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Rehabilitation: The Awkward Third Wheel in Mental Health Care

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Building on last week’s post for National Recovery Month, I would like to draw your attention to an important yet frequently overlooked and under-appreciated aspect of mental health care: rehabilitation services.  Of the three basic components of public mental health systems – prevention, treatment and rehabilitation – rehabilitation is the one most closely linked to the concept of recovery.

Prevention efforts focus on education and promotion of healthy lifestyles.
Treatment is mainly concerned with alleviating symptoms and distress.
Rehabilitation focuses on improving quality of life, usually after a person has been diagnosed and treated for a serious mental illness.

Rehabilitation is the awkward third wheel that gets people past the potholes on the road to mental health.   While prevention is aimed at large groups of people in the general population, and treatment may be aimed at anyone with a mental health problem, rehabilitation is aimed at the relatively small number of people who have a serious psychiatric disability that significantly interferes with major life activities.

While 25% or more of Americans may experience a mental health problem in any given year, as few as 2.6% are sufficiently impaired to require rehabilitation services.  Usually, these are people with a serious and persistent mental illness (schizophrenia, bipolar disorder, depression, and some personality disorders), and serious functional impairment in two or more of the following areas:

  • unemployed or with limited skills and a poor work history
  • requires public financial assistance
  • unable to establish or maintain a social support system
  • needs help with basic living skills
  • exhibits inappropriate social behavior, which may result in the need for interventions by the police or mental health professionals.

Without adequate support, people in this group tend to function poorly in their living, work, school and social environments.  Even when there is significant involvement from professionals and mental health care systems, it is often family members who end up in the role of primary caregivers for this group.  Rehabilitation services can relieve some of the burden on families by teaching their disabled loved ones strategies and skills that help them improve their functioning and live more independently.

Rehabilitation services can take different forms and follow different models and occur in different environments.  Examples are:

  • transitional, supported, and supportive housing
  • halfway houses and group homes
  • supported employment and education
  • cognitive rehabilitation
  • community support programs
  • multidisciplinary treatment teams
  • peer and self-help groups
  • clubhouses
  • social clubs and drop-in centers

The one thing they all have in common is that they seek to improve or otherwise impact the functioning of people with serious mental illness in their various roles as students, workers, tenants, or members of the community.

In selecting a provider of rehabilitation services, look for one that is “recovery-orientated.”  This starts with a belief on the part of providers that recovery is possible, even for people with serious mental illness.  However, belief alone is not enough.  Mental health rehabilitation services should also be able to demonstrate that the people who use their services gain skills and improve their functioning.    So many mental health providers claim to be “recovery-oriented” without understanding or following this basic concept, that Resources to Recover was compelled to spell it out in a recent post, Towards a Functional Definition of Mental Health Recovery:

Recovery is a process of setting goals, learning skills and taking actions that enable a person living with mental illness to connect with others and effectively pursue his or her aspirations for a life of meaning.”

Effective rehabilitation services embrace this concept of recovery, regardless of the service type.  Does a prospective provider offer hope that your loved one with a serious mental illness can learn to manage his or her condition and still have a meaningful life in the community?  Only those providers which offer such a hope can be considered in any valid sense a rehabilitation service.

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Jay Boll, Editor in Chief www.rtor.org

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