Education in Psychiatric Rehabilitation Column—Psychiatric Rehabilitation Education for Psychiatrists: A Canadian Experience

Leisure or recreational rehabilitation is not much developed in psychiatric rehabilitation. I present some definitions and a (very) brief history of the notion of leisure, as well as the role of leisure in health. I then describe a novel classification of leisure activities relevant to people with psychiatric disabilities. Following that, I conceptualize the process of psychiatric leisure rehabilitation, illustrated by a case study. I conclude with the benefits of psychiatric leisure rehabilitation and with suggestions for further study and development in this field. Leisure or recreational activities are central in modern life. Not so for persons who have serious and disabling mental disorders. This is manifest even in psychiatric rehabilitation, which mostly addresses vocational and residential--rather than leisure--environments (Anthony, Cohen, Farkas & Gagne, 2002; Corrigan, 2003). Yet leisure is important for persons with psychiatric disabilities, perhaps especially so for those who are not successful or satisfied in vocational environments. This paper outlines a conceptual framework for psychiatric leisure rehabilitation, based on a novel classification of leisure activities, and illustrates this with a case vignette. But first, some definitions and a (very) brief history of the notion of leisure is in order, as well as a presentation of facts about the role of leisure in health (physical and mental).

Psychiatric Rehabilitation (PSR) focuses on person-centered and evidence-based sets of mental healthcare practices that facilitate the recovery of people with mental health challenges. PSR aims to enhance and maintain adaptive skills and supports for personally meaningful and valued social roles. Research in PSR continues to progress, with growing knowledge and evidence to support PSR practices and the provision of mental health services within a recovery-oriented framework. As one of the more person-centered sets of healthcare practices, a periodic review of recent and developing PSR literature is warranted for its own sake and for the consideration of how lessons from PSR may be transferable to other areas of healthcare. Recent developments and future directions in PSR addressed here relate to (1) enhanced conceptual understanding of recovery, (2) increased understanding of how individuals and families cope with mental illness, (3) PSR ethics, (4) increasing use of technology in PSR practices, (5) integration of evidence-based and promising practices, (6) psychiatric leisure rehabilitation and (7) PSR education and systems. These areas of focus are discussed in a selective review of the literature and a clinical case example which illustrates how PSR practices can facilitate recovery.

This position paper by the international IMMERSE consortium reviews the evidence of a digital mental health solution based on Experience Sampling Methodology (ESM) for advancing person-centered mental health care and outlines a research agenda for implementing innovative digital mental health tools into routine clinical practice. ESM is a structured diary technique recording real-time self-report data about the current mental state using a mobile application. We will review how ESM may contribute to (1) service user engagement and empowerment, (2) self-management and recovery, (3) goal direction in clinical assessment and management of care, and (4) shared decision-making. However, despite the evidence demonstrating the value of ESM-based approaches in enhancing person-centered mental health care, it is hardly integrated into clinical practice. Therefore, we propose a global research agenda for implementing ESM in routine mental health care addressing six key challenges: (1) the motivation and ability of service users to adhere to the ESM monitoring, reporting and feedback, (2) the motivation and competence of clinicians in routine healthcare delivery settings to integrate ESM in the workflow, (3) the technical requirements and (4) governance requirements for integrating these data in the clinical workflow, (5) the financial and competence related resources related to IT-infrastructure and clinician time, and (6) implementation studies that build the evidence-base. While focused on ESM, the research agenda holds broader implications for implementing digital innovations in mental health. This paper calls for a shift in focus from developing new digital interventions to overcoming implementation barriers, essential for achieving a true transformation toward person-centered care in mental health.

Introduction: Adults with psychiatric disabilities require continued community-based care to support their recovery and community reintegration. Community-based mental health services such as psychosocial rehabilitation day centres and group homes were to support community reintegration of these adults. However, these services are limited and opportunities for adults with psychiatric disabilities to engage in meaningful occupations that promote occupational well-being are scarce, particularly in South Africa.In addition literature exploring the experiences of adults with psychiatric disabilities using these services, is limited. The aim of the study was to describe the adults with psychiatric disabilities' experiences of participating in an activity programme at a psychosocial rehabilitation day centre.Method: A descriptive qualitative design was adopted, and eight participants were recruited through purposive sampling. Data were collected through observations and focus group discussions and analysed using thematic analysis.Findings: Two themes emerged: "What's nice about the activities that we do do, is it takes you out your head for a while and If you don't do anything [...] your brain goes that way a bit". The activities were valued as they offered opportunities for improved socialization and enabled participants to meet various occupational needs.Conclusion: Adults with psychiatric disabilities derived meaning, purpose and improved occupational well-being from participating in the activity programme. There is a need for more community-based mental health services to support the recovery of adults with psychiatric disabilities, thereby improving their quality of life within their communities. Key words: psychiatric disability; occupational well-being; psychosocial rehabilitation day centre; community mental health services

Back to table of contents Previous article Next article Book ReviewFull AccessPrinciples and Practice of Psychiatric Rehabilitation: An Empirical ApproachSteven L. Webster M.Div.Steven L. Webster M.Div.Search for more papers by this authorPublished Online:1 May 2008https://doi.org/10.1176/ps.2008.59.5.578AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The book Principles and Practice of Psychiatric Rehabilitation is an outstanding contribution to the field of psychiatric rehabilitation. The authors, each a prominent leader in psychiatric rehabilitation, draw from their varied interests, skills, and research experience to produce a text that is comprehensive and authoritative. The volume's 21 chapters are divided into four parts. Part 1 focuses on persons with psychiatric disabilities, the stigma of mental illness, and the definition of psychiatric rehabilitation. Part 1 also includes a review of the diverse historical context in which the field has evolved. In part 2, the authors discuss the multitude of service approaches used in psychiatric rehabilitation and organize them into ten broad categories: rehabilitation assessment, illness self-management, case management, medications, housing, employment and education, social functioning, family interventions, cognitive impairment, and management of criminal justice involvement.The five chapters in part 3 examine special populations and problems with respect to trauma, dual diagnosis, physical health and medical care, peer services, and the management of aggressive behavior. Finally, part 4 includes three chapters that address the rehabilitation system's issues of erasing stigma and promoting empowerment and cultural competence; policy considerations are also addressed. Each of the book's four parts begins and ends with succinct and precise introductions and summary conclusions. Throughout the book, personal examples describe life situations of individuals with psychiatric disabilities.The authors are immensely successful in a variety of ways. First and perhaps foremost, their approach—true to the book's title—is consistently empirical. Psychiatric rehabilitation is reviewed and analyzed through the lens of the evidence base associated with specific services and practices. The volume includes 90pages of references. The personal examples further augment the focus on empiricism, bringing the discussions to life and serving to remind the reader that psychiatric rehabilitation is astonishingly clear and simple in mission yet infinitely complex in practice.The authors make a significant contribution by consolidating the most up-to-date information and empirical conclusions about psychiatric rehabilitation. As psychiatric rehabilitation continues to evolve, it is important to examine the evidence, or lack thereof, for specific practices currently in use and identify areas in need of future study. This volume does that well.Principles and Practice of Psychiatric Rehabilitation is also a useful tool. As director of an inpatient rehabilitation program, I have already found it to be a valuable resource when conducting program and job description reviews, considering assessment instruments, designing staff training, and educating inpatients in a group setting. My sole criticism is that the book makes no mention of the extraordinary transformation occurring in the many inpatient psychiatric facilities that have designed and implemented centralized and integrated rehabilitative programs, such as "treatment malls." A description of such initiatives would have strengthened the book and helped to bridge the gap between inpatient and outpatient experiences with psychiatric rehabilitation.Overall, the authors deliver a comprehensive, well-written, and well-organized volume that will undoubtedly become a text of choice for their intended readers, who include students and future social scientists, individuals with psychiatric disabilities, practitioners, and administrators.Mr. Webster is director of the Psychosocial Rehabilitation Program, Dorothea Dix Hospital, Raleigh, North Carolina. FiguresReferencesCited byDetailsCited ByNone Volume 59Issue 5 May, 2008Pages 578-578PSYCHIATRIC SERVICES May 2008 Volume 59 Number 5 Metrics PDF download History Published online 1 May 2008 Published in print 1 May 2008

This article describes the historical, contemporary, and probable future roles of biosystemic whole-health perspectives in the evolution of psychiatric rehabilitation. We identify and discuss three examples of failures to fully consider the interaction of biological, psychological, and social levels of functioning, which have led to significant barriers to recovery: failure to account for physical morbidity in psychiatric disorders, lack of integration with modern understanding of inflammatory processes in psychiatric symptoms, and disregard for social and interpersonal factors. Significant limitations in rehabilitation outcomes arise from failure to fully consider the molar (i.e., integrated) implications of molecular impairments and vulnerabilities, and vice versa. We articulate the consequences of molecular models of personal and social functioning as barriers to future research and clinical care and propose looking beyond the traditional scope of psychopathology and boundaries of mental health services to reach a whole-health understanding of psychiatric disorder and disability, rehabilitation, and recovery. The integrative biopsychosocial model is a particularly promising direction in the evolution of psychiatric rehabilitation, with strong clinical and theoretic implications that may guide much-needed change in policy and practice. Key to progress in our understanding of psychiatric disorder, disability, rehabilitation, and recovery is a perspective on science and clinical practice that values integration of multiple domains of knowledge as much as analytic dissection of molecular (i.e., unitary) processes. Reforms must be expected at all levels of health care service systems, in practitioner training, administration, and social policy. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

An accumulating body of empirical data suggests that current Department of Veterans Affairs (VA) psychiatric disability and rehabilitation policies for combat-related posttraumatic stress disorder (PTSD) are problematic. In combination, recent administrative trends and data from epidemiological and clinical studies suggest theses policies are countertherapeutic and hinder research efforts to advance our knowledge regarding PTSD. Current VA disability policies require fundamental reform to bring them into line with modern science and medicine, including current empirically supported concepts of resilience and psychiatric rehabilitation.

This article provides an overview of international, national, and local policy initiatives that support the clinical and programmatic changes being championed in psychiatric rehabilitation and recovery. California, with the 6th largest economy in the world and one of the largest public mental health systems, has become a leader both nationally and internationally in modeling such change efforts. The Mental Health Services Act of 2004 (MHSA) has been the vehicle within the state that has set up the framework for the transformation. Many of the components of the MHSA support the national recommendations of the President's New Freedom Commission. A case example contrasting the California MHSA and the President's New Freedom Commission recommendations is included to highlight how California has conceptualized and begun to implement those recommendations.

Research Article Health AffairsVol. 11, No. 3 Psychiatric Rehabilitation: Key Issues And Future PolicyWilliam A. Anthony AffiliationsThe Boston University Center for Psychiatric RehabilitationPUBLISHED:Fall 1992No Accesshttps://doi.org/10.1377/hlthaff.11.3.164AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSDisabilitiesMental healthMental disordersTechnologyPsychiatric hospitalsMedicaidMental health servicesCase managementActivities of daily livingQuality assurance Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 11 History Published online 1 January 1992 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.ACKNOWLEDGMENTSThis Perspective reflects the knowledge generated and/or analyzed by staff at the Center for Psychiatric Rehabilitation, Boston University.PDF downloadCited byNeed for Cardiovascular Risk Reduction in Persons With Serious Mental Illness: Design of a Comprehensive Intervention8 February 2019 | Frontiers in Psychiatry, Vol. 9Clients’ experiences of the Boston Psychiatric Rehabilitation Approach: A qualitative study8 April 2014 | International Journal of Qualitative Studies on Health and Well-being, Vol. 9, No. 1Relatives’ experiences of the Boston Psychiatric Rehabilitation approach: A qualitative study8 April 2014 | International Journal of Qualitative Studies on Health and Well-being, Vol. 9, No. 1Case Management and Client Access to Health and Social Services in Outpatient Substance Abuse Treatment24 July 2007 | The Journal of Behavioral Health Services & Research, Vol. 34, No. 3Le programme de remédiation cognitive IPT (Integrated Psychological Treatment) destiné aux patients schizophrènes: une expérience en hôpital de jour de secteurAnnales Médico-psychologiques, revue psychiatrique, Vol. 165, No. 3Attitudes of Mental Health Workers Toward Community Integration of the Persons with Serious and Persistent Mental IllnessAmerican Journal of Psychiatric Rehabilitation, Vol. 10, No. 1The Fountain House movement, an alternative rehabilitation model for people with mental health problems, members' descriptions of what worksScandinavian Journal of Caring Sciences, Vol. 20, No. 2Implantation multisite du programme Integrated Psychological Treatment (IPT) pour les personnes souffrant de schizophrénie. Élaboration d’une version renouvelée3 August 2005 | Santé mentale au Québec, Vol. 30, No. 1The integration of psychiatric rehabilitation services in behavioral health care structures: A state exampleThe Journal of Behavioral Health Services & Research, Vol. 29, No. 4Serving street-dwelling individuals with psychiatric disabilities: outcomes of a psychiatric rehabilitation clinical trialAmerican Journal of Public Health, Vol. 90, No. 12Organizational determinants of psychosocial treatment activity of providers in Va mental health facilities1 January 2000 | The Journal of Mental Health Policy and Economics, Vol. 2, No. 4

The article aims to demonstrate advances in methodological means suggested by L.S. Vygotsky’s cultural-historical concept in application to benefits of clinical psychology and medicine, in development of a theoretical model of person-centered mental health care. This is achieved through the fact that the cultural-historical concept (due to its humanistic nature and epistemological content) is closely related to the model of person-centered integrative diagnosis. But for all that the concept corresponds to the ideals of postnonclassical model of scientific rationality with a number of “key” features. Above all it manifests its “ methodological maturity” to cope with open self-developing systems , which is most essential at the modern stage of scientific knowledge. According to authors’ opinion, this approach applied in theoretical and practical fields of clinical psychology and mental health care is highly efficient on the current stage of the science evolution due to potential of new methodological context of postnonclassical model of rationality and completeness of cultural-historical concept concerning person and its mind as a self-developing open systems. The authors emphasize the importance of consideration of a number of methodological principles, such as the principle of subjectivity, principle of systematization, the principle of probabilistic and complex causation, as well as the development principle, and the principle of partnership, for the implementation of the person-centered approach to diagnosis and treatment. The article gives consideration to the high prospects of such mental constructs as the “subjective pattern of disease” and the “social situation of personal development in disease” within the context of person-centered integrative diagnosis.

The study of psychiatric manpower needs is both important and difficult. Some previously available data on the numbers of psychiatrists in each province of Canada are examined in conjunction with one new item relating to the number of residents in each Canadian university department of psychiatry. Unfortunately, no clear-cut conclusions can be drawn, ‘but some suggestions are made for further studies. Probably more questions are raised than answered, but this reflects the state of our current knowledge or lack of it. The data show that there are currently (fall 1973) 1,614 psychiatrists in Canada compared with 1,478 in 1971; 944 in 1966 and 549 in 1961. There was thus a net increase of 929 (169.2 percent) psychiatrists in Canada between 1961 and 1971. Even allowing for the increase in the size of population, the ratio of 1 psychiatrist: 33,200 of population in 1961 decreased (improved) to 1 psychiatrist: 14,600 of population in 1971, which represents a 56.0 percent change. There were 549 residents in Canadian university departments of psychiatry in the fall of 1973. This level if maintained, would double the number of practising psychiatrists in Canada in 14 years. However, this also assumes that all residents complete their training and continue practising in Canada, that none of the existing Canadian psychiatrists retire or leave the country, and no immigrant psychiatrists arrive in Canada. These assumptions are unlikely, but accurate data are not available to correct them. McGill and the University of Toronto departments of psychiatry are dominant and they are currently (fall 1973) training 45.3 percent of all Canadian psychiatry residents (McGill 20.5 percent and Toronto 24.8 percent). Unfortunately a number of university departments did not or were unable to supply information on the number of psychiatry residents in training in past years, which makes a comprehensive study impossible.

Despite many challenges, recent developments in the field of psychiatric rehabilitation offer opportunities for an increased focus on serving parents with psychiatric disabilities and their children. One such trend is the growth of psychosocial rehabilitation (PSR) programs that serve children and youth. The new Certificate in Children's Psychiatric Rehabilitation program offers practitioners education and training to meet the needs of children and families. Another opportunity can be found in the recent growth of family services in PSR programs for veterans with serious mental health problems. The Veterans Administration's new Psychosocial Rehabilitation and Recovery Services model explicitly includes family members in supporting veterans and acknowledges the need to deliver direct services to their spouses, children, and parents. A third relevant trend is the emergence of a new generation of recovery-oriented PSR services for mothers and fathers. Opportunities for enhanced services are provided in particular by self-help, peer support programs for parents with lived experience.

Introduction by the column editors: Most rehabilitation programs for persons with severe mental illness are provided by interdisciplinary teams whose members include professionals, paraprofessionals, and, sometimes, “prosumers”— individuals who both provide and consume mental health services. Despite the ubiquity with which psychiatric rehabilitation techniques such as social skills training, vocational rehabilitation, and family psychoeducation are used within a team approach, with few exceptions practitioners are taught these techniques without reference to how they may fit in with a team that delivers the mental health services. One exception is the approach of the Program for Assertive Community Treatment (PACT), which emphasizes adequate preparation of practitioners for working together as a team. Staff members who work on PACT teams have clearly specified roles and frequent face-to-face meetings and use methods of group problem solving that have been operationalized for day-to-day practice. Without recognition of the importance of the team context in which rehabilitation modalities are delivered, rehabilitation practitioners may compromise clinical goals and lose a valuable source of social support and encouragement—namely, positive feedback and reciprocal reinforcement from their teammates. In this month’s Rehab Rounds column, Patrick W. Corrigan, Psy.D., and Stanley G. McCracken, Ph.D., describe their method of combining educational and organizational strategies for teaching teams to deliver better psychiatric rehabilitation programs. They show how combinations of strategies offer the greatest promise for assisting rehabilitation teams in developing programs that meet clients’ needs effectively.

The present study was designed to describe individuals receiving psychiatric rehabilitation (PR) service and investigate program outcomes and factors associated with progress in a multisite, descriptive evaluation across Pennsylvania. Through an outcomes-monitoring process integrated into routine service delivery, survey responses from 408 individuals participating in PR were summarized. Linear mixed models were used to examine change over time in self-reported progress ratings in rehabilitation domains and factors associated with progress. Significantly lower utilization of inpatient psychiatric service was observed in the 12 months after initiating PR versus the 12 months before service (15% vs. 24%; p = .002). Peer and case management service increased after initiation of PR. Specifying a domain as a goal in the service plan was associated with higher progress ratings in the learning (β = .75, p < 0001), working (β = 1.06, p < .0001), and physical wellness (β = 1.27, p < .0001) domains. Average hopefulness rating was positively and significantly associated with self-reported progress in all domains. The current investigation provides some evidence that individuals participating in PR decrease utilization of inpatient service. This finding and the goals and activities reported in domains over time support the added value of PR as a Medicaid-reimbursable service to managed care efforts to promote rehabilitation outcomes and recovery for individuals with psychiatric disabilities. (PsycINFO Database Record

ObjectiveThere is a projected shortage of psychiatrists in Canada in forthcoming years. This study assessed factors in medical school education that are associated with students selecting psychiatry first and matching as a discipline.MethodThe Canadian Organization of Undergraduate Psychiatry Educators (COUPE) conducted telephone interviews and sent e-mail questionnaires to the 17 medical schools across Canada; all schools provided data for 2012. Relevant data were obtained from the Canadian Resident Matching Service. Statistics were performed using v12 STATA program, and significance was set at a p value of <0.05.ResultsMedical student enrollment ranged from 54 to 266 students (mean = 158 ± 16). Of these students, 4.9 ± 0.6 % ranked psychiatry as their first choice for residency. Final match results yielded similar numbers at 5.0 ± 0.6 %. Ten out of 17 programs filled all psychiatry residency positions, whereas the remaining 7 programs had vacancy rates from 5 to 100 % (mean = 43.4 ± 15.1 %). Medical students were exposed to an average of 2.8 ± 0.5 pre-clerkship psychiatry weeks and 6.2 ± 0.3 clerkship weeks. Linear regression analysis demonstrated that the percentage of graduating medical students entering a psychiatry residency program could be predicted from the number of weeks of pre-clerkship exposure (p = 0.01; R2 = 0.36) but not from the number of clerkship weeks (p = 0.74).ConclusionsThis study indicates that the duration of pre-clerkship exposure to psychiatry predicts the number of students selecting psychiatry as their first choice as a discipline. Thus, increasing the duration of pre-clerkship exposure may increase the enrollment of medical students into psychiatry.