psycho social rehabilitation

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Definition of PSR Psychosocial rehabilitation can be defined as a process initiated by a health or mental health profession in collaboration with the patient’s family and community, and supported by the policy planner implementing an individualised intervention programme that seeks to maximise the patient’s assets and minimize his abilities in the area of socio occupational functioning,centering around the philosophy of mobilizing and utilising resources available to the community, with the final objective of main streaming the client.

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PSR – A revised definition Pshycosocial rehabilitation is a process initiated by the family of a person with severe mental disorder, in collaboration with the community’s natural support system which includes the health professional, that seeks to maximise their socio occupational functioning of the patient with the final stated objective of preventing marginalization.

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Guiding Models Medical Model : Curative Model Disability Model : Emphasis on adaptation/ Readaptation Skills Model : Developing skills (Anthony and Coworker’s) Needs Model : Individual tailoring (Conning and Rowland 1992) Role Model : Social role model (Lam and Power 1991)

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Conceptual Issues Illness : Physical or mental states which are deviation from the normal state of health described in terms of signs and symptoms. Impairment :Any loss or abnormality of “psychological or anatomical structure or function”. Disability : Any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being. Handicap : Disadvantage resulting from impairment or disability that limits or prevents the fulfillment of a role that is normal for the individual.

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Disability – Parameter for intervention Mild disability : Medication- Compliance Family support and education Cognitive refraining. Moderate disability : Medication – Psychosocial intervention Job oriented, Social skills,Individual psychotherapy and support, cognitive refraining. Severe disability : Scheduling of a day, self care,social skills,group therapy, custodial care.

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Problem areas 1. Rehabilitation of more educated,sophisticated group. 2. Continuation of intervention. 3. Slow progress – Disheartening. 4. Dearth of trained professionals – Trading programmes to be started.

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People with psychriatric disability ,chronic mental illness. Chronicity is defined by Diagnosis Severity of illness Duration Include : Mental disorders like Schizophrenia,Recurrent AD (D nd MDP),OBS, Paranoid Psychosis and others which may become chronic

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Current nosological issues from the rehabilitation perspective. DSM III R,Multi axial classification More inclusive view of the patients current situation than indicated psychiatric diagnosis alone. Axis iv,v crucial for current situation. DSM III highlights the importance of disabilities in severe mental disorders by making them criteria for many diagnosable psychiatric conditions. “To diagnose schizophrenia, it is not sufficient to experience the characteristic symptoms.But the person must also evince a detoriation from a previous level of functioning in such areas like work social relations and self care”

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Rehabilitation assessment Aims: 1.Diagnosis of main problems 2. Determination of appropriate intervention 3. Plan of evaluation 4.Prediction of outcome.

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Essentials of assessment methods: Detailed History. Case diagnosis. Current pshycopathology, Disability – Vocational. Current social and environmental factors(Augumenting and Detrimental). Resource. Family. Needs.

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Rehabilitation planning. Stating main problems Prioritising. Assigning interventions. Monitoring plans.

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PSR Interventions Patient Family Rehabilitation Worker

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Interventions Patient centered: Medication related Individual counseling and psychotherapy Social skills training Group therapy Vocational and occupational training. Cognitive refraining Relaxation technique and other behavior modification approaches

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Family centered interventions Psycho education Counseling supportive psychotherapy Coping skills,Problem solving Crisis management Other support Resource mobilization Job placement Training in income generating activities Self help groups.

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Areas for rehabilitation Self care Communication Independent living skills Work related Self esteem/Motivation Leisure activities Dealing with delusions,Hallucinations and aggressive behavior

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Areas for rehabilitation Cognitive dysfunctions Managing relapse Medication management Managing stress Resourse mobilization

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Patient interventions

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Case management Vs Rehabilitation Case management is an “ Environmental free “service that provides the ongoing coordination of other service providers. Rehabilitation is an “Environmental specific “ service that focus on developing the skills and supports needed for success and satisfaction in a chosen environment. Case management: Need based/Holistic view/Attempts/Comprehensive care to patient. Rehabilitation: Need based/Deficit oriented/Strategic approach Goal : To improve the quality of life of the patient.

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Factors influencing case management: Patient factors: Illness status Medication Medication compliance Disability Assets Motivation

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Factors influencing case management: Familiy factors: Availability Accessibility Willingness Felt burden Needs Understanding/Knowledge of the illness and the patient Social support,Other needs (economic etc)

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Locale: Patient is at home attending day care is in a residential facility of scarf(I) PSR services: Availability,Accessibility of facilities Structured Vs Unstructured skills, Training programmes – Group Vs Individual approaches Other medical support systems E.g.: Acute care facilities.

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The role of the MHP Resource person Social change agent Trainer of rehabilitations Support figures Educator Advocate Not primary care giver

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Medication – Non compliance Reasons: Being relieved from symptoms Side effects Poor /No insight Stigma Cost Management Patient : a) IC b) BM c)Groups Family: Education – Drugs /Need/Side effects - Methods of monitoring.

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Behaviour management : Indications: 1.Inculcating new behavior 2.Modifying problem behaviors 3.Extinction of maladaptive behaviors

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Behaviour management : Methods: Goal setting Negotiating Planning – contract Implementation Rewarding achievement of goals Transfer Follow-up

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Cognitive rehabilitation: Cognitive remedial approach: Nueropsy assessment Identification of target deficits Designing of CR tasks CR can be done by Non computerized techniques (Puzzles, Chess) Computerized techniques (computer games, sustained attention tasks,computer games) Home based exercises (Rangoli,Grain sorting)

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Cognitive rehabilitation: CR has to meet individual needs Number of patients – 3/therapist Duration –Min 3 months(Daily sessions) Evaluation Improvement in responses Improvement in day to day functioning Pre and post evaluation.

THANX….. : 

THANX….. Shine Vayala shinevayala@gmail.com