Psychosocial rehabilitation: Approach of choice for those with serious mental illnesses

Abstract

We begin by thanking Editor of Journal of Rehabilitation Research and Development (JRRD) for commissioning a special issue on psychosocial rehabilitation (PSR) for persons with serious mental illnesses. For many years, conventional wisdom in field of mental health has been that serious mental illnesses result in inevitable deterioration. Professional practice has therefore focused on managing psychopathology and its symptoms. A wider variety of outcomes has been identified as critical over past 30 years, however, particularly for individuals with schizophrenia [1-4]. These outcomes include regaining functioning over long term, developing friendships, and living satisfying lives [5-9]. Thirty years of empirical evidence, as well as first-person accounts [10-13], support notion that recovery from serious mental illnesses is possible. As a result, governments in several countries have convened expert panels to review evidence and recommend policy about kinds of services that are best for those with serious mental illnesses. In United States, three most widely recognized of these are 1999 report of Surgeon General on mental health [14], recommendations of President's New Freedom Commission on Mental Health [15], and Institute of Medicine's report on mental health and substance abuse [16]. The single most potent recommendation is to introduce a vision of recovery into mental health system, a vision based on accumulated evidence of what is possible. The result is that nothing less than recovery from serious mental illnesses has become guiding force behind policies and practices in many U.S. Federal and state mental health systems, as well as those of other countries such as Canada and New Zealand [15,17-19]. * PSYCHOSOCIAL REHABILITATION IN CONTEXT OF RECOVERY The vision of recovery should be unifying mission of all mental health services [9,15,20]. Each service should clearly identify recovery outcomes for which it holds itself responsible. In this context, PSR or psychiatric rehabilitation services contribute to recovery by focusing on outcomes related to role functioning in real-world community [20]. Rehabilitation of any kind (i.e., physical, psychiatric, social, etc.) is an ecological approach (person-environment fit) that fits framework of consequences of disease and goals of health proposed by World Health Organization (WHO) (i.e., classifying intervention effects in terms of their contribution to health, activity, and participation) [21]. PSR is concerned with return of functional capacity and participation in valued societal roles. The dictionary definition of rehabilitation is the restoration of someone to a useful place in society (http:// www.thefreedictionary.com/rehabilitation). Rehabilitation thus has two goals: facilitating success and satisfaction in performance of personally preferred and valued roles and creating or promoting an increase in opportunities for participation in society. These goals are accomplished by ensuring that person has skills and supports necessary for success and satisfaction, a basic principle of PSR [20]. Techniques designed to promote role competencies, support for role success, and interventions to increase empowerment and societal opportunities and reduce discrimination are all within pantheon of recognized rehabilitation techniques [22]. The PSR field is relatively young and still at earliest stage of researching interventions that constitute it. While well-executed randomized clinical trials (RCTs) are considered gold standard for rigorous research, recent caveats have emerged about RCTs, especially in psychosocial intervention [23-24]. These caveats particularly apply when goal is recovery, as opposed to more limited outcomes, such as preventing relapse or rehospitalization, for example. …