Abstract
Rehabilitation is oriented to psychiatric patients’ recovery through specific techniques and structured projects, not yet fully standardized, carried out in territorial services. This study aims to apply an operational structured outcome indicator model (hospitalizations, continuity of care, LAI treatment adherence, working support) through a recovery-centered model in a rehabilitation community in Milan. This observational-retrospective study included 111 patients from a University High Assistance Rehabilitation Community (C.R.A.) based in Milan. Psychopathological and psychosocial functioning was evaluated with Kennedy Axis V, Brief Psychiatric Rating Scale (BPRS), Life Skills Profile (LSP), AR module of the VADO scale. Statistical analyses were performed using SPSS software version 19. Student t test and Wilcoxon Test were used to analyze quantitative variables, while McNemar test for qualitative variables. The minimum level of significance was set at 0.05 (p <0.05). The results showed that CRA rehabilitation program led to significant improvement in global functioning in terms of hospitalization reduction; improved continuity of care; stable adherence to psychopharmacological treatment with Long Acting Injectable (LAI) antipsychotics; stable employment maintenance during the year following discharge from the CRA. This study confirmed the utility of a structured outcome indicator model and highlighted its feasibility in daily clinical context of a rehabilitative community. Our results supported the effectiveness of a community-based rehabilitation program to improve individual functioning and clinical stability. However, further studies are required to better achieve the development of a recovery-oriented rehabilitation model and rigorously define an outcomes evaluation model.
Highlights
Psychiatric diseases are debilitating disorders and a leading cause of ill-health and disability worldwide, estimating that at least one out of four people is affected by mental illness either directly or indirectly [1]
The remaining 111 patients were included in statistical analysis. 56 (50.5%) of the sample were females and 55 (49.5%) were males with a mean age of 41.8 years (± 11.9) and a duration of illness of 18 years (± 11.1). 44 (39.6%) patients presented a diagnosis of Psychotic Disorders (Schizophrenia, Delusional Disorder, brief Psychotic Disorder and Drug-induced psychosis); 10 (9%) with Schizoaffective disorder; 34 (30.6%) with Bipolar disorder; 7 (6.3%) with Unipolar Depression; 8 (7.2%) with Obsessive-compulsive Disorder and 8 (7.2%) with Personality Disorder
This study identified variables that might be collected in clinical practice and representative of goals in psychiatric rehabilitation in order to evaluate and compare rehabilitative program since the actual lacking of uniform and validated evaluative model in this field as underlined by several studies [62, 63]
Summary
Psychiatric diseases are debilitating disorders and a leading cause of ill-health and disability worldwide, estimating that at least one out of four people is affected by mental illness either directly or indirectly [1]. The consequence of mental illness is the progressive individual impoverishment, which can lead to isolation, promoting chronicity of the disease. In 2011, the World Health Organization defined rehabilitation as "a set of interventions aimed at helping people who experienced disability to achieve and maintain adequate functioning in everyday life”. Psychiatric rehabilitation aims to identify, reduce and prevent the causes of disability, helping a person to develop and use their resources in order to gain more confidence and self-esteem, counteracting the risk of chronic psychiatric illness [2, 3]. The patient represents the fulcrum of this process, overcoming the concept of mental illness as an immutable and chronic disease, to re-gain an effective role in the society [5]
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