Rehabilitation of the chronically mentally ill in England

Abstract

1. Rehabilitation is defined as the process of restoring a handicapped person to a situation in which he can make the best use of his residual capacities within as normal as possible a social context. - 2. The legislation which allowed many of the recent advances to take place is described. - 3. Psychiatric illness can be thought of as producing two sorts of disability.Primary handicaps are the chronic symptoms of illness together with the accumulated loss of skills through disease.Secondary handicaps consist of unhealthy personal attitudes to illness together with unfavourable attitudes adopted towards the patient by relatives, employers and hospital staff. Rehabilitation schemes do not so much attempt to modify the chronic symptoms of psychosis as aim at decreasing or preventing secondary handicaps and at increasing the social acceptability of patients. - 4. In recent years progressively more hospitals have started industrial units, and various specialised rehabilitation units have been opened.- 5. Many studies have shown that money and rather crude psychological incentives fail to increase the output of schizophrenic patients under experimental conditions. Social incentives, however, when given in natural and less arbitrary conditions, do seem to work quite well. - 6. The beneficial effects of courses at Industrial Rehabilitation Units are described in detail. Problems of psychiatric entrants are shared with, and similar to, those of a large proportion of nonpsychiatric entrants. - 7. Discharged long-stay patients impose a considerable burden on the community, and when readmission does occur it tends to follow recrudescence of symptoms. The patient's ability to stay out of hospital is significantly related to the type of living group to which he is discharged. - 8. The problems of short-stay schizophrenic patients are not dissimilar in general (although they differ in detail) to those of long-stay patients. The tendency to develop secondary handicaps is still present, and rehabilitation techniques which have been developed for use in hospitals need to be adapted for use in the community as well.