Mental Disorders: Burden to Families; Part 2: Road Map to Psychosocial Rehab

Article excerpt

The economic costs of mental disorders are high. These economic effects are seen as the direct costs in the provision of treatment and rehabilitation and the attendant social services, as well as other economic setbacks as a result of lost employment and productivity caused by mental disability. These costs add up to significant burden to the family and the community.

Measured in ?disability adjusted life years? mental disorders are among the top 10 conditions causing severe activity limitation and disability. In 1998, depression ranked No.1 and schizophrenia No. 6, with mental retardation No. 7. It is expected that this ranking will be sustained by year 2020.

The World Association for Psychosocial Rehabilitation (WAPR), through its Philippine chapter, coordinates with other private and government agencies to encourage psychosocial rehabilitation (PSR).

Psychosocial rehabilitation is a major intervention strategy in order to address this priority concern. The range of psychosocial rehabilitation activities however needs to involve all sectors of society because among the barriers to the successful implementation is the prevailing stigma against anything ?mental? in the community.

PSR is complex and ambitious because it encompasses many different sectors and levels, from mental hospitals to homes and work settings.

Experience has shown that PSR efficiency is highest when provided in the context of a community-based activity. The main components of PSR can be described at different levels of operation, of which the most relevant are the individual, the service, and the environment.

Housing. A serious effort to set up an alternative to a mental hospital is an essential component of PSR. Different housing strategies can be adopted, depending on local resources and local cultural norms. Ideally, normal housing (single or shared if acceptable to clients) with appropriate support from specialist staff should be provided. If sufficient resources are not available, group living alternatives may have to be considered.

The risks of maintaining large groups of disabled people together in institutional settings should not be overlooked. While alternative housing is most desirable, the environment of many mental hospitals can and must be improved.

Vocational training. The importance of work and employment for people disabled by mental disorders cannot be over-emphasized. Working and having a job increase the person?s self-esteem and breaks the cycle of poverty and dependence. In addition, work gives an opportunity to socialize and communicate. Therefore, it is essential to set up vocational training activities that are related to real work experiences.

Vocational training should start in hospital settings and later move outside to protected workshops in contact with the labor market. …