Current Psychiatry Reviews - Volume 9, Issue 3, 2013

Psychosocial/psychiatric rehabilitation (PSR) reflects best practice in mental health services. Principles of client-centered care, empowerment and progress in vocational and educational spheres are applied to the individual with the ultimate goal of living a fulfilling and productive life as much as any other person in society. However, the methods of PSR often involve artificial constructs to achieve personal growth for the client. This has traditionally included sheltered workshops, day programs and consumer social centers and more recently supported employment and staffed housing. However, these models of care often promote negative feelings of group identification and perpetuate stigma. In this first person account, the author describes how after a major relapse of schizophrenia involving hospitalization five years ago, he was able to achieve real work, friendships and family reconciliation which translated to a satisfactory and successful life for him. The writer argues that PSR procedures do not necessarily have to be further developed but rather that our society should offer natural opportunities for individuals to develop, thus reflecting PSR principles in an authentic and meaningful structure that benefits society as well as the individuals involved.

Introduction: Psychiatric/psychosocial rehabilitation (PSR) is a set of practices aimed at facilitating the recovery of people with serious mental illnesses (SMI) such as schizophrenia. This paper reviews the history and foundations of PSR. Methods: A selective literature search using ERIC, Psychinfo and Medline from 1970 to 2012 was conducted with input from leading experts in the field of PSR to produce a narrative review. Results: PSR emerged as a significant field of practice and study during the 1970s and 1980s, in part as a response to the policy of deinstitutionalization which resulted in the discharge of large numbers of state hospital patients to unsupportive communities. In the last twenty years, the notion that individuals with psychiatric disabilities could recover, transitioned from an optimistic belief to an empirical understanding of the progress that could be made. Recovery emerged as an appropriate mission for services, consistent with progress in PSR development and implementation. This emphasis on promoting the ability of individuals with psychiatric disabilities to claim or reclaim a meaningful life, makes PSR services focused on success and satisfaction in valued roles, an even more critical component of a comprehensive mental health service system. Conclusion: Considerable agreement has developed about PSR’s fundamental philosophy, principles and values along with a significant body of research that informed the development of its practices, provider training and pre-service preparation based on a set of distinct evidence-informed interventions and other practices that providers and administrators across disciplines can and do use to help individuals with serious mental illnesses reach their recovery goals.

Introduction: A variety of treatment, rehabilitation and support options assist people with serious mental illness (SMI) in their pursuit of recovery. Psychiatric/psychosocial rehabilitation (PSR) is an effective means to assist individuals with SMI achieve recovery, including successful community living. Housing is an important part of such community living. This paper addresses the role of PSR (skills training and environmental supports) in relation to residential environments of people with SMI. Method: A systematic narrative review of the research literature was conducted to explore the role of PSR in relation to housing, including homelessness, supportive/supported housing and independent living. Factors supporting adaptive psychosocial functioning and thus contributing to housing stability and community integration were also considered. Results: PSR interventions that focus on enhancement of independent living and social skills promote greater social role functioning and engagement with community. Individualized approaches, respect for client preference and use of empowering strategies to engage with clients as equal partners in decision-making processes have similar relevance and importance. Other factors influencing housing stability include continuity of supports, safety, and presence (or lack of it) of neighborhood stigma toward people with SMI. Conclusion: Successful community integration and achievement of housing stability for individuals with SMI is dependent upon achieving balance in terms of adequacy and flexibility of informal and formal mental health supports and attainment of desired socio-environmental conditions. PSR is an important component of mental health services and of housing-related supports for people with SMI.

Introduction: People with serious mental illness (SMI) have an interest in working, but they experience high levels of marginalization from the community based labour force. Psychiatric/psychosocial rehabilitation (PSR) has advanced a variety of innovative approaches to address the range of individual, occupational, workplace and societal factors that contribute to this marginalization. Employment and education-related approaches consistent with the values of PSR include those that are directly focused on securing and sustaining employment or education, and those that create employment opportunities. The objective of this review was to summarize the evidence for these approaches, report predictors of outcomes where available and identify relevant gaps and other issues. Method: A selective (but within that comprehensive) narrative review of the peer reviewed literature was conducted to evaluate the status of the scholarship for four employment and education-related intervention approaches in this area. Results: The individual placement and support (IPS) model has demonstrated efficacy in improving employment outcomes. There are few empirical studies of social businesses and other initiatives to create employment for people with SMI, although there has been a recent wave of promising literature and research on these approaches. There is some support for supported education for this population, with a recent focus on the potential of supported education that is directly linked to employment supports. Conclusion: Work and education participation is improved with approaches that provide direct and comprehensive supports to individuals with SMI as they engage in work and school. Career trajectories, the social status of jobs and the economic status of individuals are emerging issues for further study to promote full social inclusion.

Introduction: Social isolation and a lack of physical activity are common difficulties experienced by persons with serious mental illnesses living in the community, contributing to high suicide rates and early mortality among this population. Despite the gravity of these concerns, few efforts have been made to target these issues specifically through the development of social and/or psychological interventions to increase the engagement of persons with serious mental illnesses in social, leisure, and recreational activities. Methods: On-line databases were searched for articles addressing the social, leisure, and recreational needs of persons with serious mental illnesses from 1995 to the present. These articles were reviewed and are summarized in the Results section. Results: Despite the advances made in supporting persons with serious mental illness in pursuing other important life domains–such as employment, education, and housing–relatively little progress has been made thus far in increasing socialization and physical activity among this population. Promising models have been developed based on the combination of skills training and the provision of community-based (in vivo) support, and are showing initial promise. Much work remains to be done, however, in offering these opportunities on a broader scale to most individuals who would benefit from them. Conclusions: While a sense of urgency and much activity has been generated by recent findings that adults with serious mental illnesses die on average 25 years earlier than their peers, these efforts have primarily focused on ensuring access to, and improving the quality of, medical care. Few efforts have focused on the role of such mutable lifestyle factors as participation in social and recreational activities, even though these factors are known to play an important role in improving and maintaining the health and wellbeing of the general population. Models are now being developed, however, that promise to extend these benefits to adults with serious mental illnesses as well.

Introduction: Psychiatric/psychosocial rehabilitation (PSR) aims to facilitate the recovery of people with serious mental illness (SMI), and consists of enhancing and maintaining adaptive skills and supports of people with SMI so that they can be satisfied and successful in their environments of choice. The objective of our paper is to review PSR in relation to various health care environments, specifically in relation to mental, substance use-related, physical (medical and dental), and complementary and alternative medicine (CAM) health care environments. The primary questions we pose for this review are: 1. What are PSR and related practices regarding these health care environments? 2. What are PSR outcomes regarding these health care environments? 3. What are predictors of these outcomes? Method: Data collection consisted of a systematic review of PSR in relation to these health care environments. Data analysis consisted of a narrative review (a meta-analysis was not conducted due to the wide diversity of PSR practices and outcome measures found). Results: PSR is effective in relation to mental health care environments and is promising in relation to substance userelated and physical (medical and dental) health care environments. There is no rigorous study of PSR in relation to CAM health care environments. Conclusion: PSR in relation to health care environments is helpful for people with SMI. Further research on PSR in general, and in relation to CAM health care environments in particular, is needed.

Introduction: Since the 1980s, it has been asserted in the scholarly literature that education in psychiatric/ psychosocial rehabilitation (PSR) theory and techniques is a necessary component of academic preparation for practitioners providing services to people with serious mental illness (SMI) and, in fact, may be considered an academic discipline in itself. This paper is a systematic review of peer-reviewed publications on the practices, outcomes and predictors of PSR education.] Method: A systematic search of PubMed, PsycINFO, CINAHL, Academic Search Premier, and ERIC databases was conducted using the phrases psychiatric/psychosocial rehabilitation and academic/professional education/training. These terms were then combined with the terms education, higher education, undergraduate education, graduate education, medical education, psychology education, and social work education. Contents of three special issues of peer-reviewed journals devoted to psychiatric rehabilitation education were also included. Results: Fifty-three non-duplicated articles were identified. Several were non-systematic literature reviews of the subject that often included proposals for curricular changes to specific disciplines including psychiatry, social work, and psychology. Several others were surveys on the issue of PSR content within the rehabilitation counseling field. No controlled studies on the subject were found. Several non-experimental studies have been published, primarily program evaluations of the impact of specific PSR curricula on student career outcomes, their knowledge of PSR practices, and their attitudes. Student proximal outcomes were predicted by the number of completed courses in PSR as well as by demographic and career variables. Conclusion: Delivering PSR services to persons with SMI is acknowledged as requiring distinct knowledge and skill development. Despite this fact, there is not much research and relatively modest empirical support for specialized academic and professional education on this. More rigorous research on PSR education is required.