It is a treatment approach to improve the lives of people with disabilities by teaching emotional,social and cognitive skills to work independently in the community.

1. PSYCHIATRIC REHABILITATION
PRESENTED BY
Sakuntala Giri
M.Sc. Tutor
SUM Nursing College
Siksha ‘O’ Anusandhan
(Deemed to be)University

2. PSYCHIATRIC REHABILITATION
 Rehabilitation is the process of enabling
the individual to return to his highest
possible level of functioning. It is an
important component of the community
mental health program, and is undertaken
at the level of tertiary prevention.

3. Definition
 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]

4. Principles of Rehabilitation
 Increasing independence would be the first
step in rehabilitation process.
 Primary focus is on improvement of capabilities
and competence of clients with psychiatric
problems.
 Maximum use must be made of residual
capacities.
 Patient's active participation is very essential.
 Skill development, therapeutic environment
are fundamental interventions for a successful
rehabilitation process.

5. Psychiatric Rehabilitation
Approaches
 a. Psychoeducation: Includes diagnosing
the problem, telling the person what to
expect regarding illness and discussing
treatment alternatives.
 b. Working with families: Encouraging
family members to get involved in
treatment and rehabilitation programs.

6. Cont..
 c. Group therapy: Positive aspects of
group
therapy include an opportunity for ongoing
contact with others, validation of their
perceptions, sharing their views about
problems and problem solving abilities.
 d. Social skills training: It involves
teaching specificliving skillsthat the
patient is expected to have in order to
survive in the community.

7. Rehabilitation Team
 Professionals contributing to psychiatric
rehabilitation include:
 psychiatrist, clinical psychologist,
 psychiatric social worker,
 Psychiatric nurse,
 occupational therapist,
 recreational
 therapist, counselor and
 other mental health paraprofessionals.

8. Steps in Psychiatric Rehabilitation
 Psychiatric rehabilitation begins with a
comprehensive medical psychiatric
diagnosis and functional assessment.
These are key elements in identifying
impairments and disabilities.
 The steps of rehabilitation include:

9. Cont..
 a. 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 part by various
psychotropic agents.

10. Cont…
 b. 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.

11. Cont..
 c. Remediating disabilities through supportive
 interventions: When restoration of social and
vocational functioning through skills 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.

12. Cont…
 d. Remediation of handicaps:
 In addition to clinical rehabilitation
interventions, the disabled persons can be
helped to overcome their handicaps
through social rehabilitation
interventions,e.g.community support
programs.

13. Disability
 A disability is an impairment that may
be cognitive, developmental, intellectual,
mental, physical, sensory, or some
combination of these. It substantially
affects a person's life activities and may
be present from birth or occur during a
person's lifetime.

14. Cont..
 Disabilities is an umbrella term, covering
impairments, activity limitations, and
participation restrictions.
 Disability is a complex phenomenon,
reflecting the interaction between features
of a person’s body and features of the
society in which he or she lives.
(World Health organization)

15. COMMUNITY REHABILTATION
 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.

16. Cont..
 The focus of community rehabilitation is
on:
 empowering the patient towards
independent living in the community, and
strengthening family relationships.

17. PROGRAMME OF COMMUNITY INTEGRATION
 Preventive Health
 Lifelong Learning Opportunities
 Social / Recreational Activities
BARRIERS TO SUCCESSFUL COMMUNITY
REINTEGRATION:
 Double stigma
 Lack of family and social support
 Co morbidity
 Adjustment problems
 Boundary issue

18. ROLE OF NURSE IN PSYCHOSOCIAL
REHABILITATION
Assessment:
Individual
Family
Community

19. Cont…
 Assessment of the Individual
 The nurse should assess the individual in
the areas of symptoms present,
motivation, strengths, interpersonal skills,
self-esteem, activities of daily living and
drug compliance.

20.  Assessment of Family
 Components of family assessment:
 Family structure including developmental
stages, roles, responsibilities, norms and
values.
 Family attitudes towards the mentally ill
member.
Cont….

21. Cont…
 Emotional climate of the family.
 Social support available to the family.
 Past family experiences with mental
health services.
 The family's understanding of the
patient's problems and the plan of care.

22.  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.
Cont….

23. Cont…
 Planning and Implementation
 Planning and implementation in
rehabilitative psychiatric nursing focuses
on fostering independence by maximizing
personal strengths.
 The nurse and the patient must work
together to find ways for the patient to
overcome any remaining impaired areas
of functioning.

24. INTERVENTION
• INDIVIDUALS
• INTERVENTION
• •Skill training
• •Supportive
• intervention
• •Community
• supportive
• programs
• •Vocational
• rehabilitation
• activities
• FAMILY
• INTERVENTION
• •Family therapy
• •Group therapy
• •Family
Counseling
• •Supportive psycho
educational
programs
• •Crisis intervention
programs
• •Outreach
programs
• COMMUNITY
• INTERVENTION
• •Halfway
homes
• •Residential
prevention
programs

25.  Individual Interventions
 Hospital rehabilitation (Inpatient
rehabilitation):
 This involves therapeutic community,
recreational therapy, social skills training and
training in basic living skills.
 Community rehabilitation:
 Providing care in community settings (Homes,
residential care settings, foster homes etc).
Cont…

26.  Family Interventions
 Health education regarding
 the disease process,
 available resources,
communication skills
problem solving techniques.
 Motivating the family members to provide
proper care to the patient.
 Group therapy and support to family members
through self-help groups.
• Nurses help to cope with stress and adapt to
changes in the family structure.
Cont….

27.  Community Interventions
 There are several ways that nurses can
intervene in the community tertiary
prevention programs.
 Among these are health education to the
public,training to school teachers, village
leaders and paraprofessionals in the
rehabilitation of mentally ill people.
Cont…

28.  Evaluation
 Evaluation of psychiatric rehabilitation
services usually takes place at the level of
impact on the patient, family and the
effectiveness of the community service
system.
Cont…

29. INSTITUTIONS IN INDIA WHICH PROVIDES PSYCHO-SOCIAL
REHABILITATION
 GOVERNMENT SECTOR
 1)Centre for Rehabilitation
 Central Institute of Psychiatry, Ranchi
 2) Centre for Comprehensive care and
rehabilitation
 NIMHANS, Bangalore
 IMHANS, Kerala
 Institute of Mental Health, Chennai

30.  NON GOVENMENTAL
ORGANISATION
 Vishwas Day Care Centre with Vocational
Training
 VIMHANS (Vidyasagar Institute of
Mental Health and Neuro-Sciences New
Delhi6)
 Shraddha Rehabilitation Foundation-
Mumbai