Abstract
A major driver during the era of 'deinstitutionalisation' was the change in societal attitudes towards people with mental illness, away from exclusion and marginalisation towards inclusion and participation in society. More recent mental health policy has tended to focus on promotion, prevention and early intervention, with little mention of those with more complex problems. However, despite the significant investment in early intervention services, long term studies consistently show that around a quarter of people newly presenting with psychosis do not do well. Nevertheless, there is good evidence that with appropriate treatment and support from specialist mental health rehabilitation services, even people with the most severe problems can achieve, sustain and enjoy a rewarding life in the community, yet many 'deinstitutionalised' countries fail to provide rehabilitation services, placing this group at risk of neglect, exploitation and institutionalisation. Happily, this situation is beginning to change. The publication of the first National Institute of Health and Care Excellence (NICE) Clinical Guideline on Rehabilitation for People with Complex Psychosis (NICE; CG 181, 2020) represents a sea change in the recognition of the needs of those with the most severe mental health problems and provides evidence-based recommendations about the treatment and support that should be provided. Alongside this, policy makers in many countries are beginning to recognise the need to include rehabilitation services in their mental health plans. It has been a long time coming, but mental health rehabilitation services are finally being acknowledged as an essential component of the mental health system.
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