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Psychiatric Rehabilitation: Its

Principles and Practices

Psychiatric Rehabilitation: Its Principles and Practices The Challenges of Communicating these Through Training and Education Kenneth

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


  • 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


Understanding Psychiatric Rehabilitation Four Part Model

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


  • 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


  • 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


    • 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


    • 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


    • 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