Rogers, & Dellario, 1985), and patients withsubstance abuse problems (e.g. Lehman, 1996; USDepartment of Health and Human Services, 1994).This article uses the terms ‘individuals with seriousmental illnesses’, ‘individuals with lived experience’or ‘people’ interchangeably with ‘clients’ or ‘con-sumers’ to refer to the target population. The term‘individual’ or ‘person’ underscores rehabilitation’sinterest in the human being, across all of his or herroles (e.g. resident, student, worker, friend).Individuals who themselves have mental illnessesuse the term ‘lived experience’ (Deegan, 1988) toemphasize a commonality based on experience,rather than on labels or the acceptance of any oneexplanation of serious mental illnesses.
Context
In contrast to the practice of psychiatric rehabilita-tion, service delivery over most of the last century hasgenerally been heavily influenced by the mistakenassumption that people with severe mental illnessesdo not recover and, in contrast, deteriorate over time(Bond et al., 2001; Farkas, Gagne, Anthony, &Chamberlin, 2005). There is a growing body of literature examining the concept of recovery frommental illnesses and its outcomes (e.g. Anthony,1993; Davidson, Harding, & Spaniol, 2005; Farkas,2007; Harding & Zahniser, 1994; Liberman,Kopelowicz, Ventura, & Gutkind, 2002; Ridgway,2001; Silverstein & Bellack, 2008; Spaniol,Wewiorski, Gagne, & Anthony, 2002). People withpsychiatric disabilities have published their experi-ences of recovery (e.g. Deegan, 1990, 1993; Fisher &Ahern, 1999; Mead & Copeland, 2000; Ridgway,2001; Spaniol, Gagne, & Koehler, 1999), and withlike-minded professionals are advocating for systemand agency strategies to facilitate recovery (e.g. Frese, Stanley, Kress, & Vogel-Scibilia, 2001; Jacobson & Greenley, 2001; Torgalsboen & Rund,1998). Clearly, people with psychiatric disabilitieshave the same aspirations as any other citizen forrespect and as fulfilling a life as possible. Thirty yearsof empirical evidence as well as first person accountssupport the notion that recovery from serious mentalillnesses or the gaining or regaining of a meaningfullife is not only desirable but possible. Recovery isacknowledged to be the patient’s experience of ajourney from the catastrophic effects of mental illnessto a meaningful life and full citizenship (Deegan,1990; Farkas, 2007; Ridgway, 2001). Contributingto this journey and multidimensional outcomes isnow promulgated as the necessary unifying missionof all mental health services (Farkas et al., 2005;New Freedom Commission on Mental Health,2003).
Definition of psychiatric rehabilitation in thecontext of recovery
Psychiatric rehabilitation (PR) is neither a particulartechnique nor one intervention but a field and aservice within a mental health system, along withother services such as treatment services, crisisintervention services or basic support services.Since recovery is a consumer experience and not aprogramme model or provider practice, no servicecan ‘do’ recovery. Psychiatric rehabilitation can anddoes promote a vision of recovery or the achievementof a meaningful life, rather than simply supportingadaptation or survival in the community (Farkas, 2007). Typically, recovery outcomes haveincluded multidimensional variables ranging from asan increase in physical health and well-being togaining or regaining valued societal roles, andreducing symptoms (Farkas et al., 2005). Each typeof service within a recovery orientated mental healthsystem should therefore be able to clearly identify therecovery outcomes for which it holds itself responsi-ble.Forexample,treatmentservicescancontributetorecovery by reducing symptoms and distress, what-ever other functions they may perform. In thiscontext, psychiatric rehabilitation services contributeto recovery by focusing on outcomes related to rolefunctioning in ‘real world’ settings chosen by theindividual (Anthony et al., 2002).Rehabilitation operates at the intersection betweenthe individual, an individual’s personal network and the wider social context (Barbato, 2006).Rehabilitation, of any kind (i.e. physical, psychiatric,social, etc.) is ecological (‘person–environment fit’)and specifically targets improving role performance.The term ‘psychiatric rehabilitation’ reflects thefocus of this field on people with psychiatricdisabilities and their improved abilities within theirspecific preferred role in the ‘real’ world, using thedevelopment of skills and supports as its primary types of interventions (Anthony et al., 2002;Farkas, 2006). Without a process committed tosupporting chosen roles and settings, functioningmay be improved but the individual’s vision of ameaningful life may still not be achieved.Rehabilitation, therefore, works with social relation-ships, work, leisure, family life, higher education andother student pursuits, using interventions that focuson increasing competencies or skills and providingenvironmental supports, rather than focusing onsymptoms and pathology. It does not deny thatsymptoms and pathology exist nor the importance of intervening to reduce these, however its own exper-tise targets the International Classification of Impairment, Disability and Handicap (ICIDH)dimensions of activity, participation and environ-ment (WHO, 2001), rather than health.
Psychiatric rehabilitation interventions: A review
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