Psychosocial Rehabilitation—The Past, Current Approaches and Future Perspectives

Abstract

Severe mental illness imposes a heavy burden on the individual, the family, community and society at large. Although there has been considerable improvement in the treatment of severe mental disorders, their rehabilitation has remained mostly neglected. Mental disorders such as schizophrenia can incapacitate an individual and can cause an enormous burden on their caregivers. A large part of the burden is due to the deficits that persist even after the recovery from the acute symptoms. Pharmacological intervention is effective in the acute management of symptom reduction, but does not have much beneficial effect on cognition and social skill deficits. The majority of patients even after recovery from the acute illness continue to have cognitive dysfunctions as well as significant social and vocational disability leading to poor functional recovery and poor quality of life. One of the major challenges in mental health care is the holistic recovery from mental illness. Psychosocial rehabilitation (PSR) is an essential component of the management of persons with chronic mental illness along with pharmacological management. In the past two decades, the importance of psychosocial rehabilitation is increasing. The concept and approaches of PSR have been spreading steadily all over the world. It is a growing field in developing countries like India. The goal of psychiatric rehabilitation is to help disabled individuals to develop the emotional, social and intellectual skills needed to live, learn and work in the community with the least amount of professional support, in other words, to be independent. The philosophy of psychiatric rehabilitation is both person centerd aiming to develop the patient’s skills in interacting with a stressful environment and also ecological, directed towards developing environmental resources to reduce potential stressors. We need to innovate strategies to meet these challenges and the Kerala experience cited here as a model suitable for low- and middle-income (LAMI) countries.