follow – up counseling Educational and vocational program Additional activities such as religious activities etc. Social skill training Training in independent skills

23. Community integration programs It is a community based program that promotes recovery, community integration and improved quality of life for members who have been diagnosed with a behavioral health condition that significantly impairs their ability to lead meaningful lives. The focus is on empowering the patient towards independent living in the community and strengthening family relationships. Eg . Preventive health Lifelong learning opportunities Social/recreational activities

24. advantages The promotion of more independent social activity in patients who may have lost this facility due to illness To allow the psychiatric care team to maintain contact with patient’s families and in many cases to allow them to work with the family. In maintaining patient’s contact with their normal social background, they can be encouraged not to avoid problems whose origins lie in the family constellation or work situation.