Developments in psychosocial rehabilitation for early psyshosis

Abstract

Rehabilitation is as necessary for a good outcome in major psychiatric illness as effective symptom control. The majority of first-episode psychotic patients do not recover fully and are left with social problems. Rehabilitation aims to minimize these secondary social handicaps. Effective social reintegration depends on the provision of a comprehensive infrastructure of community supports, particularly in the areas of housing and employment. Recent shifts from sheltered living and working arrangements towards supported models, driven by user preferences, are welcome, but have created problems for the most disabled. The lack of high-support housing and work programmes is causing these patients to accumulate inappropriately on acute admission wards in the United Kingdom, stimulating a government initiative for 24-h nursed care beds which is similar to the ward-in-a-house approach. Such models are effective for many, but do not suit all, largely because of the stigma that is attached to quasi-institutionalized settings. User surveys indicate that success of housing and employment programmes depends critically on users' perceptions of the general public's attitude towards them. Issues of stigma and public prejudice must, therefore, be addressed. Services are bound to fail unless they are acceptable to users, professionals and public alike.