Psychosocial Rehabilitation Services Research Articles

Should older adults who have been injured at work be encouraged to return to work?: A study on life satisfaction of older adults with experience in industrial accidents

Work is generally defined as a positive factor in the lives of older adults. However, older adults who have experienced a industrial accidents need to also consider whether they want to work, as they face the double burden of disability and aging. Current rehabilitation services for injured workers focus on return to work without considering the life cycle. The purpose of the study was to determine whether returning to work affects life satisfaction in older adults and to discuss appropriate service directions. The data used to examine this are from the third year of the second cohort of the Panel Study of Workers’ Compensation Insurance. Participants were divided into three groups: Group 1 (under 55, 1,176 participants), Group 2 (from 55 to 64, 1,036 participants), and Group 3 (65 or older, 611 participants). Multiple regression analysis was conducted to examine the impacts of demographic variables (sex, marriage), care and health variables (treatment duration, self-rated health status, disability grade), economic variables (earned income, unearned income, employment status), rehabilitation service (vocational and psychosocial rehabilitation services), and psychosocial variables (self-esteem, social relationship) on life satisfaction. Returning to work and income were found to have no positive impacts on older adults’ life satisfaction. Better self-rated health, higher self-esteem, and good social relationships all had positive effects on life satisfaction among older adults. For the under-65 cohort, a number of factors contributed to life satisfaction, including income, employment, high self-esteem, etc. Indiscriminately encouraging injured older adults to return to work does not always make sense. There is a need to focus on sustainable health and psychosocial services in the community. This study demonstrates the importance of taking a non-work approach with injured older adults who have the dual characteristics of being both old and disabled.

Association between psychosocial rehabilitation and recovery center service receipt and reported internalized stigma among veterans.

Internalized stigma, also known as self-stigma, is negatively associated with a person's willingness to seek mental health services and follow their treatment plan. This can hinder a person's recovery, exacerbate their mental health illnesses, and reduce their quality of life. A primary directive of the Veteran Affairs Psychosocial Rehabilitation and Recovery Center (PRRC) program is to help veterans overcome their internalized stigma. This study is the first to evaluate the association between receiving PRRC services over time and veteran reported levels of internalized stigma based on Internalized Stigma of Mental Illness-Brief-10 scores using longitudinal PRRC Forms Data. The analysis was performed using a random-effects ordered logistic regression adjusting for veteran sociodemographic and clinical characteristics. Our study cohort consisted of 2,774 veterans who received PRRC services between fiscal years 2018 and 2021 and who had an intake form at the start of the PRRC service and at least one follow-up form. Our study found that veterans had lower odds of having a higher level of internalized stigma at the first follow-up relative to their intake (OR: 0.80; 95% CI [0.70, 0.92]), and these odds continued to decrease with each subsequent follow-up. These results potentially indicate the effectiveness of the PRRC program in reducing levels of internalized stigma among the veterans. Our study also suggests the need for greater clinical attention and resources for subgroups such as older veterans, male veterans, and veterans with posttraumatic stress disorder, anxiety, or personality disorders, who reported higher levels of internalized stigma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family Fellowship Society for Psychosocial Rehabilitation Services (1993-2019): A Self-help Movement.

Family Fellowship Society for Psychosocial Rehabilitation Services is an initiative of families of persons with mental illness and with psychiatric disabilities. It has been advocating self-help movement on the part of the families who have been on the lookout for alternative care services. This venture has been technically supported by the mental health professionals at National Institute of Mental Health and Neurosciences, Bangalore. It is a collaborative effort of families and professionals to address the needs that have been felt by the consumers and the professionals. It is the first of its kind in India. Over a period of 26 years, 150 + families have availed the alternative care for psychosocial rehabilitation services for their wards. In this context, an attempt was made to enlighten the psychosocial rehabilitation services at family fellowship society.

Job Satisfaction of Nurses Versus Other Mental Health Professionals Working in Psychosocial Rehabilitation Services.

The objectives of Psychiatric Reform were, on the one hand, psychiatric hospitals' shutting down and, on the other hand, the creation of Psychosocial Rehabilitation facilities, in order to provide appropriate care to individuals suffering from mental health problems in community. Therefore, mental health professionals' job satisfaction constitutes one of the fundamental factors leading either to success or failure of each reforming effort. The aim of this study was to investigate the level of professional satisfaction of nurses working in Psychosocial Rehabilitation facilities compared to other mental health professionals. Three hundred and sixty-seven mental health professionals, working in the field of psychosocial rehabilitation completed (a) a sociodemographic questionnaire, and (b) Spectοr's Job Satisfaction Survey (JSS). Moderate levels of total professional satisfaction were observed. Low satisfaction rates were recorded in "Pay," "Promotion," and "Fringe Benefits" subscale. High satisfaction rates were recorded in "Supervision," "Cooperation between colleagues," and "Nature of work," while moderate satisfaction rates were reported in "Contingent rewards," "Operating procedures," and "Communication" within facilities. It is noteworthy that nurses were statistically significant less satisfied with the "Contingent rewards" (p=0.028), the "Nature of work" (p=0.001), and the "Communication" (p=0.019), while they were statistically significant more satisfied with "Supervision" (p=0.007) compared to the other specialties of mental health professionals. The results can be used by those with administrative and scientific responsibilities in the field of mental health in order to recognize professionals' difficulties and solve their problems in psychosocial rehabilitation facilities. These interventions could improve their levels of job satisfaction, in order to achieve optimal therapeutic results for mentally ill and improve the quality of the services provided.

Psychosocial Rehabilitation: A New Management Dynamics of Patients suffering from Mental Illness due to COVID-19

Psychosocial Rehabilitation encourages personal recovery, successful community incorporation and pleasing quality of life for persons who have a mental sickness or mental health distress. During the phase of COVID-19 the psychosocial rehabilitation's services and supports performed a collaborative role, person directed, individualized, and a vital element of the human services spectrum. It helps in developing skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning and social environments of their choice and include a wide continuum of services and supports. In this article we have explained about how the psychosocial rehabilitation during the phase of COVID-19 played a great role and given a new dimension of management. Its strategies vary according to patients’ needs, the setting where the rehabilitation is provided (hospital or community), and the culture and socioeconomic condition of the country.

COVID-19 impact on the provision of psychosocial rehabilitation services in Latin America and the Caribbean

Health care services have been deeply affected worldwide by the COVID-19 pandemic. However, and despite its importance to psychiatric reforms, very little has been written on actual responses to the COVID-19 pandemic in community psychiatry and psychosocial rehabilitation settings. Fifty-two mental health professionals from thirteen countries in Latin America and the Caribbean were interviewed in May and June 2020 and shared their opinions on the state of psychosocial rehabilitation services and programs during the first one-hundred days of the COVID-19 pandemic. Simple quantitative measures were added to a thematic analysis of responses. The results indicated that the disruption of group activities deeply affected psychosocial rehabilitation services, non-core activities (e.g., food and medication supply) became the most relevant aspects of these programs, shifting to remote mode proved to be a significant hurdle for many psychosocial rehabilitation service users, and long-term effect on rehabilitation services is expected by almost 90% of interviewees.

Modified assertive community treatment program for patients with schizophrenia: Effectiveness and perspectives of service consumers from a South Indian setting.

Schizophrenia is a disabling mental illness. Antipsychotic treatment in conjunction with comprehensive psychosocial rehabilitation services is essential in promoting functional recovery. Assertive Community Treatment (ACT) is an evidence-based approach in promoting recovery in schizophrenia. The evidence for the effectiveness and feasibility of such community-based assertive interventions in low and middle-income countries is limited. To evaluate the effectiveness of modified assertive community treatment in a South Indian setting and evaluate the perspectives of patients and caregivers who participated in the program. Socio-demographic details, illness characteristics, course of the illness including the number of relapses and hospitalization, adherence level at baseline, the scores on the Social and Occupational Functioning Assessment Scale (SOFAS), and Global disability score on Indian Disability Evaluation and Assessment Scale (IDEAS) were compared before and after the initiation of the M-CAT program using retrospective file review. The perspectives of the clients were assessed using a 6-item questionnaire. Ten patients (six male and four female) with a diagnosis of schizophrenia were under the Manipal Assertive Community Treatment (M-ACT) program for a median duration of 3 years (IQR 1.25) participated in the study. There was a significant improvement in the overall level of functioning, medication adherence, relapse rates, and disability after the enrolment into the program. The majority of the respondents had a positive attitude towards the M-ACT program. Assertive community interventions with suitable modifications for local resource-limited conditions may be an effective option in promoting functional recovery in Schizophrenia.

Profile of Psychosocial Rehabilitation Centres for Persons with Substance Use Disorders in Bengaluru: A Cross-Sectional Study.

Substance use disorder is a major global health problem. There is limited information available about the pattern of utilization of psychosocial rehabilitation services (de-addiction service centres) for persons with substance use disorder. To study the profile of psychosocial rehabilitation centres (de-addiction service centres) for persons with substance use disorder in Bengaluru. To assess the staff profile, organisation profile, to examine the nature, types of treatment and psychosocial rehabilitation services offered by the de-addiction centers. Cross-sectional study design was used. Sample size: Out of 43 private organizations, 32 were eligible to participate. Out of 32, one-third (N=10) of the organizations participated in the study. Based on minimum standards of care manual for substance use disorders, an online questionnaire regarding organizational profile, staff pattern, nature and type of treatments, range of psychosocial rehabilitation services offered. Data was collected through online using google forms. Descriptive statistics such as frequency was used to analyse the data collected. All 10 organizations have a minimum one social worker, psychologist, nursing staff, and other supportive staff in the psychosocial rehabilitation centers. All the organizations have basic infrastructure and amenities as per minimum standards of care. Most organizations provide recovery oriented services, almost all organizations provide telephonic follow-up and home visit services. Most organizations provide psychosocial rehabilitation services. Most organization expressed need for training their counsellors on on group therapy and family therapy techniques. Most organisations possibly comply with a minimum standard of care and service, follow a twelve-step treatment approach, reintegrate the recovered clients in the community, provide an opportunity to work in their respective organisations. Most organisations have self-help (AA) groups, offer assistance programmes for family members, supportive educational groups and halfway-home care services.

Professional satisfaction of nurses in psychosocial rehabilitation services

IntroductionThe increase of job satisfaction in mental health nurses, working in community mental facilities, helps them to become more efficient and understand the needs of individuals suffering from mental health problems.ObjectivesTo investigate sociodemographic and job characteristics, as well as the level of professional satisfaction of nurses working in psychosocial rehabilitation facilities of the psychiatric hospital of Athens, named Dafni.Methods220 nurses, working in the field of psychosocial rehabilitation completed (a) a sociodemographic questionnaire, (b) Spectοr’s Job Satisfaction Survey (JSS).ResultsNursing staff consists of mental health nurses (44.1%) and nursing assistants (55.9%) in the present study. 90% of the participants were female; while the 65% were married, the 19.5% had a university-level education and the 25% had administrative responsibilities. The 44.1% of our sample worked in hostels, 41.8% in nursing homes and 6.8% in Community Mental Health Centers. More specifically, moderate levels of total professional satisfaction were observed. Concerning the dimensions of satisfaction, low satisfaction rates were recorded in “salary”, “promotion” and in “privileges and benefits”. High satisfaction rates were recorded in “supervision by their superiors”, “cooperation between colleagues” and “the nature of their work”, while moderate satisfaction rates were reported in “communication” within facilities, as far as the explanation of tasks and objectives is concerned.ConclusionsThe results can be exploited by those with administrative and scientific responsibilities in the field of mental health in order to recognize nurses’ difficulties and solve their problems in psychosocial rehabilitation facilities.

Contribution of the Freudian Theory of Psychosis in the Diagnosis of Mental Disorder

The article presents my research in psychoanalytic psychopathology on the psychic etiology of psychosis, carried out between 2012 and 2020 at Universidade Federal Fluminense (Volta Redonda, Brazil). In Brazil, patients with various mental disorders rely on the Brazilian Unified Health System which aimed at treatment and psychosocial rehabilitation services. These services are called Psychosocial Care Centers (CAPS). There is an innovation in mental health treatment because they replace the treatment model for mental disorders directed only at hospital admissions. The clinical treatment of mental disorders in CAPS is organized into unique therapeutic projects. It is characterized by a multidisciplinary team in an open, non-hospital environment, close to the patient’s place of residence. Since 1996, the SUS-Brazil diagnostic guidelines are used to conduct epidemiological studies, formulate public policies on mental health, and establish its funding for the mental health network. These manuals ignore the presence of etiological factors of a psychological nature and exclude the theoretical framework in the definition of disorders. The absence of consideration of etiological factors and the exclusion of theoretical frameworks is evident in the way the DSM-5 defines the spectrum of schizophrenia, resulting in the predominance of schizophrenia in the clarification of psychotic disorders and, consequently, in the weakening of the classic category of psychosis. My research aims to contribute to psychosis by examining the role of delusion in the onset of psychosis, triggering events, and stabilizing the psychotic structure. This article aims to present the hypothesis of the psychic etiology of psychosis from the contributions of Sigmund Freud. This theorizing is significant as it introduces the hypothesis of loss, restitution, and recovery into the psychiatric lexicon of the opposition between schizophrenia and paranoia. To this end, this article exhibits a survey of Freudian references to emphasize the construction of an original theory of psychosis, where: 1) The consideration of the functioning of drives is relevant in isolating psychic etiology from its triggers; 2) A redefinition of the concept of delusion signals the originality of the Freudian theory of the stabilization of psychoses: delusion is defined as a psychic effort of recovery, an attempt at reaching a cure.

정신재활서비스와 정신장애인 자립생활역량과의 관계에서 사회적 지지의 조절효과

본 연구의 목적은 정신재활서비스가 정신장애인의 자립생활 역량에 미치는 영향요인과 사회적 지지의 조절효과를 검증하는 것이다. 연구대상은 정신재활시설 이용 및 독립주거 거주기간이 3개월 이상인 정신장애인들이며, 총 231명의 설문조사 자료를 활용하여 조절회귀분석을 수행하였다. 주요연구결과로는 첫째, 다양한 유형의 정신재활서비스를 많이 이용할수록 정신장애인들의 자립생활 역량이 향상되었다. 둘째, 지역사회의 복지서비스를 이용할수록 정신장애인들의 자립생활 역량이 향상되었다. 셋째, 정신재활서비스 이용자의 서비스 도움 만족도가 높을수록 정신장애인의 자립생활 역량이 향상되었다. 넷째, 자립생활 교육을 받은 정신장애인의 자립생활 역량이 향상되었다. 다섯째, 자립생활과 관련한 사례관리를 제공받고 있는 정신장애인의 경우 자립생활 역량에 부정적인 영향을 받는 것으로 나타났다. 마지막으로 사회적 지지가 정신재활서비스 이용종류 수와 자립생활 역량과의 관계를 조절하는 것으로 나타났다. 이는 사회적 지지에 기반한 지역사회 중심의 통합적인 정신재활서비스가 정신장애인 자립생활 역량을 강화하는 효과를 가짐을 의미하며, 연구결과를 바탕으로 정신장애인의 자립생활 역량을 향상을 위한 정신재활서비스의 발전방안을 제안하였다.

Musas. Un proyecto de Arteterapia y Creación Artística para la inclusión social, con enfoque de Género, en Salud Mental

En este artículo se describe la intervención y la investigación del proyecto de Arteterapia y Creación Artística para la Inclusión Social, desde el enfoque de género: MUSAS. Que se viene desarrollando desde el año 2017 en el CRPS. Latina, en colaboración con la Asociación Arte para la Vida y el proyecto de investigación ALETHEIA. Arte, arteterapia, trauma y memoria emocional, de la Universidad Complutense de Madrid. Las participantes son un grupo de trece mujeres, con diagnósticos de enfermedad mental severa y que son usuarias del servicio de rehabilitación psicosocial. El Objetivo principal del proyecto es: generar un espacio abierto de Creación Artística, de carácter social e inclusivo, que sea favorecedor de procesos de Resiliencia y Empoderamiento personal y grupal de las participantes, gracias a la expresión y gestión emocional, a través de las posibilidades que emergen de los procesos creadores.

Interorganisational cooperation and its effects on community rehabilitation for people with severe mental disorders in Beijing, China: A case study.

A national comprehensive management pilot project for mental health has been implemented in China to provide integrated care for people with severe mental disorders through strengthened cooperation among government organisations and between government and other relevant social organisations. The promotion of community rehabilitation has been included as a key part of this pilot program. The present study took the AD district of Beijing as a case study to examine interorganisational cooperation and its effects on community rehabilitation in a real-world setting. Interviews were conducted with 14 frontline workers, including 7 mental health workers from community health centres and 3 staff and 4 social workers working in rehabilitation centres. Five officials from relevant health and social welfare departments and a social work organisation were also interviewed. Experiences in Beijing revealed that interorganisational cooperation helped to build a multiagency workforce furnished with basic mental health knowledge at the community level, which rendered it possible for frontline workers to provide fundamental follow-up services, pilot the case management model of service provision and increase the provision of psychosocial rehabilitation services within the poorly resourced context of Chinese mental healthcare. Moreover, the engagement of social organisations provided bottom-up pressure to innovate through the active bringing forward of new ideas concerning cooperation and service delivery. However, differences in professional authority and commitment were observed. Health department officials and health professionals seemed to exercise a dominant role as compared to social welfare department officials and social workers. Future policy making should motivate social welfare department officials to improve social care for people with severe mental disorders. Social workers require training to improve their knowledge of mental health matters, and social organisations need greater latitude to strengthen their influence over the development of community rehabilitation services for people with severe mental disorders.

PSYCHOSOCIAL REHABILITATION AS AN EFFORT TO ACHIEVE INDEPENDENCE FOR THE PATIENTS OF SCIZOFRENIAL (STUDY AT THE HOSPITAL OF MARZUKI MAHDI BOGOR)

Sebagian besar masyarakat Indonesia masih belum menyadari bahwa kesehatan jiwa merupakan hal yang sangat penting untuk diperhatikan. Pasien gangguan jiwa tersebut memerlukan pelayanan rehabilitasi psikososial agar dapat meningkatkan kemandirian pasien ketika nantinya kembali ke keluarga dan lingkungannya. Tujuan Penelitian ini untuk menjelaskan proses rehabilitasi psikososial sebagai upaya mencapai kemandirian bagi pasien gangguan jiwa skizofrenia di RSMM, Bogor. Metode Penelitian yang digunakan adalah metode deskriptif dengan pendekatan kualitatif. Hasil Penelitian menunjukkan bahwa proses pelaksanaan rehabilitasi psikososial yang dilakukan oleh RSMM terbagi menjadi dua yaitu latihan non vokasional dan vokasional. Rehabilitasi psikososial memberikan dampak bagi pasien gangguan jiwa skizofrenia yaitu mengalami peningkatan dalam hal fungsi personal dan sosial. Kemandirian dalam aspek sosial, emosi, intelektual dan ekonomi serta memiliki keterampilan. Untuk menunjang pemulihan pasien gangguan jiwa skizofrenia disarankan adanya dukungan keluarga dan lingkungan masyarakat. Most Indonesian people still do not realize that mental health is a very important thing to consider. Mental patients need psychosocial rehabilitation services in order to increase patient independence when they return to their families and environment. The purpose of this study is to explain the process of psychosocial rehabilitation as an effort to achieve independence for schizophrenic psychiatric patients at RSMM, Bogor. The research method used is descriptive method with a qualitative approach. The results showed that the process of implementing psychosocial rehabilitation carried out by RSMM was divided into two namely non-vocational and vocational training. Psychosocial rehabilitation has an impact on patients with schizophrenia, which is an increase in personal and social functioning. Independence in social, emotional, intellectual and economic aspects and have skills. To support the recovery of mental patients with schizophrenia, it is suggested that there is family and community environment support.

An Influence of Psychosocial Rehabilitation Services to Independent Living Competency of People with Mental Illness

An Influence of Psychosocial Rehabilitation Services to Independent Living Competency of People with Mental Illness

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults: Guideline V. Assessment of Cultural Factors.

(Excerpted from "The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition." Copyright © 2016, American Psychiatric Association. Reprinted with permission.).

Culture clash? Recovery in mental health under Australia's National Disability Insurance Scheme - a case study.

Using a case study, we aim to report on the compatibility of funding and policy settings under Australia's National Disability Insurance Scheme (NDIS) with the delivery of evidence based, recovery-oriented psychosocial services. Type of program or service: We reflect on the impact of the NDIS on a psychosocial rehabilitation service run by Woden Community Service (WCS), one of the major service providers in the Australian Capital Territory, and specifically its Transition to Recovery (TRec) program. We examine NDIS funding and policy settings and consider the recovery-oriented practices underpinning psychosocial programs like TRec. The construct of the program, its staffing and related issues are considered. The article draws on a formal evaluation of TRec conducted in 2015. The NDIS is having a seismic impact on Australia's psychosocial sector. Despite its positive evaluation, the future of the TRec program is problematic. Practically, service exit points have disappeared, reducing the program's capacity to properly transition clients between services and effectively increasing the likelihood of relapse. More generally, current NDIS policies are threatening the fidelity of WCS's approach to recovery practice. This case study highlights tension between a new public insurance scheme primarily aimed at better managing consistent conditions and circumstances, and the recovery philosophy which has emerged in relation to episodic mental illness. This has implications for psychosocial services nationwide. The psychosocial rehabilitation sector has always been a peripheral element of Australia's mental health service mix. The advent of the NDIS offers hope that this may change. However, WCS's experience suggests that the NDIS must reconsider how best to foster recovery-oriented practice in mental health. This should be part of a more fundamental reconceptualisation of the role of psychosocial rehabilitation services in contemporary mental health care, not just for NDIS recipients. This work is urgent if Australia is to nurture its already rare psychosocial rehabilitation workforce and not see it dissipate.

Psychosocial rehabilitation and severe mental illness: Factors that influence patients' attendance in a support group

Psychosocial rehabilitation for people with chronic-severe mental illness mainly aims to social integration by restoring independent functioning in the community, improving quality of life, and addressing risk factors that lead to social disability. Support groups (SG) are usually part of this multilevel mental health process. Given that non-adherence to treatment is a common phenomenon in people with chronic- severe mental illness, the aim of the current study was to identify which factors influence members' attendance in a support group in a vocational training Program of the Psychosocial Rehabilitation Unit of Byron-Kaissariani Community Mental Health Centre. The SG sessions were weekly, with 45-minute duration, opened to any new member of the Program and coordinated by two therapists. Members' demographic and psychiatric data were gathered from the medical records of the Center. Information about SG was obtained from the reports of the sessions. The sample consisted of 18 women, with mean age 38.56 (±6.92) years. Most of them were high school graduates (61.1%), unmarried (83.3%), with low socioeconomic status (55.5%), suffering from a schizophrenic spectrum disorder (61.1%) with a mean duration 15.22 (±8.44) years. Out of 83 sessions in total, twenty-two (26.5%) were in absence of a co-therapist, 11 (13.3%) after a member's entrance or withdrawal and 11 (13.3%) after a session cancellation. Furthermore, an average of four issues was discussed per session, with mental illness (62.7%) and interpersonal relationships (73.5%) being the most popular topics during the sessions. The statistical analysis demonstrated that members' demographic (age, education, marital status, residence, socioeconomic status, working experience) and psychiatric characteristics (diagnosis, illness duration, rehabilitation program experience) were not associated with the attendance rate in the SG. Similarly, the proportion of participants attending the sessions did not seem to be significantly related to the absence of a co-therapist, to a member's entrance or withdrawal and to a session cancellation. In contrast, attendance seemed to be significantly reduced when the topic of a session focused on members' future expectations/goals (having a family, further education, finding a job) (Beta=-0.32, p=0.006). This finding highlights the need for future research in order to incorporate interventions that promote and address future goals and expectations of people with chronic-severe mental illness in psychosocial rehabilitation services.

A Qualitative Study of Implementation Challenges of Mental Health Clubhouse Rehabilitation Services in China's Hunan Province.

Psychosocial rehabilitation has been established as a critical component of client-centered recovery-oriented services for people with serious mental illness. Despite its importance, the implementation of mental health rehabilitation services in low- or middle-income countries has not been well studied. In this study, the authors document the regional challenges of planning and implementing mental health rehabilitation services in clubhouses in Hunan Province in the People's Republic of China. Participants were purposively selected and consisted of diverse stakeholders, including rehabilitation directors and psychiatric hospital leaders in Hunan Province, China. Information was collected from 33 individuals by using three focus groups, 23 semistructured interviews of key informants, and participant observation. Interview transcripts were coded and analyzed by using standard qualitative methods. Implementation challenges were characterized by four themes: skepticism toward psychosocial rehabilitation services, resource shortage, insufficient system integration and incentives, and stigma of mental illness. Psychosocial rehabilitation is an emerging public health priority in China. This study on clubhouses in Hunan Province used qualitative methods to inform future directions for service development and research. Early identification of regional implementation challenges is a first step in assessing the applicability of psychosocial rehabilitation services locally in Hunan Province. Successful implementation of clubhouse psychosocial rehabilitation services will benefit not only from strong government commitment but also from developing standard evaluations of evidence-based practices, tackling stigma, and addressing low resource investment.

Challenges for psychosocial rehabilitation services in the Lisbon Metropolitan Area: A qualitative approach.

In Portugal, a mental health reform process is in place aiming to redefine the model of service provision. In 2008, a National Mental Health Plan (NMHP) was approved to provide policy guidance over the transition period. The NMHP intended, among others, to develop community-based services, with a specific focus on rehabilitation and deinstitutionalization. This study aims to explore the perspectives of service managers of psychosocial rehabilitation services regarding the main challenges to support the community living of persons with severe mental illnesses (PWSMI) in the Lisbon Metropolitan Area (LMA). The paper also contextualises the provision of psychosocial services within the country's mental health reform process and characterises the profile of service users in socio-occupational units (SOUs) of the LMA. Semi-structured interviews were performed with all SOUs' managers of the LMA (n=13). Information regarding service user characteristics was collected based on service records (n=344). Interviews were analysed according to the framework methodology. The results of the interviews were triangulated using document analysis. Fieldwork took place between June and July 2016. The findings suggest that the development of the mental health reform ensured significant changes to service delivery. Community-based mental health organisations are an important actor for service provision. However, important asymmetries were identified in the provision of psychosocial care within the LMA. At the same time, family carers are perceived as responsible for ensuring a large part of the social needs of the PWSMI but there is an increasing concern with their own ageing processes. As a conclusion, it is highlighted the current inequality between services and the need to contemplate a life-course perspective that comprehends the ageing process of caregivers poses an emerging challenge for psychosocial rehabilitation. These findings are also important for other low- and middle-income countries passing through similar reforms.