Mental Health Rehabilitation After a Major Crisis: A Longitudinal Study of Service Recipients.

Psychiatric rehabilitation services (PRS) were developed to facilitate recovery and community integration by addressing psychosocial needs such as housing, employment, illness management, and social inclusion for individuals with serious mental illness. However, PRS are primarily designed for and available in community settings. The objective of this conceptual article is to explore the potential role of PRS during inpatient psychiatric hospitalization and offer a forward-looking vision, identifying trends to guide future efforts. This article presents a conceptual analysis of the potential benefits and impacts of PRS on the recovery process of individuals with serious mental illness if these services were also provided during hospitalization. This critical analysis was coauthored by various stakeholders, including individuals with lived experience, psychiatric, and other mental health providers, and psychiatric rehabilitation researchers. Integrating PRS into routine care during psychiatric hospitalization supports recovery and facilitates postdischarge community connections and outcomes. While PRS were originally conceptualized and designed for community settings, efforts should be made to tailor and adapt them for use in inpatient settings. Shifting staff attitudes toward inpatient recovery-oriented care, developing interventions and training for PRS integration, and securing leadership and institutional buy-in are the next practical steps to make this vision a reality. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

In Canada and other countries, such as the United Kingdom,1 we seem to be permanently in an era of budgetary restrictions. A balanced mental health system has been difficult to achieve during the last few decades because funding associated with downsizing and closure of psychiatric hospital beds has been moved to other health care and social services.2 The justice system has taken over some of the functions of the mental health system, with the police in many areas being the only 24/7 service, and the jail system housing people with schizophrenia, who frequently receive inadequate mental health care.3 Not to mention the system failure indicator that homeless people with severe mental illness (SMI) represent in Canadian cities, or the excess mortality of psychiatric patients.4 Moreover, even if medication is generally well provided for people with SMI, evidence-based psychosocial interventions are only implemented piecemeal in our resources-rich systems of care (see the 2 In Review papers by Mr Matthew Menear and Dr Catherine Briand5,6 in this issue of The Canadian Journal of Psychiatry [The CJP]).However, with proper leadership by clinicians and managers at the regional and provincial levels, regional psychiatric rehabilitation centres and authorities, properly funded, could offer better tertiary psychiatric services and evidence-based rehabilitation interventions to all patients requiring it in their region or province.We will briefly describe the system issues, such as reform of mental health services in Canada, under the 4 headings suggested by Health Canada7 (governance, funding, training, and evaluation), supported by the In Review papers in this issue on evidencebased rehabilitation interventions (see Dr Tania Lecomte, Dr Marc Corbiere, and Dr Claude Leclerc8) and effective implementation strategies in programs and systems (see Menear and Briand5 and Briand and Menear6). For training of the future generation of Canadian psychiatrists in the rehabilitation of SMI (see Freeland et al9 in the Canadian Psychiatric Association's book Approaches to Postgraduate Education in Psychiatry in Canada).FundingThe system costs for the array of required services in the treatment and rehabilitation of SMI, estimated at 1.5% of the population, are illustrated as a simulation in Table 1. The table excludes other direct system costs, such as medical services, medication, disabilities, and income supplement, or other sectors, such as the judiciary system; it represents what most provincial ministries of health and social services consider as their mental health program expenditures. The items, proposed ratios, and costs could be modulated and are further explained in Lesage.10 It is of interest that the simulated average per capita of $134 is only 20% higher than Quebec's mental health program when it launched its action plan in 2005: a balanced mental health care system for SMI need not be much more expensive, but must be better organized. In Table 1, it can be seen that hospital and supervised residential settings will represent at least 65% of this total simulated mental health budget. A similar funding distribution has been reported by the United Kingdom11 and in a best practice area of Italy, which has been a leader in mental health care reform.12GovernanceIn the United Kingdom, it has been suggested that in each local area, psychiatric services, along with social services and health services, develop specialist psychiatric rehabilitation services working with all the other relevant mental health and social programs. The latter include the Community Mental Health Teams (CMHTs), mental retardation teams, and specialist substance dependence teams. Interestingly, in Quebec, mental retardation and specialist addiction services are under the authority of regionalized mental retardation or addiction rehabilitation centres. These local or regional psychiatric rehabilitation services cover the patients in the array of services described in Table 1, from long-term hospitalization to supplement to rent. …

Managed behavioral healthcare emphasizes cost containment, necessitating an understanding about the reasonable expected costs of services. The purpose of this study was to design a statistical model aimed at predicting the cost of community-based psychiatric rehabilitation services from selected consumer variables. The model was constructed on a sample of 159 people with severe and persistent mental illness and cross-validated with a sample of 163 participants. The prediction model demonstrated a statistically significant but moderate relationship to the cost of psychiatric rehabilitation services, implying that other types of variables may be better predictors. Implications for theory, practice and policy were discussed.

Despite the increase in arts-based programs in community rehabilitation services in many countries, little is known about how these programs are perceived by health professionals who can refer individuals with mental health conditions to community-based psychiatric rehabilitation services. This study examined how senior professionals with key positions in the public health system perceive the integration of the arts in community-based psychiatric rehabilitation services in Israel. Semistructured interviews were conducted with 10 professionals. The thematic analysis revealed 2 main themes. The first reflected "the perceived position of arts-based programs among other rehabilitation services," and had 2 subthemes: arts as a legitimate supplemental service, and arts as a motivating rehabilitation. The second theme reflected "the unique contribution of the arts to recovery processes," and had 3 subthemes: art-making facilitates self-expression and communication and bypasses resistance, art-making facilitates socialization, and art-making shapes and enhances personal identity. Because most of the professionals were exposed to the creative arts in their workplace, they valued their contribution to the rehabilitation process. Thus, direct contact can provide more information, more accurate perceptions, and a better understanding of the benefits of arts-based services, which may in turn encourage service managers and policymakers to include these services. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

People with severe mental illnesses experience difficulty finding and maintaining employment, even if they are offered psychiatric vocational rehabilitation services. When service recipients are able to apply more effective illness self-management strategies, vocational rehabilitation outcomes improve. To assess the use of these strategies, the Illness Self-Management assessment instrument for Psychiatric Vocational Rehabilitation (ISM-PVR) was developed. Experts were consulted to design the ISM-PVR instrument which was then tested by 8 vocational rehabilitation workers and 26 of their service recipients. This study indicated sufficient internal consistency of the ISM-PVR self-report questionnaire, especially for the subscales assessing goal related self-efficacy, perceived illness-related barriers, and four of the eight coping scales. The number of self-reported illness barriers was associated with a higher number of reported work-related coping strategies. The ISM-PVR aided the identification of specific mental illness-related barriers perceived by the service recipients. The instrument also facilitated obtaining information on individual self-management strategies that clients employed to overcome such barriers or make them manageable. The application of the ISM-PVR in vocational rehabilitation practice warrants further research. The study suggests that this instrument is a useful add-on to existing vocational assessment and provides insight in self-management strategies that people use, and that may help those people and their job coaches make more effective vocational plans.

BackgroundIn recent years, the Chinese government has increased its support for the development of community-based psychiatric rehabilitation (CBPR) services and initiated pilot programs for government purchasing of CBPR services from non-governmental organizations (NGOs) in order to address the inadequacy of the government’s own supply capacity of CBPR services. This study investigated how the NGOs in Shanghai perceived the challenges and opportunities for participating in the provision of government-purchased CBPR services.MethodsA qualitative descriptive approach was employed in this study. The local NGOs’ program directors who had been responsible for the provision of government-purchased CBPR services in Shanghai were interviewed regarding their perceptions of the challenges and opportunities. Interview transcripts were coded and analyzed using Braun and Clarke’s thematic analysis method.ResultsA total of 19 NGOs’ program directors were interviewed. The challenges perceived by them for NGOs to participate in the provision of government-purchased CBPR services included difficulty with engaging individuals with mental illness and their families, lack of resources, lack of knowledge and skills, inadequate collaborations with other stakeholders, and limitations of services. The opportunities could be grouped into external and internal ones. External opportunities included China’s favorable policy environment, Shanghai’s developed economic environment, and increased public awareness of mental health, while internal opportunities included NGOs’ greater flexibility, high team cohesion, stronger focus on the holistic needs of clients, better resource integration capabilities, and ability to provide long-term follow-up and support for clients.ConclusionsBased on the findings, recommendations for future actions are provided in the areas of research, public awareness, funding, training, referrals, collaboration, and service designing to improve the mechanism of government purchasing of CBPR services from NGOs in China.

本研究從精神障礙者（以下簡稱精障者）的個人經驗與主體立場出發， 探討精障者個人日常生活遭遇的各項社會融合經驗，及其對於社區精神 復健服務的主觀評價，並藉此描述精障者的主體性如何受到精神復健機 構的形塑。透過深度訪談八位使用社區精神復健服務的精障者，本研究 歸納發現：（一）精障者對社會融合的想法乃是回歸社區自立生活，並 期待透過工作所得賺取獨立生活費用，精障者願意為生活增添其他可能 性而努力，也藉由信仰產生自然的人際交流；（二）精障者的主體性源 自於對生活步調的掌控、對生活安排的自主權，並獲得他人的尊重與平 等對待；反之，當精障者被迫接受機構的權威管理與過度生活規範，其主體性將受到傷害；（三）對精障者而言，機構安排豐富多元的日常活 動與工作訓練，以及提供社會融合的橋樑等，都是符合其需求的精神復 健服務，而長期留置復健機構從事一成不變且低薪的勞力工作，則是精 障者最期待有所改善的服務層面。基於上述研究發現，本研究最後提出 相關政策與服務建議。Research purpose Empirical studies on the social inclusion of people with mental disabilities in Taiwan are limited. This study aims to fill this gap. As social inclusion emphasizes the subjective feelings, willingness, and motivation levels of people with mental disabilities, this study explores the issue of social inclusion faced by people with mental disabilities from their individual perspectives and experiences. It also examines how psychiatric rehabilitation services shape the subjectivity of people with mental disabilities, reviewing the pros and cons of psychiatric rehabilitation services in fulfilling the needs of service users. There are three research questions to be answered in this study. First, what are the viewpoints and subjective experiences regarding social inclusion of people with mental disabilities? Second, how is the subjectivity of people with mental disabilities shaped by psychiatric rehabilitation services? Third, what services meet these needs, and what improvements in services need to be made for people with mental disabilities in psychiatric rehabilitation institutions? Method This study follows a qualitative research approach to delineate the social inclusion of people with mental disabilities in Taiwan. Since psychiatric rehabilitation institutions are set up to help people with mental disabilities recover, the research participants in this study were people with mental disabilities in these institutions. Considering the various degrees of autonomy and opportunities for social interaction among people with mental disabilities, the interviewees recruited in this study included residents of halfway houses, members of community rehabilitation centers, clubhouse members, and residents of community houses. Ethical approval was obtained before conducting the research interviews in 2022. Six participants recorded face-to-face semi-structured qualitative interviews and two participated in online interviews because of the pandemic breakout. In total, eight interviews were conducted. After transcribing the interview recordings, thematic analysis was used to analyze the interview transcripts, and thematic findings were derived in accordance with the repetitive analytical procedures of “whole-part-whole.”Results The findings are summarized as follows. People with mental disabilities think social inclusion is to live independently in the community. They hope to work and earn a living, and strive for other possibilities. They may also engage in interpersonal interactions through religious affiliations. In addition, rights of choice and autonomy, equal interaction and treatment, and respect for individual needs in psychiatric rehabilitation units are supportive factors of the subjectivity of people with mental disabilities. However, some adverse conditions such as class differences, inappropriate authoritarian management, and incomplete autonomy jeopardize the subjectivity of people with mental disabilities. Rehabilitation services that meet the needs of people with mental disabilities include various daily activities, multiple job training programs, and bridges for social inclusion. In contrast, rehabilitation services that need to be improved are mainly concerned with low wages, a limited variety of job opportunities, and reverse service effects. Conclusion Based on the research findings, some implications for government policy reform and service improvement in community mental health and social care are proposed. First, it emphasizes the subjectivity of people with mental disabilities. Training courses for rehabilitation institutions’ staff should emphasize the subjectivity of people with mental disabilities, help them achieve social inclusion and avoid the negative effects of institutionalization. Meanwhile, staff in rehabilitation institutions should return the choice and autonomy to people with mental disabilities and play the role of assistants with the belief that people with mental disabilities can be experts on their own lives. Second, they should provide employment opportunities for people with mental disabilities. Owing to the stigma of mental illness, poor educational backgrounds, aging problems, and other physical illnesses, people with mental disabilities are susceptible to social exclusion. Consequently, it is necessary to ensure that people with mental disabilities acquire various employment opportunities and job redesigning in response to functional impairment. To increase employment opportunities and income for people with mental disabilities, government sectors should work with rehabilitation institutions to expand employment resources, subsidize social enterprises, and establish shelter shops. Third, community support resources should be increased for individuals with mental disabilities. In the opinion of people with mental disabilities, financial problems are the most challenging for independent living. If government subsidies or residential services such as community houses are offered to people with mental disabilities to maintain a minimum quality of life, more people can return to community life. Additionally, people with mental disabilities require supportive community services to help them adjust to independent living and organize their daily lives. It is believed that by providing the abovementioned services, not only can the independent living and social inclusion advocated by the CRPD be fulfilled, but family caregivers’ stress and burden can also be reduced.

China sets up the Specialised Committee of Mental Health Rehabilitation

Objective To detect disparities in health outcomes, measures should demonstrate invariance across groups. Whether responses to recovery-related measures vary by race for psychiatric rehabilitation service recipients is unclear. This study examined the psychometric properties of three recovery-related scales, including the Satisfaction with Life Scale (SWLS), Subjective Happiness Scale (SHS), and Recovery Assessment Scale Short Form (RAS). Methods Using cross-sectional, retrospectively collected data from a mental health center, the authors tested uniform and non-uniform differential item functioning (DIF) by race. Data were available for 599 psychiatric rehabilitation service recipients aged 18 or older, diagnosed with a schizophrenia spectrum disorder (F20–F29), and who identified as non-Hispanic Black (n = 460) or non-Hispanic White (n = 139). Results One SHS item (#4) showed uniform DIF (R2 = 0.0041, p < .01). One RAS item showed non-uniform DIF (#4) (R2 = 0.02, p < .001). DIF was undetected in the SWLS. Conclusion and implications for practice This was one of the first studies to test for DIF in the SWLS, RAS, and SHS among a sample of psychiatric rehabilitation service recipients. DIF was largely unobserved in each scale. Future research should explore DIF in more racially and ethnically diverse psychiatric rehabilitation service recipients. Impact and implications Cultural factors may influence how people receiving psychiatric rehabilitation services respond to measures of mental health recovery and related concepts. This study found that common measures of recovery, happiness, and well-being performed similarly for Black and White service recipients with psychotic disorders. Additional research is warranted to ensure that measures of personal recovery perform equitably across cultures.

The Importance of Psychiatric Rehabilitation Services During and After the COVID-19 Pandemic.

This study compared the quality of treatment relationships and engagement in peer-based and regular case management. It also assessed the value of positive relationship qualities in predicting motivation for and use of community-based services for persons with severe mental illness. One hundred thirty-seven adults with severe mental illness participated in a 2x2 prospective longitudinal randomized clinical trial with two levels of case management intervention (peer and regular) and two interviews (six and 12 months). Self-report questionnaires assessed treatment relationships, motivation, and service use, and providers rated participants' initial engagement and monthly attendance in treatment. Participants perceived higher positive regard, understanding, and acceptance from peer providers rather than from regular providers at six months only, with initially unengaged clients showing more contacts with case managers in the peer condition and decreasing contacts in the regular condition. Six-month positive regard and understanding positively predicted 12-month treatment motivation for psychiatric, alcohol, and drug use problems and attendance at Alcoholics and Narcotics Anonymous meetings. Early in treatment, peer providers may possess distinctive skills in communicating positive regard, understanding, and acceptance to clients and a facility for increasing treatment participation among the most disengaged, leading to greater motivation for further treatment and use of peer-based community services. Findings strongly suggest that peer providers serve a valued role in quickly forging therapeutic connections with persons typically considered to be among the most alienated from the health care service system.

Although a number of established practices are known to promote good outcomes for persons with psychiatric disabilities, significant challenges remain. As scholars and practitioners, we must work to ensure that psychiatric rehabilitative services are culturally relevant, accessible to the people who need them, and reflective of the needs and lived experiences of persons with psychiatric disabilities in today's context. Facilitating access to culturally relevant services involves conducting foundational research on the effectiveness and efficacy of established practices in diverse samples; tailoring existing services and developing new services to better meet the needs of diverse populations; and delivering such services in a manner that reduces health care disparities. Promoting service accessibility entails putting research findings into practice; ensuring that a trained workforce is available to provide services; and aligning policies and funding. Enhancing the relevance and impact of psychiatric rehabilitation services requires incorporating the perspectives of persons with lived experience across all phases of research and program delivery. The author's goal is for the research published in Psychiatric Rehabilitation Journal (PRJ) to address these critical issues. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This article describes a model for integrating psychiatric rehabilitation services in a managed behavioral health care structure. Psychiatric rehabilitation and managed care are two distinct developments in the provision of mental health services that have proceeded independently though they can have compatible methods and outcomes. Descriptive detail is provided about a state initiative in Iowa to provide psychiatric rehabilitation services to those with serious mental illness through the state-contracted managed behavioral health care corporation. The article describes factors leading to the program's implementation, service delivery structures, reimbursements, personnel requirements, and performance indicators. Evidence for supporting this innovation is provided through a case-controlled outcomes study of mental health service units used and their costs for participants and matched controls.

Bennett (1) defined rehabilitation as process whereby disabled persons are enabled use their residual abilities function effectively in social situation as normally as whereas according Babiker, (2) the aim of rehabilitation is to enhance personal autonomy and enable the individual adopt an appropriate social role and lead as fulfilling life as possible. (1,2) According the World Health Organization, rehabilitation is defined as a process aimed at enabling people who experience disabilities reach and maintain their optimal physical, spiritual, occupational, sensory, intellectual, psychological and social functional levels. provides people who experience disabilities with the tools they need attain independence and self-determination. (3,4) Rehabilitation, therefore, has dual function of reducing impairment and disabilities while strengthening cognitive, social, family, vocational, recreational, self-care, money management, and other independent living skills. In psychiatric services, the concept of rehabilitation recognises the importance of quality of life, and the enabling of an individual's capacity. (5) Psychiatric rehabilitation provides spectrum of services that enable disabled individuals perform those cognitive, emotional, social, intellectual, and physical skills needed live, learn, work, and function as normally and independently as possible in the community with the least interference by symptoms. On the other hand, the concept of recovery has appeared in the patient's self-help literature since the 1930s and it gradually emerged as prominent concept in the mental health literature in the late 1980s. (6) Recovery is an active process through which persons with psychiatric disability travel adapt living with In the realm of recovery, the professional works with these persons share an understanding of their life story and helps them draw upon the resources and skills available in rehabilitation services. (5) Researchers have rather diversified views on the definition of recovery. (7) Deegan (8) stated that instead of focusing primarily on symptom relief, as the medical model dictates, recovery casts much wider spotlight on restoration of self-esteem and identity and on attaining meaningful roles in society. This definition by Deegan does not imply full recovery, i.e. state in which full functioning is restored and no medications are needed. Instead, recovery is described as a journey or process, not destination or cure. Anthony (9) has developed widely used definition of recovery as a way of living satisfying, hopeful and contributing life even with the limitations caused by Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness. The difference between the concepts of rehabilitation and recovery has been described by Deegan, (10) Rehabilitation refers the services and technologies that are made available people who experience disabilities so they may learn adapt their world. Recovery refers the lived or real-life experiences of persons as they accept and overcome the challenge of the disability. The incorporation of the concept of recovery in the design and implementation of rehabilitation services has been recent trend in the field of psychiatry. Most psychiatric rehabilitation services have developmental history that bridges deinstitutionalisation, reprovision in its many forms, community care, and now, social inclusion, reduce the impact of stigma and promote recovery. (5) Recovery underpins the way rehabilitation services are developed and delivered, and provides philosophical approach service delivery. (4) Embracing the concept of recovery, and promoting the recovery ethos throughout rehabilitation service provision probably represent clear new direction. …

Being parent is associated with suicidal history in people with serious mental illness enrolled in psychiatric rehabilitation