PSR_Gill

							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