Psychiatric Rehabilitation: Its
Principles and Practices
The Challenges of
Communicating these Through
Training and Education
Kenneth J. Gill, Ph.D., CPRP
Challenge –Defining Psychiatric
Rehabilitation
Is it really Psychosocial Rehabilitation?
Is is only skill training and skill
development?
Is it only a set of values?
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?
Challenge of Defining (con’t.)
Is Psychiatric Rehabilitation unique to
community services?
Is it a set of evidence-based best
practices?
Is it a set of program models?
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
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
Understanding Psychiatric
Rehabilitation
Four Part Model
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
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)?
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)
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
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
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)
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
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
What’s the problem with them?
They take the moral “high ground”?
Implies others may not have these values
Not particularly unique
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
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
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)
The Approaches or Settings
Day services
Residential/independent living
Case management/assertive community treatment
Vocational
Educational
Hospitals
Families
Consumer-operated
Why are the challenges in
Psychiatric Rehab training?
Trainee’s attitudes
Lack of optimism or demoralization
“Wouldn’t work with our people”
“Wouldn’t work in our place”
Organizational Barriers
Dysfunctional teams
Unsupportive supervisors,
Poor leadership
Sympathetic supervisor, poor leader
Lack of relevant organizational vehicles or structures
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