Academic journal article The Israel Journal of Psychiatry and Related Sciences

Rehabilitation of the Disabled Mentally Ill in the Community

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Rehabilitation of the Disabled Mentally Ill in the Community

Article excerpt

Abstract: The purpose of this article is to review the latest developments in the area of rehabilitation of disabled mentally ill patients. Rehabilitation is a comprehensive and multi-disciplinary treatment. It involves a wide variety of interventions. These interventions are designed to enable the client to integrate into the normal life of the community and to improve his quality of life. This review discusses the different approaches and their effectiveness. The approaches that are described include comprehensive psychiatric, psycho-social and psycho-educational interventions including family therapy, training in social skills, and vocational intervention in programs and services in the community. The approaches that have been shown to be the most effective in controlled studies include: follow-up psychiatric drug treatment, individual and family psycho-educational treatment; social skills training; community sheltered-housing facilities and vocational rehabilitation programs. It has been emphasized that the effectiveness of treatment is conditional not only on the client's resilience and a comprehensive and multidisciplinary treatment approach, but also on the community financial resources and the level of training of the professionals.

Introduction

Rehabilitation of the mentally ill in the community aims at helping the disabled to develop the intellectual, emotional and social skills that are needed for integration into community life. Such skills include management of independent daily life activities, meaningful social relationships, occupation and participation in leisure activities (1). The basic underlying belief is that the individual has the right to choose his way of life in a normal environment, thus protecting the person's autonomy, dignity and freedom. This is consistent with liberal attitudes and the aims of the de-institutionalization movement (2).

Concepts of Mental Disability

Severe psychiatric disorders, mainly schizophrenia, may cause the development of a disability. Disability relates to a process that may start from the first episode of the mental disorder and continues through the subsequent episodes, to the chronic stage. However, the clinical diagnosis does not reflect the overall problem of disability. In order to evaluate the severity of the dysfunction, the WHO (World Health Organization) (3) defined the range of dysfunctions according to the following concepts: Impairments - relate to the function of one organ; Disabilities - relate to the function of the person, and Handicaps - relate to the function of the person in his environment. In this respect, severe mental disorder causes handicaps in daily life skills, resulting in difficulty in independent living in the community; with associated dependence, and sometimes aggression (4). Their health, nutrition and hygienic care may deteriorate. Social and employment adjustment are poor, and there may be associated delinquency and addiction. The cognitive and social dysfunctions constitute the main difficulties during rehabilitation (5,6).

Development of Psychosocial Rehabilitation Models

During the second half of the 20th century, Anthony et al. (1,7), Wing and Morris (6, 8), and Liberman et al. (9, 10) formulated the basic principles and the technology required for psychosocial rehabilitation of the mentally disabled. Their approach focused on the individual and his needs, interests, and qualifications, by developing skills and knowledge as well as the resources required for social activities in the community. Spi vak (11) emphasizes the need to combine the subjective inner-experience with realistic needs forcoping and adjustment. Cnaan et al. (12) emphasize the importance of motivation, responsibility, self-control, and involvement in planning and implementing the rehabilitation process. In 1985, a broader definition of psychosocial rehabilitation was adopted by the NIMH (13): "a range of programs for the mentally disabled. …

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