How important is the Psychosocial Rehabilitation to our clients who are mentally ill ?

Are you familiar with stories like that of our client ?

Mr. Sampath  is a 30-year-old,single male who had suffered from schizophrenia for five years. His illness is diagnosed, and he receives treatment years after the onset. After treatment, he goes back to his home and surroundings, and finds out that his classmates and friends are now settled in their careers, are doing well and have their own families. His family wants him to stay occupied, and suggests he take up a blue-collar job. This demoralizes him; he feels confused and lost. At the same time, he is well enough to remember and use his skills and capabilities. In this case, he needs the support of a mental health professional to assess his changed circumstances, and decide what skills he may be able to use, or what career path he would like to take. His family also needs to see him as an individual and not just as the illness – this will help them acknowledge his strengths and his aspirations.

What    do you think would be the next step  in Sampath’s treatment plan?

The answer is Psychosocial Rehabilitation

Unlike in the case of physical illnesses where medication or surgery may provide a complete cure, mental disorders require medication along with other forms of treatment such as rehabilitation.

Rehabilitation can help you get your life back on track after treatment for a mental illness

It is an aspect of treatment that focuses on helping the person return to an optimal level of functioning and to achieve their life goals. This is brought about by providing medical, psychological and social input.

Why is Rehabilitation important ?

People with severe and chronic psychiatric illnesses such as bipolar disorder and schizophrenia may be mentally disabled by their condition, and require rehabilitation to pick up basic skills.

An individual who has to re-learn skills after the onset of mental illness is said to undergo a process of rehabilitation

The process of rehabilitation aims to help the patient develop the social and intellectual skills that they will need to integrate with mainstream society. This helps the person find a meaningful role for themselves, at home and at work. Rehabilitation supports the patient by providing opportunities, preventing stigma and discrimination.

Most chronic mental illnesses have their onset between the ages of 18 and 25. This is the period when most people set concrete life goals and work towards achieving them. When a person is diagnosed with a severe mental illness, they have a gap of months or years during which they are unable to study or work. The situation worsens if they are denied opportunities after their treatment. Sometimes, their friends and family may be overly critical or overly protective. This adds to the disability caused by their illness.

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. 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 person’s strengths and create opportunities for them to make a meaningful contribution at home, or in the society.

Therefore, it is much more clear that  successful psychiatric rehabilitation would reduce iatrogeny, improve social competence, reduce discrimination and stigma, and improve family and social support and consumer empowerment.

What would be the Sampath’s family’s role in this situation?

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.

Sampath’s family need a meeting with treating Mental Health Team (Consultant Psychiatrist, Social Worker, Occupational Therapist ,Psychologist etc.) ,to discuss with team about Sampath’s recovery plan including rehabilitation and to negotiate with the team about their role in order achieve maximum level of recovery.

What  is rehabilitation process?

The rehabilitation process usually begins with the psychiatrist or other mental health professional speaking to the patient and family, to find out the patient’s strengths and interests.  At this point, what is most required is for the family to have a realistic understanding of the individual’s capabilities, and to set realistic expectations of them. For instance, a person with a severe mental illness may not be able to socialize or perform in certain kinds of tasks. The family needs to understand that, rather than put pressure on them to conform to their expectations.

Once the family understands the person’s skills and limitations, they may recognize that the person can lead a happy, satisfactory life according to their own preference, and with a set of expectations more suited to their circumstances.

In some cases, the psychiatrist or other mental health professional may engage repeatedly with the person to build a rapport, and understand any problems the patient may be facing, and the family’s outlook towards their illness. The psychiatrist is then able to help them envision a better life despite the limitations posed by their mental illness.

What is the purpose of training and development of skills?

After treatment, some patients are able to use their original skills and get back to their work. If a patient is left with significant challenges, they are then offered training to help them develop the skills needed to be in alignment with their new goals, priorities or values. Once the person is able to make a breakthrough – in learning a new skill or finding a new interest – there is an aspirational value to this process. This creates what experts call a positive cycle in which the quality of the person’s life stands to improve.

Undoubtedly ,psychosocial rehabilitation emphasize on skills and abilities rather than symptom and disabilities, focus is on areas of activities of daily living, socialization and work: all share a belief that most person with serious mental health problems can improve if properly evaluated, trained and supported in the community.

Once in the line with the  rehabilitation process, our client Sampath would be able to achieve his realistic, set goals and aspirations as the time pass on, while receiving moral and other support from mental health professionals. Further, he might be able to overcome difficulties of playing a social role living in a social environment.

 

Dr Nayana Edirisinghe
Consultant Psychiatrist
DGH-Polonnaruwa

Mission : Fulfilling the mental health information needs of public through increased access to accurate information effectively and efficient delivered with established ethics.
Vision : The realization of optimum mental health of Sri Lankan community.

Recent Publications
Useful Link