Melissa M. Roberts

The Experience of Mental Illness: An Introduction to Psychiatric Rehabilitation

This chapter introduces you to the field of psychiatric rehabilitation, an evolving set of services designed to foster the community integration, improved quality of life, and recovery of persons with severe mental illness. The final section of the chapter discusses how psychiatric rehabilitation knowledge is developed, the identification of evidence-based practices, and the sources of that knowledge for professionals and students.

Symptoms and Etiology of Serious Mental Illness

The symptoms of serious mental illnesses can be catastrophic in their impact, threatening the integrity of the person’s thoughts, feelings, and sense of self. This chapter and the next include brief vignettes about individuals with mental illnesses. All are factually based, but keep in mind that they represent only a brief interval in that person’s life and only one aspect of the life of a person with a severe mental illness. All individuals have characteristics, abilities, interests, and experiences that make them unique. A person who is utilizing mental health services should never be viewed simply as having an illness.

Assertive Community Treatment and Case Management

Psychiatric rehabilitation (PsyR) responds to the variety of needs of persons living with serious mental illness. Given the multifaceted nature of the challenges caused by these illnesses and fragmented systems of care, it is necessary to coordinate both services and resources. This coordination is generally known as case management and it is an essential ingredient of many psychiatric rehabilitation programs. Some people with psychiatric illnesses who need a variety of services and resources may not receive them unless they are sought out and contacted in the communities where they live. The most effective strategy for accomplishing this is known as assertive community treatment (ACT).

Chapter 11 – Supported Education

Successful educational achievements such as completion of an academic degree or a technical training program help many people achieve their long-term vocational goals and improve the quality of their lives. A psychiatric rehabilitation approach known as supported education is designed to help individuals coping with a psychiatric disability to complete their education and training. This chapter will explore the challenges encountered by these students, the strategies employed by supported education, and the benefits people with psychiatric disabilities gain from these services. Successful educational achievements such as completion of an academic degree or a technical training program help many people achieve their long-term vocational goals and improve the quality of their lives. A psychiatric rehabilitation approach known as supported education is designed to help individuals coping with a psychiatric disability to complete their education and training. This chapter will explore the challenges encountered by these students, the strategies employed by supported education, and the benefits people with psychiatric disabilities gain from these services. This chapter will answer the following questions: 1. Can people with severe and persistent mental illnesses successfully pursue postsecondary education? 2. What are the special needs of students with psychiatric disabilities? 3. What does higher education offer persons with severe and persistent mental illnesses? 4. What types of special services and supports can be provided? 5. Are there supported education strategies that have been proven effective? 6. What is the future of supported education as a psychiatric rehabilitation service?

6 – Health and Wellness

People with serious mental illness tend to have poor overall health due to medication side effects, lifestyle issues, and poverty, often dying 20 to 25 years earlier than others their age. This chapter introduces you to the areas of health promotion and wellness, how they are consistent with the principles of psychiatric rehabilitation (PsyR), and to an evolving set of services and practices to foster better overall health. This chapter begins with the story of Ted, a man in his forties who is successfully coping with a severe mental illness, but succumbs to other health problems and dies prematurely. After reading about Ted, you will learn that his tragic story is not unusual. People with serious mental illness tend to have poor overall health due to medication side effects, lifestyle issues, and poverty, often dying 20 to 25 years earlier than others their age. This chapter introduces you to the areas of health promotion and wellness, how they are consistent with the principles of psychiatric rehabilitation (PsyR), and to an evolving set of services and practices to foster better overall health. This chapter will provide answers to the following questions: 1. What are the most common, non-psychiatric health problems faced by persons with serious mental illness? 2. What are the factors that contribute to these health concerns? 3. Which concerns are unique to persons with serious mental illness? Which are shared with the general population? 4. What strategies are being used to help people recover from these health conditions? 5. How can the principles of psychiatric rehabilitation be applied in this context? 6. What more can be done to help individuals with serious mental illness maintain or regain their physical health?

Psychiatric Rehabilitation Methods

This chapter will outline the basic strategies involved in the rehabilitation of persons living with serious mental illnesses. In the past, most mental health professionals believed that symptoms should be ameliorated and long-term stability achieved before rehabilitation could begin. Today, as evidenced by the fact that many persons with serious mental illnesses lead full and productive lives, there is general agreement that rehabilitation should begin as soon as possible. There is also a growing body of evidence that there are many social, vocational, emotional, and psychological benefits to the rehabilitation process.

Psychiatric Day Programming

This chapter will explore the historical roots of community-based programs in the clubhouse movement and in the partial hospitalization programs set up as part of the Community Mental Health Center initiative. We will examine some of the reasons these programs may be less effective today and how they may be designed and operated to help facilitate specific rehabilitation outcomes. Finally, we will discuss the potential for improved services inherent in the advent of evidence-based practices and the recovery movement.

The Goals, Values, and Guiding Principles of Psychiatric Rehabilitation

This chapter reviews the goals, values, and guiding principles of psychiatric rehabilitation (PsyR). Psychiatric rehabilitation is an evolving discipline, so the approaches and strategies used constantly undergo adjustment and change as the field matures and the methods become more refined. These differences are reflected by the wide scope of PsyR practice currently in use. Despite the diversity of practice, you will see that there is agreement about the goals and values of PsyR. This agreement is clearly demonstrated by the similarity among the many formulations of PsyR principles that have been suggested by different groups and authors.

Self-help and Peer-delivered Services

This chapter outlines the important contributions people diagnosed with a severe mental illness make to their own rehabilitation and the rehabilitation of others. Like the fields of alcohol and drug addiction treatment, there is a long tradition of mutual self-help among persons living with mental illness. Today, these individuals are designing and delivering services and moving into psychiatric rehabilitation service provider positions in larger numbers. They are involved in operating peer support agencies, participating on boards of directors, educating and training practitioners and service recipients, and conducting research.

Co-occurring Disorders and Integrated Treatment

This chapter deals with the treatment and rehabilitation of persons who have both a serious mental illness and a substance abuse disorder, commonly referred to as co-occurring disorders. Persons with a severe mental illness have a much greater risk of developing a substance abuse disorder than those without mental illness. The difficulties of having both types of disorders at the same time are multiplied by the fact that they interact, each aggravating or exacerbating the other. In addition, coming from different philosophical and educational backgrounds, the service providers for these different conditions often have conflicting and sometimes contradictory approaches. Services that have been developed to address these problems and other issues involved in helping this dually diagnosed population are discussed.