Magazine article Clinical Psychiatry News

Rehabilitation and the Psych Patient

Magazine article Clinical Psychiatry News

Rehabilitation and the Psych Patient

Article excerpt

Rehabilitation is an important aspect of the treatment of psychiatric inpatients. Only with rehabilitation can those with severe and persistent mental illness come close to getting their lives back.

This month, CLINICAL PSYCHIATRY NEWS spoke with Estelle Douglas about the role of rehabilitation in the treatment of the psychiatric inpatient. Since 1980, Ms. Douglas has served as director of psychiatric rehabilitation at Zucker Hillside Hospital, Glen Oaks, N.Y.

Her department has won numerous awards for its various programs. Ms. Douglas, a licensed mental health counselor in New York state, is the principal investigator in eight service grants funded by the state's office of mental health and department of education, and in the departments of mental health for both New York City and Nassau County.

CLINICAL PSYCHIATRY NEWS: At what point do psychiatric inpatients become involved with your department?

Ms. Douglas: At Zucker Hillside, all patients are engaged in a rehabilitation-readiness assessment from the start of their inpatient hospitalization. This is an important foundation that serves to build to the discharge plan.

CPN: Do patients typically come to you with a treatment plan?

Ms. Douglas: When patients enter the department of psychiatric rehabilitation's programs, they might have some notion that they would like to work or to be less isolated, but they typically do not have a specific plan. In fact, our initial step is to instill a sense of hope that change is not only possible, but accessible.

The goal, then, is to build their plan of action through a network of community supports to ensure that they not only have assistance to secure work, attend school, live more independently, and be socially active in the community, but also are able to sustain their goal after discharge. For the past several years, we have followed patients after discharge to ensure this.

CPN: What is your philosophy on the rehabilitation of the severely and persistently mentally ill?

Ms. Douglas: An important aspect of our philosophy is to instill within the patient the belief that autonomy is possible. It is not a productive goal to make someone a good patient in a program. Our goal is to assist the patient in finding a more satisfying and independent life in the community. That's why we begin this evaluation and intervention from day 1 of inpatient treatment.

CPN: What is the first step that your department takes with patients?

Ms. Douglas: Psychoeducation must come first. This assists patients in learning the skills they need to manage their illness, including identifying triggers that might prompt relapse, as well as coping with stressors they might encounter after discharge. Again, these concepts are introduced early in inpatient treatment.

Helping patients maintain stability also involves removing barriers and providing skills training. Clearly, patients face the same set of complex issues we all do. But these issues often prove overwhelming to patients. The idea is to give them the skills they need to manage their problems.

CPN: What kinds of skills does rehabilitation seek for patients?

Ms. Douglas: We focus on three skill sets: interpersonal, organizational, and everyday living skills. The first two are self-explanatory, and the last category focuses on issues such as money management and self-care.

The thing to remember is that because the onset of illness occurred so early for many of these patients, they did not have the opportunity to develop skills needed to function productively in the community. Yet, because they are adults, they are expected to have achieved a certain skill level. This expectation can be a great source of anxiety and can bring about isolation, a return of symptoms, and other maladaptive coping.

CPN: Do patients understand which areas of their life plans need attention? …

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