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Psychiatric Rehabilitation

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A TERM PAPER ON PSYCHIATRIC REHABILITATION PROGRAMME

COURSE: MENTAL HEALTH NURSING

COURSE CODE: NSG 417

SUBMITTED JUNE, 2017


PSYCHIATRIC REHABILITATION PROGRAM

INTRODUCTION
Psychiatric rehabilitation program is a service designed to teach or restore
skills necessary for recovery from mental illness. This program offers group and
individual services for those who have experienced multiple serious episodes of
mental illness. The services focus on psychosocial support, healthy living
practices, residential support, community activities, medication management and
teamwork. Many patients report improved symptom management and better life
skills after participation in the PRP Program.

What is a mental health rehabilitation service?


Mental health rehabilitation service is a service to help people recover from
the difficulties of longer-term mental health problems. It will help and support
people who still find it difficult to cope with everyday life or get on with other
people. It will aim to help you deal with problems, to get your confidence back,
and to help you to live as independently as possible.

The difficulties with living with a longer-term mental health problem can mean
that you can't be discharged home, but you may have to spend some time in a
specialist rehabilitation service.

The service will try to help patient recover, while accepting that he or she may still
have serious difficulties which need continuing help and support.

The rehabilitation team includes psychiatrists, nurses, occupational therapists,


psychologists and social workers.

Who might need a mental health rehabilitation service?


 Usually if you have a diagnosis of schizophrenia, schizoaffective disorder or
bipolar disorder. However, only around 1 in every 100 people with a diagnosis
of schizophrenia require rehabilitation. Typical difficulties include:
 Problems with organising and planning your daily life - finding it hard to plan
and actually carry out what you mean to do.
 Symptoms of mental illness, such as hearing voices that are distressing or make
it difficult to communicate with other people.
 Being exploited or abused by others.
 Behaving in ways that other people find difficult or threatening - this can lead
to contact with the police or courts.
 Harmful use of alcohol and non-prescribed ("street") drugs.
 The patient have difficulties because:
 Medication just doesn't work well enough for you. The illness affects your
concentration, motivation and ability to organise yourself.
 Also a patient that suffer from depression and anxiety.
 You may struggle to manage everyday activities - like self-care, budgeting,
shopping, cooking, managing your money.
 The stigma of mental illness can be an added burden. It may be particularly
difficult to find work, have a reasonable income, or to be included by other
people. You may have to cope not only with a difficult mental illness, but also
with the attitudes of other people.

When are people referred to rehabilitation services?


 Usually after a few years of mental health problems - and a number of hospital
admissions. However, it can sometimes be helpful if the patient are trying to get
over a first episode of illness.
 If patient can't be discharged from an acute ward, but are unlikely to get any
better there.
 If you are moving to a placement with less support and supervision. This can
happen if you are leaving a forensic or secure service, or if you are moving
from residential care to a more independent home in the community.
 If patient might benefit from the structured environment and intensive
therapeutic programmes that are available on a rehabilitation unit.
Aims of mental health rehabilitation?
 To learn or re-learn life skills.
 To get confidence back.
 To cope better without so much help.
 To achieve the things you want to, like living in your own flat, getting a job or
starting a family.
 To feel independent and comfortable with your life.
 Professionals working in rehabilitation services support people with their
particular problems, but, as they get better, adjust this support as needed.
 Rehabilitation services will usually work for you for months or years. They will
support you as you feel more confident and improve your skills. It can be hard
to keep hopeful over these long periods - and the staff will do their best to help
you do this.

Treatments and support are provided?


 Medication.
 Talking therapies (e.g. cognitive behaviour therapy and specific work with
families and carers).
 Guidance on healthy living (e.g. diet, exercise and stopping smoking).
 Help to reduce or stop alcohol and street drug use.
 Support to manage everyday activities such as personal hygiene, laundry and
more complex living skills such as budgeting, shopping and cooking.
 As you get better, you will spend more time in the community. You might do
some sport, go to the cinema, do a course, learn some skills for work, or start to
get a job.
 Help with accommodation and social security benefits.
 Sometimes legal advice.
 The rehabilitation service should be helping the patient to regain your skills for
community living, with the same opportunities as anyone else. You need to be
able to have useful and interesting activities.
 Rehabilitation units should provide a safe and homely space where you can feel
comfortable, safe and are able to have safe relationships with other people.
What does a rehabilitation psychiatrist do?
 He or she will have specialist expertise in the long-term treatment and care of
people with severe mental illness and complex needs. They look at the long-
term possibilities for the patient, not just symptoms of the illness, and work
closely within a team of other professionals. They will provide:
 Thorough assessment and treatment.
 Advice to colleagues on the diagnosis and management of severe and complex
mental health problems for people who are not helped quickly by standard
treatments.
 Advice on residential and community support services.
 Advice to commissioners about what services should be developed, and how to
run high-cost placements.
 Management of patients in rehabilitation units.
 Supporting joint working with voluntary sector agencies that provide supported
housing and work opportunities for rehabilitation patients as they recover.

Inpatient rehabilitation

 When a patient first admitted to a rehabilitation service, a detailed assessment


which includes patient views and preferences we be carried out.
 The staff will discuss a care plan with the patient. This should be developed as
far as possible with patient - and sometimes with a carer or patient family.
 As time goes on, you will spend more and more time doing things in the
community (see above), and less time in the unit.
 A rehabilitation unit should help the patient to feel better about him or her self,
more confident, more easy with your feelings and more hopeful for the future.
the length of stay will depend on how patient get on - according to what he or
he need

Community rehabilitation
 . These services support people who have made the move from a rehabilitation
unit to some form of supported accommodation, but who require ongoing
support with their day-to-day lives, both social and personal.
 The community rehabilitation team can give more specialised support than the
more general community mental health teams.
 The team will continue the work of the rehabilitation unit. They will work with
patient to update your care plan and make sure that it progresses. They will
support him or her with managing medication, looking after the patient home,
and doing any activities the patient may want to get involved with,
 The team will involve the patient carer(s) or family (if appropriate) to help them
have the understanding and support the patient need.

7 Types of Rehabilitation Therapy

There are many types of rehabilitation therapy,

Each designed to address specific ranges of issues. What they all have in
common is their primary goals: To help individuals recover from illness, injury,
surgery, stroke, cardiac events or other medical issues and regain functional
abilities and independence lost to these events. Here we'll outline

Physical Therapy
This type of rehabilitation therapy works to improve movement dysfunction.
Therapists work with patients to restore movement, strength, stability and/or
functional ability and reduce pain via targeted exercise and a range of other
treatment methods.
Occupational Therapy

This form of therapy focuses on restoring an individual's ability to perform


necessary daily activities. This may mean working to improve fine motor skills,
restore balance, or assist patients in learning how to increase their functional ability
via use of adaptive equipment, among other potential treatment options.

Speech Therapy

This type of rehabilitation therapy is used to address difficulties with speech,


communication and/or swallowing.

Respiratory Therapy

Used to aid patients who have breathing disorders or difficulties, this form of
rehabilitation therapy works to help them decrease respiratory distress, maintain
open airways and, when necessary, learn how to use inhalers and supplemental
oxygen properly

Cognitive Rehabilitation

Also commonly called cognitive-behavior rehabilitation, this type of therapy


works with patients to improve memory, thinking and reasoning skills
.
Vocational Rehabilitation

This form of therapy is geared towards preparing individuals to return to work


after an injury, illness, or medical event.
Each type of rehabilitation therapy can be accessed in various healthcare settings.
These include inpatient rehabilitation facilities, outpatient rehabilitation clinics and
home-based rehabilitation
Vision Rehabilitation
focuses on improving each patient's overall functional independence by addressing
individual physical and sensory limitations.

Psychology and Neuropsychology ,


including Cognitive Rehabilitation : addresses problems with cognition, emotional
functioning or behavioral functioning.

Wheelchair Seating and Mobility Assessments:


enables you to try a wide variety of manual and power wheelchairs, seating and
positioning accessories and environmental challenges.

Music Therapy:
address the cognitive, speech/language, physical, and psychosocial needs of a
patient, using Neurologic Music Therapy techniques.

Spasticity Management :
addresses the impairment of one's mobility, positioning, comfort, care and ability
to perform activities of daily living.

Vestibular Therapy:
a form of therapy designed to help patients with complaints of falls, dizziness,
vertigo, sense of imbalance, disequilibrium, motion sensitivity and balance
disorders.

Aquatic Therapy:
combines traditional exercise with the water's buoyancy to enhance and accelerate
the rehabilitation process.
ASSESSMENT OF PATIENT DURING
REHABILITATION

The preliminary stage in the rehabilitation process is assessment, a process


that identifies impairments and disabilities to enable the multidisciplinary team to
execute a plan of care (Sinclair and Dickinson, 1998). Cognitive status also needs
to be determined during assessment, as this will affect the level of a patient’s
motivation (Resnick, 1998). The assessment process does not usually address the
patient as a whole. This is due to the model of nursing/rehabilitation used.

Psychiatric rehabilitation assessment should not to be confused with the


traditional psychiatric diagnosis. A rehabilitation assessment and a traditional
psychiatric diagnosis are very different. The goal is different; the process is
different; the tools are different. Yet, each provides useful and meaningful
information, each requires training to implement, and each has a role in a
comprehensive treatment and rehabilitation intervention.

Psychiatric rehabilitation assessment is the first phase of the psychiatric


rehabilitation process. The psychiatric rehabilitation process itself varies greatly in
terms of its formality, specificity, and documentation. At its most generic level, the
practice of psychiatric rehabilitation involves consumers figuring out the
residential, vocational, educational, and/or social goals they want to achieve and
developing the skills and supports they need to reach their goals.

The psychiatric rehabilitation assessment evaluates the client's skills and


supports in the context of the environment in which the client chooses to live,
learn, socialize, and work. The assessment contains three components:
 An overall rehabilitation goal

 A functional assessment

 A resource assessment

The overall rehabilitation goal is typically determined by means of an


interview. The overall rehabilitation goal identifies the particular environments in
which the client chooses to live, learn, socialize; and work during the next 6 to 18
months. The particular environment may be one the client currently is in and in
which the client wants to stay; or the environment may be one the client desires to
move to within the next year or two. After the goal environment has been
determined, assessment instruments may then be used to complement the interview
process to help the client figure out what skills and supports need to be developed
to maximize their success and satisfaction in the chosen goal environment(s).

The overall rehabilitation goal is established during a series of interviews with


the client in whom the client's satisfaction and dissatisfaction with the current
environment and choice of future environment is explored. The overall
rehabilitation goal is critical to the assessment because the hope of its achievement
motivates the client to engage in the assessment. In addition, the overall
rehabilitation goal focuses the practitioner and client on those skills and supports
that are relevant to success.

The necessity of establishing the client's overall rehabilitation goal is consistent


with the philosophy of psychiatric rehabilitation (Anthony, 1982; Cnaan,
Blankertz, Messinger, & Gardner, 1988). Taking the time to work with the client to
set overall rehabilitation goals is also important because if this process is
neglected, the practitioner and client very likely may be pursuing different goals
without knowing it.

PSYCHIATRIC REHABILITATION ASSESSMENT INTERVIEW

The psychiatric rehabilitation assessment typically begins with a series of


interviews with the client. There are two principles guiding the assessment
interview.

 First, the practitioner attempts to maximize the involvement of the client in


the interview process.

 Second, the information collected during the interview is recorded in a way


that maximizes the client's understanding of the assessment results.

Involving the client in the interview means facilitating the client's active
participation in completing each of the tasks that are part of doing a rehabilitation
assessment. Client involvement increases the client's ownership of the
rehabilitation assessment. An important ingredient of the assessment process is the
interpersonal skill of the person conducting the assessment (Anthony, Pierce, &
Cohen, 1980). Several practitioner skills serve to involve the client in the
assessment.

These skills include;

1. Orienting; orienting means that the practitioner describes the task, the
purpose of the task, and the roles of both the practitioner and client.

2. Giving instructions; giving instructions is similar to orienting in that both


provide direction. Giving instructions, however, specifically directs a person
to perform a particular action or set of actions. The instructions tell a person
what exact steps to follow.

3. Requesting information; requesting information encourages participation


rather than directly telling the client how to be active. Requesting
information is asking for facts, opinions, and feelings. Requesting
information encourages someone to talk about a particular topic.

4. Demonstrating understanding throughout the interview; Demonstrating


understanding is capturing in words what the client is feeling or thinking.
Demonstrating understanding-also known as active listening (see, for
example, Egan, 1999) and paraphrasing or reflecting feelings (see, for
example, Carkhuff, 2000)—tells the client that the practitioner is listening
and helps clarify the client's perspective.

GENERAL DESCRIPTION OF ASSESSMENT INSTRUMENTS

The process of selecting and implementing Psychiatric Rehabilitation


treatment is founded on three key clinical principles.

 The process is a collaborative effort between the consumer and clinician


aimed at achieving the consumer's goals for more personally rewarding
community functioning.

 The process is rooted in the empirical information provided by thoroughly


validated assessment instruments; and
 The outcomes of the process are continually assessed so that the treatment’s
services can be adjusted for maximum efficacy and effectiveness.

The assessment instruments offered by Psychiatric Rehabilitation Consultant


(PRC) are listed below, and each operates in accord with these three key principles.
Each fosters collaboration by gathering information from the consumer and various
treatment stakeholders; each is a thoroughly validated instrument designed
specifically for use with persons with serious and persistent mental illness; and
each can be periodically administered to provide longitudinal information about
the outcomes of ongoing treatment.

The instruments may be combined to obtain the comprehensive information


needed to plan individualized or programmatic treatments, or each can be
administered independently to provide information needed to answer more focal
questions. Each instrument is briefly described below; please click on the
instrument’s name to obtain more information.

Expanded UCLA Brief Psychiatric Rating Scale (BPRS)

The Expanded UCLA BPRS is a rigorous assessment of the severity of a


consumer's psychiatric symptoms. The individual’s responses to questions asked
during a semi-structured interview are combined with the interviewer’s
observations to rate the severity of 24 symptoms on a 7-point scale. The instrument
can be administered as often as needed to provide a sensitive measure of changes
in symptoms as various medical and rehabilitation treatments are added, modified,
or deleted.

Client’s Assessment of Strengths, and Goals (CASIG)


CASIG is designed to be the primary assessment instrument for planning
and evaluating an individual’s rehabilitation treatment. CASIG assess six key
areas: the client’s goals for improved community functioning, his/her current
functioning, medication practices (adherence and side effects), quality of life and
treatment, symptoms, and unacceptable community behaviors. Data are gathered
from the consumer (CASIG-Self Report; CASIG-SR) and knowledgeable
informants (CASIG-Informant; CASIG-I). The results are used by the consumer-
clinician partners to plan rehabilitation treatment, and the results of the ongoing
administrations of CASIG provide the partners with a measure of the treatments’
effects. Furthermore, If CASIG is administered to participants in a treatment
program; the aggregated results provide an evaluation of the program’s ongoing
success.

Independent Living Skills Survey (ILSS)

The ILSS is a detailed assessment of an individual’s social and independent


living skills. Data are gathered from the consumer (ILSS-Self Report; ILSS-SR)
and knowledgeable informants (ILSS-Informant; ILSS-I), and the results can be
used for planning and evaluating individualized and programmatic rehabilitation
treatment.

Medley of Assessment Instruments

This collection of assessment instruments developed by the UCLA


Psychiatric Rehabilitation Program (Director: Robert P. Liberman MD) for specific
applications have proven useful in diverse facilities and treatment programs. The
instruments can be easily and accurately used by all staff regardless of discipline or
clinical background.

Reinforcement Surveys
Understanding what “motivates” an individual is a key step in designing
effective rehabilitation treatment. Treatment may require a considerable investment
of the client’s time and energy before its rewards and benefits are fully realized.
This delay can be bridged by providing intermediate rewards at each step, raising
the value of the rewards as more and more steps are successfully accomplished.
Each of the four surveys included in this assortment gathers the information to
identify possible rewards. One is an open-ended questionnaire; the others are
closed-ended rating scales. Each includes a different set of possibly rewarding
objects and activities.

Assessment of Interpersonal Problem-Solving Skills (AIPSS)

The AIPSS is a role play test of the examinee's cognitive and behavioral
skills to solve interpersonal problems. These are situations between two people in
which one person hinders the other from obtaining a desired goal. The second
person must determine the nature of the problem, decide on some appropriate
solution, and then perform the solution the solution in a socially appropriate and
effective manner.

In conclusion, assessment in psychiatric rehabilitation is not instrument


dominated. It requires a practitioner who is able to develop a trust-based
relationship with the client. Practitioners who conduct such assessments must have
good interpersonal skills (e.g., the ability to demonstrate understanding). The
practitioner must be skilled in involving clients in a psychiatric rehabilitation
assessment process that the clients themselves understand.

Most existing instruments lack many of the characteristics that would make
the instrument most useful for psychiatric rehabilitation assessment. Although
increasing numbers of psychiatric assessment instruments are focusing on skill and
resource assessments as opposed to a symptom and pathological focus, these
instruments are still limited in their clinical application. The most obvious
limitation is their lack of environmental specificity.

Existing instruments, because of their need to be standardized, provide


information relevant to general environments rather than specific environments
(e.g., a general work setting rather than a specific job site). To be used effectively,
any assessment instrument must be integrated into the broader context of
psychiatric rehabilitation, a process and partnership that is driven by the client's
goal.

MANAGEMENT OF PATIENTS/INDIVIDUALS UNDERGOING


REHABILITATION

A patient undergoing rehabilitation needs to be cared for properly so as to


ensure that the whole goal of rehabilitation is achieved. It is usually a collaborative
effort of all the health team members. But, as nurses, we have unique roles to play
during the management regimen of patients.

In standard settings, there are nurses who specialize in rehabilitation as a


program, such nurses are referred to as rehabilitation staff nurses. Nurses that
deal particular with individuals undergoing substance abuse rehabilitation are
referred to as substance abuse nurses. The goal of rehabilitation nursing is to
assist individuals with a disability and/or chronic illness to attain and maintain
maximum function.

The General Responsibilities of the Rehabilitation Staff Nurse


include:

 Possesses the specialized knowledge and clinical skills necessary to provide


care for people with physical disability and chronic illness
 Coordinates educational activities and uses appropriate resources to develop
and implement an individualized teaching and discharge plan with clients
and their families
 Performs hands-on nursing care by utilizing the nursing process to achieve
quality outcomes for clients
 Provides direction and supervision of ancillary nursing personnel,
demonstrates professional judgment, uses problem solving techniques and
time-management principles, and delegates appropriately
 Coordinates nursing care activities in collaboration with other members of
the interdisciplinary rehabilitation team to facilitate achievement of overall
goals
 Coordinates a holistic approach to meeting patient's medical, vocational,
educational, and environmental needs
 Demonstrates effective oral and written communication skills to develop a
rapport with clients, their families, and health team members and to ensure
the fulfilment of requirements for legal documentation and reimbursement
 Acts as a resource and a role model for nursing staff and students and
participates in activities such as nursing committees and professional
organizations that promote the improvement of nursing care and the
advancement of professional rehabilitation nursing
 Encourages others to become CRRN certified, obtain advance degrees,
participate on committees, and/or join professional organizations
 Facilitates community education regarding acceptance of people with
disabilities
 Actively engages in legislative Initiatives affecting the practice of
rehabilitation nursing or the people in their care
 Applies nursing research to clinical practice and participates in nursing
research studies

The rehabilitation staff nurse also performs various roles in the inter-disciplinary
rehabilitation team. The role of the nurse changes based on the specific need of the
patient at the time.

Some of The Roles Of The Rehabilitation Staff Nurse Include:

1. Teacher:
a. Shares information about the disease processes underlying disabilities
and teaches nursing techniques to help clients and their families
develop the self-care skills necessary to move toward wellness on the
illness-wellness continuum
b. Prepares clients and their families for future self-management and
decision-making responsibilities by fostering clients' independence
and goal achievement
c. Reinforces the teaching done by specialists in rehabilitation and other
healthcare disciplines, provides resource materials for clients'
changing needs, and provides on-going patient education after
discharge
d. Provides in-service education for healthcare team members and
members of the community regarding the prevention of disabilities
2. Caregiver:
a. Assesses the physical, psychological, sociocultural, and spiritual
dimensions of clients and their families, as well as their educational
and discharge needs in order to formulate nursing diagnoses
b. Plans nursing care while acknowledging that rehabilitation nursing is
practiced within a dynamic, therapeutic, and supportive relationship
that is constantly changing, as nurses and clients influence one
another
c. Implements a plan of care by providing nursing care and education
directly or through ancillary personnel, as needed, to maintain and
restore function and prevent complications and further loss
d. Evaluates the nursing care that is being provided and modifies the
plan, as needed, to achieve measurable goals and objectives
3. Mental Health Counseling:
Because addiction is both a physical and psychological health issue,
substance abuse nurses need training and experience in general medical care
and mental health. They must understand the psychological issues that
contribute to addiction so they can help patients work through these
problems and reduce the risk of relapse.
They must also know what psychological issues arise when patients
attempt to conquer their addictions so they can help patients create strategies
for coping with the impact of starting a new life. For example, patients
sometimes suffer from anxiety, depression, mood swings and even thoughts
of suicide when going through withdrawal from the drug.
4. Collaborator:
a. Develops goals, in collaboration with clients, their families, and the
rehabilitation team, that are oriented to wellness behavior and are
reality based and that encourage socialization with others, and
promote maximal independence for patients with disabilities or
chronic disabling conditions
b. Participates in the interdisciplinary team process at team conferences
and other team meetings and offers input into team decision making
c. Intervenes with team members and other healthcare professionals to
ensure that the optimal opportunity for recovery is made available to
the client, the most significant member of the rehabilitation team
d. Collaborates with team members to achieve cost-effective care by
utilizing appropriate clinical measures to meet emergent physical,
psychosocial, and spiritual situations
5. Physical Care:
Patients going through drug rehab can suffer devastating physical
symptoms such as withdrawal, which is caused by the body's response to
going without a substance it's depended on for so long. During withdrawal,
patients might suffer from everything from nausea and vomiting to
sleeplessness. In addition, patients addicted to painkillers might see a
recurrence of their pain when they cease taking the drug.
Substance abuse nurses must be prepared for these physical effects,
and must administer treatments to ease the symptoms so patients can
concentrate on breaking their addictions. The physical effects are sometimes
so severe that patients return to drugs to ease the discomfort, something
nurses can help prevent by helping them manage their symptoms.
6. Patient Education:

Substance abuse nurses often play a teaching role in addition to


providing physical care. They teach patients about the dangers of drug
abuse, including the physical and psychological effects; the damage to
relationships and family life; and the impact on meeting basic needs such as
holding down a job.

They also educate patients regarding treatment options, including


those they can use on either an inpatient or outpatient basis, and those they
can use to stay drug-free long-term. Nurses might also educate a patient's
family members about what to expect from the rehab process and how they
can support their loved one's attempt to conquer drug addiction.

7. Client Advocate:
a. Actively listens, reflects, and guides clients and their families through
the stages of the grieving process to mourn the loss of abilities and
roles while also "instilling hope"
b. Advocates for policies and services that promote the quality of life for
individuals with disabilities and participates in activities that will
positively influence the community's awareness of disabilities
c. Contributes to a safe and therapeutic environment and supports
activities that promote the clients' return of function and prevent
complications or chronic illness
d. Intervenes on behalf of clients to ensure that medical professionals
and nonmedical professionals work to maximize clients' success when
they return to work or school
PSYCHOEDUCATION

Psychoeducation refers to the process of providing education and


information to those seeking or receiving mental health services, such as people
diagnosed with mental health conditions (or life-threatening/terminal illnesses) and
their family members. Though the term has been in use for most of the 20 th
century, it did not gain traction until movements addressing the stigmatization of
mental health concerns and working to increase mental health awareness began in
earnest.

Psychoeducation is an evidence-based therapeutic intervention for patients and


their loved ones that provide information and support to better understand and cope
with illness. Psychoeducation is most often associated with serious mental illness,
including dementia, schizophrenia, clinical depression, anxiety disorders, psychotic
illnesses, eating disorders, personality disorders and autism, although the term has
also been used for programs that address physical illnesses, such as cancer.

Psychoeducation offered to patients and family members teaches problem-solving


and communication skills and provides education and resources in an empathetic
and supportive environment.
The Purpose of Psychoeducation

Psychoeducation, the goal of which is to help people better understand (and


become accustomed to living with) mental health conditions, is considered to be an
essential aspect of all therapy programs. It is generally known that those who have
a thorough understanding of the challenges they are facing as well as knowledge of
personal coping ability, internal and external resources, and their own areas of
strength are often better able to address difficulties, feel more in control of the
condition(s), and have a greater internal capacity to work toward mental
and emotional well-being.

One study showed psychoeducation, when administered to those with


schizophrenia, helped to both reduce rehospitalization rates and decrease the
number of days a person spends in the hospital. This education is also a component
of most trauma therapies.

Many individuals who have a mental health condition know little or nothing about
the condition they have been diagnosed with, what they might expect from therapy,
or the positive and negative effects of any medications they may be prescribed.
Literature on these topics given to them by medical professionals may be
confusing or otherwise difficult to comprehend and thus of little help.

Offered in both individual and group formats, psychoeducation can benefit the
individual diagnosed, parents and other family members, and caregivers and
friends. It is not an approach to treatment in itself but represents an important early
step in treatment, as it offers those individuals involved in a person’s care
information on both how to offer support and how to maintain their own emotional
health and overall well-being and provides them with the opportunity to develop a
thorough understanding of the mental health concern(s) affecting their loved one.
Participating in psychoeducation may have a positive impact on quality of life.

Understanding the Psychoeducation Process

Psychoeducation may be general or highly specified and can be provided in a


number of ways, though it is broadly steered by four main goals: transfer of
information, medication and treatment support, training and support in self-help
and self-care, and the provision of a safe place to vent emotional frustrations.

All of the following may constitute psychoeducation:

 A therapist explaining to a person in therapy the ways a mental health


condition might impact function

 A psychiatrist describing how a prescribed medication can counteract


symptoms of a mental health condition

 A psychiatric hospital providing support and education to family members


of those receiving treatment

 Formal classes designed to educate the population about both specific


mental health conditions and mental health in general

 Classroom behavior management assistance for students diagnosed with


behavioral concerns

 Self-help and support groups designed to encourage those diagnosed with


mental health concerns to share strategies and information with one another.
Some people might receive psychoeducation through online or electronic formats
such as DVDs, CDs, or other audiovisual materials, though others may choose to
participate in sessions with a mental health professional.

USEFULNESS OF PSYCHOEDUCATION

Psychoeducation, whether administered in a clinical, school, or hospital setting or


through the telephone or Internet, often leads to increased compliance with
treatment regimens. When people who have been diagnosed with a mental health
condition are able to understand what the diagnosis means, they are more likely to
view their illnesses as treatable conditions rather than shameful diagnoses
indicating they are “crazy.” Family involvement in psychoeducation can also
improve compliance and ensure that a person experiencing mental health concerns
is given adequate support while they receive treatment.

In addition to helping those diagnosed with mental health concerns better


understand the issues they are addressing, psychoeducation also plays a vital role
in the destigmatization of mental health conditions. Organizations like the National
Alliance on Mental Illness (NAMI) have advocated for increased psychoeducation
for consumers of mental health services and their families. When people
understand more about mental health concerns–that mental health conditions are
not the result of bad choices and do not typically indicate a person is violent, for
example—they are far more likely to accept people who have mental health
conditions. As psychoeducation does much to inform about the true nature of
mental and emotional concerns, it is an important aspect of this goal.

POSSIBLE RISKS AND SIDE EFFECTS

Often acutely sick patients suffer from substantial thinking, concentration


and attention disturbances, at the beginning of their illness and care should be
taken not to overwhelm the patient with too much information. Besides positive
effects of a therapeutic measure like psychoeducation, in principle, also other
possible risks should be considered. The detailed knowledge of the condition,
prognosis therapy possibilities and the disease process, can make the patient and/or
family member stressed. Therefore, one should draw an exact picture of the risks
regarding the psychological condition of the patient. It should be considered how
much the patient already understands, and how much knowledge the patient can
take up and process in their current condition. The ability to concentrate should be
considered as well as the maximum level of emotional stress that the patient can
take. In the context of a psychoeducational program a selection of aspects and/or
therapy possibilities can be considered and discussed with the patient. Otherwise,
the patient may form an incomplete picture of their illness, and they may form
ideas about treatment alternatives from a vantage point of incomplete information.
However, the professional should also make a complete representation of the
possibilities of treatment, and attention should be paid to not make excessive
demands of the patient, that is, giving too much information at once.
ROLE OF FAMILY MEMBERS IN REHABILITATION
PROGRAMME.
One of the most important factors in a patient’s rehabilitation is the involvement
and support of the family member(s). Usually the patient family is the caregiver
and thus plays a vital role in the rehabilitation process for a number of reasons.
Rehabilitation helps the family come to terms with the diagnosis, the altered
circumstances, and their expectations of the person with the illness. It also helps
the family to understand the persons strengths and create opportunities for them
to make a meaningful contribution at home, or in the society.

Family roles in rehabilitation include;

Support
This is one of the basic and most important roles of family members during
rehabilitation. Family members provide emotional, psychological and social
support to patient undergoing rehabilitation programme. Family supports also
help patients deal with issue of self esteem related to their condition. Good family
support also improves the patient’s chances of having a positive oputcome.

Encouragement
This is needed during rehabilitation programme. Family constantly
encourages the patient in their rehabilitation programmes. They encourage them
to go for their rehabilitation therapy, encourage them to use their medication,
encourage them to visit their rehab centres etc.

Positive attitudes.
Another role of family members is to be a source of positive attitude to the
client. This will serve as an inspiration. It will inspire patients’ commitment to
recovery and help them adapt to new physical challenges or limitation
Working and in hand with professionals

Family members work hand in hand with professional health practitioners to


improve the delivery of care and to promote the health of the patient during
rehabilitation. With family involvement, patients care plan can be executed more
efficiently.

Educators
In some cases, families have become especially knowledgeable and may even
know more than many professionals, particularly about the aspects of their own
relative’s illness. This knowledge is an important resource in the rehabilitation
process. For example, they know their family member’s reaction to life stresses,
strengths and weaknesses and reactions to the illness and to the interventions of
the mental health system. This family knowledge is an important addition to the
knowledge professionals gain from their experience with their experience with
their client.

Families also need to educate professionals about how they experience the
mental illness of their family member and to confront the negative beliefs some
professionals hold towards families.

However, while playing their roles and caring for their relatives during
rehabilitation, the family members might experience some emotional derailment
like feeling of burden, loneliness, depression etc. hence, a need for them to join
support groups during this course.

There are many benefits to participating in a support group

 Feeling less lonely


 Social interaction in a safe environment
 Sense of empowerment
 Improved coping skills
 Reduction in stress
 Opportunity to gain information about treatment options.

REHABILITATION SERVICES
Psychiatric rehabilitation is also known as psychosocial rehabilitation, it
seeks to effect changes in a person's environment and in a person's ability to deal
with his/her environment, so as to facilitate improvement in symptoms or
personal distress and life outcomes. These services often "combine
pharmacologic treatment (often required for program admission), independent
living and social skills training, psychological support to clients and their families,
housing, vocational rehabilitation and employment, social support and network
enhancement and access to leisure activities. Psychiatric rehabilitation promotes
recovery, full community integration, and improved quality of life for persons who
have been diagnosed with any mental health condition that seriously impairs
their ability to lead meaningful lives. Psychiatric rehabilitation services are
collaborative, person-directed and individualised. It promotes recovery, full
community integration, and improved quality of life for persons who have been
diagnosed with any mental health condition that seriously impairs their ability to
lead meaningful lives.

Core principles of effective psychiatric rehabilitation (how services are


delivered) must include:

- providing hope when the client lacks it.

- respect for the client wherever they are in the recovery process.

- empowering the client.


- teaching the client wellness planning, and

- emphasizing the importance for the client to develop social support networks.
[34]

Psychiatric rehabilitation (what services are delivered) varies by provider


and may consist of eight main areas:

- Psychiatric (symptom management; relaxation, meditation and massage;


support groups and in-home assistance)

- Health and Medical (maintaining consistency of care; family physician and


mental health counseling)

- Housing (safe environments; supported housing; community residential services;


group homes; apartment living)

- Basic Living Skills (personal hygiene or personal care, preparing and sharing
meals, home and travel safety and skills, goal and life planning,chores and group
decision-making, shopping and appointments)

- Social (relationships, recreational and hobby, family and friends, housemates


and boundaries, communications & community integration)

- Vocational and/or Educational (vocational planning, transportation assistance to


employment, preparation programs (e.g., calculators), GED classes, televised
education, coping skills, motivation)
- Financial (personal budget), planning for own apartment (startup funds, security
deposit), household grocery; social security disability; banking accounts (savings
or travel)

- Community and Legal (resources; health insurance, community recreation,


memberships, legal aid society, homeownership agencies, community colleges,
houses of worship, ethnic activities and clubs; employment presentations; hobby
clubs; special interest stores; summer city schedules).

INDICATION FOR REHABILITATION SERVICES

1. The individual experiences symptoms that meet the diagnostic criteria for a
diagnosis from Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or
International Classification of Diseases (ICD) for psychiatric outpatient treatment
covered by his plan.

2. Significant cognitive and behavioral impairments that impede the individual's


ability to live successfully in the community and are consistent with the
DSM-5/ICD diagnosis listed, and these impairments are likely to improve with
treatment. Impairments can include long-term or repeated psychiatric
hospitalizations, difficulties in daily living, inability to function without intensive
intervention, or limited to nonexistent support system.

3. The individual demonstrates motivation for treatment and is capable of


benefiting from psychosocial rehabilitation services.

FAMILY INVOLVEMENT IN REHABILITATION .


When a person is diagnosed with a mental health disorder, the family or
caregiver also has to cope with the diagnosis. In addition, there are other factors
that make coping difficult: a changed perception of who the patient is, what they
are capable of, and what their role in the family will be. The caregivers and family
also need additional support to help them live with the diagnosis The
involvement of the family is an extremely important aspect of the rehabilitation
process. Psychiatrists say that the positive and active support of family members
forms the most effective part of the rehabilitation process. When a family spends
a considerable amount of time and effort assisting their loved one, it increases
the person’s chances of picking up new skills or setting new goals. This will, in
turn, help the family as well.

Some Psychiatric Rehabilitation services include the following:

1. Basic Rehabilitation – It is provided when an individual is having difficulties in


adjusting to his current situations. The rehabilitation staff engages the individual
weekly to provide support with the identified challenges.

2. Rehabilitation Readiness – The consumer’s capacity to make important


decisions us assessed in their lives such as where to reside, work, seek treatment,
etc. The rehabilitation staff teaches the skills needed and/or support the
individual with obtaining the necessary resources.

3. Enrichment/Support – This is provided to the individual to prevent re-


hospitalization and crises. Community intervention, empowerment sessions,
community involvement, containment, support, validation and one-on-one
support are needed

4. Case Management – This is provided to support consumers with obtaining


entitlements and other community resources. This service is essential to enable
consumers with becoming successful and satisfied in the environment of their
choice by working together to develop useful rehabilitation goals.
CONCLUSION
In conclusion, psychiatric rehabilitation program is a service designed to
teach or restore skills necessary for recovery from mental illness after many years
of battling it and after a number of hospital admissions. For a result producing
rehabilitation programme, it must be an all encompassing programme involving the
patient, health workers and family members.
REFERENCES

Ellie Williams (2018), The Role of a Nurse in a Drug Rehabilitation, Hearst


Newspapers, LLChttp://work.chron.com/role-nurse-drug-rehabilitation-15460.html

What Does a Rehabilitation Staff Nurse Do?Association of Rehabilitation Nurses,


https://rehabnurse.org/about/roles/rehabilitation-staff-nurse

Enabling recovery for people with complex mental health needs - a template for
rehabilitation services. Published by the Royal College of Psychiatrists' Faculty of
Rehabilitation and Social Psychiatry, edited by Drs Paul Wolfson, Frank Holloway
and Helen Killaspy.

Mental Health Ireland: a national voluntary organisation which includes mental


health professionals and lay people who provide care, support and friendship.

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