Brief Social Skills Training (BSST) in a General Hospital Psychiatry Unit in India

Article excerpt

Byline: T. Ismail Shihabuddeen, Susan. Anand, P. Gopinath

Social disability has been found to be a potent predictor of symptom exacerbations and re-hospitalizations. It is clear that social skills training is an effective strategy. Accessibility for the mental health consumers and the availability of services are the two main reasons which highlights the felt need of the brief skill development program in the GHPU during their hospitalization. This article reviews the need for brief skills training to enhance client's social competence to reach optimal functioning which in turn may decrease the risk of relapse or revolving door syndrome and may prevent further deterioration of individual's skills during their long stay in a GHPU's.

Introduction

Social skills are interpersonal behaviors that are socially acceptable or sanctioned in a particular community or society. When florid symptomatology is controlled by medication, most individuals who had psychiatric condition are left with social skills deficits due to various reasons. These deficit may increase the risk of relapse, where as enhanced social competence may decrease that risk. Social competence is based on the set of component response skills. These skills are learned or learnable.

Concepts

Social skill training was introduced in the 1970's mainly in the form of single case studies. Since then, the group format has been forward to be more popular as it is not only cost effective but also enhances generalization of skills by providing a learning experience (P.S.Gopinath & Kiran Rao, 1994). Impairment in social functioning is not simply a by product of positive and negative symptoms of Schizophrenia but an independent domain of the illness (Lenzeweger, M.F et al, 1991). Social dysfunction may results from three circumstances are:

*When the individual does not know how to perform appropriately. *When he or she does not use skills in his or her repertoire when they are called for. *When appropriate behaviors undermined by socially inappropriate behavior.

These circumstances are especially common in Schizophrenia (Bellack, A.S.et al, 1997). Poor social competence contributes to the improvised equality of life in many clients. This interferes with functioning within the family or in the work place. In addition, social disability has been found to be a predictor of symptom exacerbations and re-hospitalization (P.S.Gopinath & Kiran Rao, 1994). The most promising strategy for alleviating social disability and enhancing social competence has been social skills training (Wallace, E.J.et al, 1980).

Frame work:

It is clear that social skills training is an effective strategy, more work needs to be done on issues pertaining to brief social skills training during hospitalization. The care must be taken while choosing the client for Brief social skills training (BSST). The factors that can affect social functioning such as severity of psychotic symptoms, motivational factors, environmental and neurobiological factors must be taken into consideration. The brief training is more conducive if a GHPU has a Day Care Centre attached to the Psychiatry wards. Team work approach is essential for effectiveness of the training. Nurse available in the wards need to be trained to communicate and deal with the identified client for encouraging and maintaining the learned skills or taught skills throughout the hospitalization.

Skills training which is often regarded as the principal intervention in Psychiatric Rehabilitation is grounded in the assumption that many clients are left with disability in- spite of optimal pharmco therapy. Skill development interventions systematically and directly attempt to change the clients' behavior in a comprehensive array of behavioral, cognitive and functional domains.

Why GHPU?

Psychosocial interventions are feasible and realistic at GHPU, when we consider the current mental health care system of our country. …