Mental Health Nursing

1. R . R U P PA M E R C Y
M . S C N U R S I N G I I Y E A R
PSYCHOSOCIAL
REHABILITATION

2. CONTENT
• Introduction
• Definition
• Psychosocial rehabilitation services
• History
• Vision and mission
• Objectives
• Psychosocial rehabilitation team
• Indications
• Approaches
• Principles
• Aims
• Steps
• Role of nurse

3. INTRODUCTION
Rehabilitation is the process of enabling the individuals to
return to his highest possible level of functioning.
Psychosocial rehabilitation promotes personal recovery,
successful community integration and satisfactory quality of
life for persons who have a mental illness or mental health
concern.

4. DEFINITION
• REHABILITATION:
Rehabilitation is “an attempt to provide the best possible
community role which will enable the patient to achieve the
maximum range of activity, interest and of which he is
capable
Maxwell Jones(1952)
• PSYCHOSOCIAL REHABILITATION:
It is a process that facilitates the opportunity for individuals
to reach their optimal level of independent functioning in
the community.
WHO(1996)

5. PSR SERVICES
Psychosocial rehabilitation services are programs of
two or more consecutive hours per day provided to groups of
individuals in anon – residential setting.
Services include:
assessment, education to teach the patient about the
diagnosed mental illness and appropriate medications to
avoid complication and relapse
opportunities to learn and use independent living skills and
to enhance social and interpersonal skills within a
supportive and normalizing program structure and
environment.

6. HISTORY
• From the 1960s and 1970s, the process of
deinstitutionalization meant that many individuals with
mental health problems were able to live in their communities
rather than being confined to mental institutions
• medications and psychotherapy were the two major treatment
approaches, with little attention given to supporting and
facilitating daily functioning and social interaction.
• With the founding of psychosocial rehabilitation , Canada in
2004, the professional organization International Association
of Psychosocial Rehabilitation Services (IAPSRS) changed its
name to United States Psychiatric Rehabilitation Association
(USPRA) and the trend is toward the use of “psychiatric
rehabilitation”

7. VISION AND MISSION
VISION
The vision of psychiatric rehabilitation is to enable
individuals with mental disabilities to recover and to live as
normally as possible in the community.
MISSION
The mission is to engage patients and their families or
caregivers in a collaborative treatment process that teaches
skills and provides supports for fostering illness
management, psychosocial functioning and personal
satisfaction.

8. OBJECTIVES OF PSR
• Symptom reduction
• Reduction of iatrogenic
• Social skill improvement
• Reduction of discrimination and stigma
• Family support
• Social support
• Consumer empowerment

9. REHABILITATION TEAM
• Psychiatrist
• Clinical psychologist
• Medico social worker
• Psychiatric nurse
• Counselor
• Occupational therapist
• Recreational therapist
• Other mental health care professionals

10. INDICATIONS
• The individual must also meet one of the following
criteria listed below. The individual must:
• Have experienced long – term or repeated psychiatric
hospitalization
• Experience difficulty in activities of daily living and
interpersonal skills
• Have a limited or nonexistent support system
• Are unable to function in the community without
intensive intervention
• Require long - term services to be maintained in the
community.

11. APPROAHES OF PSR
Psychoeducation – includes diagnosing the problem, telling
the person what to expect regarding illness and discussing
treatment alternatives.
Working with families – encouraging family members to
get involved in treatment and rehabilitation programs.
Group therapy – an opportunity for ongoing contact with
others, validation of their perceptions, sharing their views
about problems and problem solving abilities.
Social skill training – teaching specific living skills that the
patient is expected to have in order to survive in the
community.

12. PRINCIPLES
• Hopeful: People may be left feeling demoralized as a result
of their condition; rehabilitation focuses on helping clients
feel hopeful about the future.
• Empowered: Each individual needs to feel that they are able
to set their own goals and have the power and autonomy to
pursue those aims.
• Skilled: Rehabilitation aims to teach people skills to help
them manage their condition and live the life they want to
live. This includes living skills, work skills, social skills, and
others.
• Supported: Mental health professionals should offer support
and help clients build relationships and social connections in
their community.

13. AIMS
Establish a multidisciplinary team, that applies
methods, alternative to pharmacological treatment for
the inpatients in the hospital and day department
Help people with severe end long - lasting mental
disturbances to improve life quality.
Help to adjust successfully to the environment and feel
like satisfaction with the minimal specialists supervision.
Help to restore and maintain lost skills and acquire new
one’s.

14. STEPS
Psychosocial rehabilitation begins with a comprehensive
medical psychiatric diagnosis and functional assessment.
The steps of psychosocial rehabilitation includes
• Reduction of impairment
• Remediation of disabilities through skill training
• Remediating disabilities through supportive
interventions
• Remediation of handicaps

15. REDUCTION OF IMPAIRMENTS
• Rehabilitation interventions with psychiatric patients
require reduction or elimination of the symptoms and
cognitive impairments that interfere with social and
vocational performance.
• These impairments are reduced and eliminated for the
greater party by various psychotropic agents.

16. REMEDIATION OF DISABILITIES
THROUGH SKILL TRAINING
• Skill training is used to remediate disabilities in social,
family and vocational functioning.
• Patients generally require training in self – care skills,
interpersonal skills, vocational and employment
pursuits, recreational and leisure skills.

17. REMEDIATION OF DISABILITIES THROUGH
SUPPORTIVE INTERVENTIONS
When restoration of social and vocational functioning
through skill training is limited by continuing deficits,
rehabilitation strategies aim at helping the individuals
compensate for handicap by learning skills in living and
working environments. Adjusting the individual and
family expectations to a level of functioning that is
realistically attainable.

19. REMEDIATION OF HANDICAPS
• In addition to clinical rehabilitation interventions, the
disabled persons can be helped to overcome their
handicaps through social rehabilitation interventions
• Eg. Community support programs.

20. ROLE OF NURSE
1. Assessment of the individual
The nurse should assess the areas of symptoms,
motivation, strengths, interpersonal skills, self esteem,
activities of daily living and long compliance
PLANNING AND IMPLEMENTATION
 Skill training
 Supportive interventions
 Community supportive programs
 Vocational rehabilitation activities

21. CONTD…
2. Assessment of family
Family structure including developmental stages, roles,
responsibilities, norms and values.
Family attitudes towards mentally ill member, emotional climate of
the family, social support available to the family and past family
experiences with mental health services.
FAMILY INTERVENTION
• Family therapy
• Group therapy
• Family counseling
• Supportive psycho educational programs
• Crisis intervention
• Outreach programs

22. CONTD…
3. Assessment of community
Assessment of community agencies that provide services to
people who have mental illnesses, assessment of attitudes of the
people towards the mentally ill, etc.
COMMUNITY INTERVENTION
Halfway homes
• It is the transition facility for mental patients who no longer
need the full services hospital but are not yet completely ready
for an independent living.
• It is a transitional supervised residence assigned to help the
patient after discharge from in patient settings.
• It is temporary residence where various kinds of social skill
training are given to this patient, make readjustment to the
social life and employment in the community.

23. ACTIVITIES IN HALFWAY HOMES
• The duration is maximum of one year which gives
sufficient time for them to adjust to the family and to the
home environment.
• Group counseling
• Recreational activities
• Home visiting
• Job placement
• Follow – up counseling
• Educational and vocational program
• Additional activities such as religious activities etc.
• Social skill training
• Training in independent skills

24. COMMUNITY INTEGRATION
PROGRAMS
• It is a community based program
that promotes recovery, community
integration and improved quality of
life for members who have been
diagnosed with a behavioral health
condition that significantly impairs
their ability to lead meaningful lives.
• The focus is on empowering the
patient towards independent living
in the community and strengthening
family relationships.
• Eg. Preventive health
• Lifelong learning opportunities
• Social/recreational activities

25. ADVANTAGES
• The promotion of more independent social activity in
patients who may have lost this facility due to illness
• To allow the psychiatric care team to maintain contact
with patient’s families and in many cases to allow them
to work with the family.
• In maintaining patient’s contact with their normal social
background, they can be encouraged not to avoid
problems whose origins lie in the family constellation or
work situation.