The Implementation of Evidence-Based Psychiatric Rehabilitation: Challenges and Opportunities for Mental Health Services

Abstract

In the recent past, mental health care and psychiatric service organization conceptually and structurally changed. The introduction of antipsychotic drugs in the 1950s substantially changed the treatment of schizophrenia and other psychotic disorders (1). The consequent deinstitutionalization decreased the number of hospitalizations and transferred the treatment pattern from an inpatient care to community-based outpatient services, although the latter has grown up differently through and within the countries (2). In recent years, treatment of severe mental illness (SMI) shifted from management and stabilization of symptoms, to the much broader and more ambitious goal of achieving functional recovery. Despite advances in pharmacological treatment of people with SMI, it has become clear that medications alone are not sufficient to achieve a full symptom remission and functional recovery (3–5). The effectiveness of drug treatments is further impaired by the total or partial non-adherence, affecting more than half of patients with SMI (6, 7). In this context, several non-pharmacological interventions have been developed for SMI and, among them, psychosocial rehabilitation represents one of the most relevant systematic effort to help adults with psychiatric disabilities to achieve their personal goals.