Whose Choice is Mental Health Rehabilitation?

The delineation of evidence-based practices in supported employment for people with schizophrenia now represents a paradigm shift in the theory and practice of mental health rehabilitation. The principles and methods of traditional vocational rehabilitation and traditional mental health rehabilitation are giving way to evidence-based practices in supported employment, which are consistently proving two to three times more effective at producing competitive employment outcomes. These practices include close coordination with optimal forms of mental health treatment and care and highly individualised forms of intensive supported employment. There is a focus on the vocational services being provided, whereas the traditional and currently prevailing approach follows a more gradual and stepwise process with less of an individual focus, and where individual characteristics are considered important predictors of vocational rehabilitation success. This paradigm shift now challenges occupational therapists working in mental health rehabilitation to revise their theory and practice critically in order to support the implementation of evidence-based practices in supported employment for people with schizophrenia and related psychotic disorders. This article discusses how occupational therapists can adapt to this paradigm shift and revitalise their theory and practice in mental health rehabilitation.

This paper describes the initial development of a mental health rehabilitation curriculum for Australian mental health settings and for psychiatrists and trainees wishing to develop specialist skills in mental health rehabilitation. Members of the Section of Social Cultural and Rehabilitation Psychiatry (SSCRP) established an expert working group under the auspices of the RANZCP. Existing college training resources were reviewed, and a gap analysis was conducted to guide development of new training modules. A tiered curriculum structure was created that allows a staged development of rehabilitation knowledge, skills and attitudes required to be a specialist in mental health rehabilitation. An introductory module was developed to establish the principles of modern mental health rehabilitation. Most of the curriculum was based on existing resources that are relevant to rehabilitation practice. Finalisation of a draft for review was undertaken with the assistance of the RANZCP education project advisors and curriculum experts. As a national body responsible for training psychiatric registrars and maintenance of training for psychiatrists, the RANZCP is well situated to train the specialist medical mental health workforce required to lead rehabilitation services in Australia. The RANZCP mental health rehabilitation curriculum will provide a platform to train the skilled workforce that will enable these services to be fully realised.

This paper updates clinicians and service leaders on evidence bases relevant to rehabilitation for older Australians with mental illness. Narrative review of literature and relevant public domain data supported by reflections on NSW service development. There is a paucity of high-quality evidence regarding mental health rehabilitation in older people. Available evidence supports integrating lessons from physical healthcare with adaptations of 'adult' mental health rehabilitation. Adaptation is required to respond to the specific needs, strengths and service use of older people with mental illness. Challenges for older people include ageism, increased physical and cognitive comorbidities, lower access to mental health services and earlier residential aged care entry. Strengths of older people include an ongoing desire for recovery, ongoing developmental change and often closer connections with carers and GPs. Evidence is consistent with evaluation of relevant NSW service models and initiatives including the Pathways to Community Living Initiative. Integration of recovery-oriented practice and wellness models may provide a framework for future innovative inpatient and community-based models. There is sufficient evidence to guide development of models of rehabilitation with older people, but innovation and evaluation are essential if older people are to have equal opportunities in their recovery journeys.

BackgroundFollowing the COVID-19 pandemic, millions of people continue to experience ongoing physical and mental health sequelae after recovery from acute infection. There is currently no specific treatment for the diverse symptoms associated with post-COVID-19 condition. Physical and mental health rehabilitation may help improve quality of life in such patients. This study reports the cost-effectiveness of a programme of physical and mental health rehabilitation compared to best practice usual care in people with post-COVID-19 condition who were previously hospitalised.MethodsWe conducted an economic evaluation within a randomised controlled trial from the perspective of the UK national health service (NHS) and personnel social services perspective (PSS). Resource used and health-related quality of life were collected using bespoke questionnaire and the EQ-5D-5 L questionnaire at three, six, and 12 months. Incremental costs and quality adjusted life years accrued over the follow-up period were estimated and reported as the incremental cost-effectiveness ratio. Estimate uncertainty was managed by multiple imputation and bootstrapping cost-effectiveness estimates; and displayed graphically on the cost-effectiveness plane.ResultsOver a 12-month time horizon, incremental costs and QALYs were £305 (95% CI: -123 to 732) and 0.026 (95% CI: -0.005 to 0.052) respectively. The ICER was £11,941 per QALY indicating cost-effective care. Sensitivity analyses supported the base case findings. The probability of the intervention being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 84%.ConclusionThe within-trial economic evaluation suggested that people with post-COVID-19 condition after hospitalisation should be offered a programme of physical and mental health rehabilitation as it likely reflects a cost-effective use of NHS resources. Hospitalisation for COVID-19 has become less commonplace: further evaluation in non-hospitalised patients may be worthwhile.Trial registrationISRCTN registry ISRCTN11466448 23rd November 2020.

The recent conference on psychiatric rehabilitation threw light on a host of issues, including the ‘rehabilitation needs of the country, cross-cultural perspectives on recovery and rehabilitation, legal issues pertinent to rehabilitation, role of families and communities, learning from other disabilities, geriatric perspectives, community based rehabilitation initiatives in psychiatric rehabilitation, so on and so forth. The event started with a discussion on rehabilitation needs in India and the cross cultural variations. The unmet rehabilitation needs in India with respect to severe mental illness needs more focus. NGO’s play an important role in mental health rehabilitation. It is also necessary to have a supportive legislative framework. Rehabilitation efforts could be outcome or process based focusing on ‘recovery’. It is essential to combine rehabilitation and treatment and stressed the need in training in rehabilitation. Rehabilitation goals can only be achieved by coordinated action among all stake holders including caregiver organizations, peer support groups, NGO’s and governmental agencies. It is important to develop culturally accepted rehabilitation services and models. Recovery is viewed differently across cultures and across lifespan of a person. Strategies useful to motivate a person from egocentric culture may not work in a person from sociocentric culture. Rehabilitation needs are also influenced by ethnicity, gender and urban/rural differences. Rehabilitation services have largely been confined to large mental hospitals. General hospital psychiatry units (GHPU’s) have difficulties in providing psychosocial services due to resource constraints. It is important to empower persons with psychiatric disability and utilize community resources. Focus on symptomatic remission rather than ‘recovery’ is unlikely to aid rehabilitation. A successful model of delivering palliative care clinic services using motivated volunteers was presented. The model has been tried in mentally ill patients. Each volunteer is assigned a patient with whom they work for empowerment and prevention of symptom relapse. There are various barriers to volunteeringlack of awareness about needs/opportunities; barriers to initiatinghow to start? barriers to continuelack of support. Volunteering can be encouraged by improving awareness, ensuring openness, using role models, recognizing their valuable work, and having mechanisms in place for networking and cross-volunteering. Community resources need to be tapped and utilized effectively to ensure community reintegration. Though community reintegration is ideal, we need half way homes and residential facilities for pragmatic reasons. Rehabilitation needs of geriatric patients is bound to increase as the population ages. Dementia has a significant impact on the individuals and their families. The families face a significant caregiver burden. There is a need to develop home based rehabilitation facilities which have been proved to be successful. As such, long-stay homes, nursing homes and day-care centres for geriatric patients are very few and far in number. There is still a very long way to go. The role of families in the care of patients with severe mental illness in the Indian setting is pivotal. It is important to involve family members in developing services and empower them. Family resilience, an inherent quality which involves open and honest communication, togetherness, sharing activities, affection, acceptance, and commitment needs to be nurtured through family interventions and social policy. The Role of mental health professionals is to identify C. Naveen Kumar (&) G. Desai A. Waghmare S. Thanapal Psychiatric Rehabilitation Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India e-mail: cnkumar1974@gmail.com

Keywords: Centers for Independent Living, mental health, psychiatric disabilities, physical disabilities, inter-system collaborationCenters for Independent Living (CILs) increasingly recognize the importance of providing effective services and supports to individuals with psychiatric disabilities. While those with psychiatric disabilities turn to their local CIL for the same types of assistance as do others, serving people with psychiatric disabilities may suggest the need for CIL staff to communicate and/or collaborate with their local mental health (MH) authorities, mental health clinical and rehabilitation providers, and/or mental health peer-run service programs. Productive contact across the CIL / MH divide, however, is often difficult, reflecting both mutual unfamiliarity and long-standing tensions. CILs are often unsure how much their staff should know about mental illness (that is, about symptoms, diagnosis, medication, treatment, and rehabilitation alternatives), how closely they should work with traditional mental health treatment and rehabilitation providers, and how to connect to the expanding network of mental health peer-run services and supports. This article reviews these questions in the context of the tension between the mental health and independent living paradigms, and provides initial recommendations for improved communication and collaboration across the IL/MH divide.

Purpose Criminogenic thinking refers to patterns of specific cognitive events associated with criminal behavior that facilitate the development and maintenance of patterned criminal behavior. Relatively little is known about the specific processes involved in the development of criminogenic thinking. Therefore, the purpose of this paper is to examine ego identity development and criminal associations as two possible predictors of criminogenic thinking. Design/methodology/approach Participants included 104 adult male state penitentiary inmates. Participants completed measures assessing ego identity status, criminogenic thinking, and the amount of time spent in the presence with other offers. Data were analyzed with a series of hierarchical regressions. Findings Results indicated that active engagement in the psychosocial process of identity development is associated with decreased criminogenic thinking. However, interaction with criminal associates and incarceration prior to the age of 18 were significant predictors of criminogenic thinking, regardless of identity development style. Implications for correctional mental health and offender rehabilitation are discussed. Originality/value As this is the first study of its’ kind and limitations are to be expected, there are several potential implications for correctional mental health and offender rehabilitation that are discussed.

BACKGROUND People suffering from chronic mental illness are sensitive to stressful stimuli, lack coping skills, and have low self-esteem due to problems such as social situations. They also experience depression, isolation, fear, and frustration. Due to cognitive dysfunction, people suffering from chronic mental illness have inadequate cognitive processes that lead to distorted thinking. AIM To confirm the effectiveness of cognitive rehabilitation therapy in improving cognitive function and alleviating behavioral and psychological symptoms in patients with chronic mental illness, and to identify the cognitive function that had the main effect. METHODS The quality of the studies was evaluated using the Assessment of Multiple Systematic Reviews criteria, and data published from 2011 to December 2022 were searched using PubMed, Cochrane, RISS, KISS, and DBpia. The keywords used in the search were “mental illness,” “cognitive rehabilitation,” “cognition,” and “mental.” A meta-analysis was conducted on the 12 selected papers. RESULTS The level of evidence for the 12 documents was that of a randomized experimental study. Intervention types in cognitive rehabilitation can be divided into cognitive behavior, cognitive training, cognitive rehabilitation, and computerized cognitive programs. Most of the studies were on schizophrenia, and the measurement areas were cognitive functions (e.g ., concentration, memory, and executive function) as well as depression, sociability, and quality of life. As a result of the meta-analysis of each variable, the effect size for cognitive rehabilitation treatment was in the following order: Sociability, memory, concentration, executive function, quality of life, and depression. Particularly, sociability and memory exhibited significant effects. CONCLUSION Cognitive rehabilitation aids cognitive function and sociability in patients with chronic mental illness and can be used as evidence for cognitive rehabilitation in mental health and occupational therapy.

Quality assessment of mental health rehabilitation services

There has been a resurgence of interest in mental health rehabilitation over the past decade, as it became increasingly clear that alternative services were not able to cater for the needs of patients with chronic and complex mental health issues. The study of a cohort of 80 clients was conducted in a 40-bed-inpatient rehabilitation unit retrospectively over a 1-year period, and aimed at describing the service-users’ characteristics, source of referrals and discharge destinations, along with examining the impact of an integrated medical model with psychosocial approach on Length of Stay (LOS); and investigating the sustenance of favorite outcomes over the 6-month period following discharge. Moreover, the quality of service provision on the unit was examined using QuIRC (Quality Indicator for Rehabilitative Care). The bio-psychosocial intervention model resulted in a significant reduction of LOS (p < .0001). The majority of patients were discharged to a less restrictive environment; revolving door admissions were significantly reduced, as well as the utilization of other psychiatric services (acute inpatient, p < .0001, short stay unit, p < .0001, and emergency room for mental health reasons p < .005). The quality of care provided was well above comparable average in some domains but slightly less in others. In the current climate of outcome driven services, we have demonstrated the effectiveness of an integrated model that appears to be prospectively sustainable. Investing resources and efforts on effective psychiatric rehabilitation programs for patients with enduring mental illness and complex needs, improves quality and economics that resonates throughout the wider scope of psychiatric services.

IntroductionThe National School for Training in Mental Health Rehabilitation and Recovery at the Ono academic college operates under the auspices of, and is funded by, the Division for Mental Health Rehabilitation of the Israeli Ministry of Health. Intended to hone the quality of services provided, it offers numerous training courses, that target various populations associated with and working in the field of mental health recovery, among them clients and their family members, as well rehabilitation professionals and support personnel. The novel course of trauma and posttraumatic growth (PTG) was developed and aimed at supporting recovery, coping strategies and ultimately PTG through the lenses of both recovery and trauma informed care for psychiatric and support personnel, professionals with lived experience, and family members. It is built of eleven six hours long sessions with lectures, in-vivo assignments, and group supervision.ObjectivesPortray the development, implementation, and outcomes of the course from psycho-educational, clinical, social, and personal perspectives of students as well as the course’s developers.MethodsA case study of the course that will be portrayed through qualitative anonymous testimonials from students’ surveys and assignments, as well as the analyses of processes that the course underwent through the years.ResultsThe course has several dimensions that allow the integration between trauma, recovery, and PTG in psychiatric rehabilitation: the integration between academia and research-based knowledge with experiential knowledge; integration between the perspectives of PTG and recovery; and, integration between social and cultural perspectives and person-centred care. In addition, the course promotes trauma-informed models in psychiatric rehabilitation; offers new perspective and implantation to psychiatric recovery-oriented tools so as to promote PTG; and enhances social support and cohesion within mental health services and personnel.ConclusionsThe current case study portrays the unique processes of knowledge development, implementation, and training in psychiatric rehabilitation personnel, supported staff and people with lived experience. The course brings a focus on PTG as a promising addition to the trauma-informed approach in psychiatric rehabilitation, which is only scarcely linked to recovery.Disclosure of InterestNone Declared

Interactional use of compliments in mental health rehabilitation

In many European countries, deinstitutionalisation has been an ongoing process over the last few decades. Mental health organisations were transformed to provide support in a more integrated and comprehensive manner, preferably in their own homes in the community. Yet, despite the welcome aspiration of community integration for all, people with complex mental health problems (also termed severe mental illness) have continued to require high levels of support, in inpatient settings and in the community. This group's needs make them highly dependent on their caregivers. The attitudes, knowledge and skills of the staff providing treatment and support is crucial to their recovery. Rehabilitation programmes provide a much-needed framework to guide practitioners and help them organise and focus their recovery-oriented approach. In this editorial, we will provide a non-exhaustive overview of such rehabilitation programmes and interventions to illuminate the wide scope and practical usability of these interventions for this group of people with complex mental health problems.

ObjectiveThe basic aim in this paper is to discuss health care professionals’ experiences of person-centered collaboration and involvement in mental health rehabilitation and suggest ways of improving this perspective. Furthermore, the paper explains the supportive systems that are at work throughout the process of rehabilitation.MethodThe study design is a qualitative approach using three focus group interviews with a total of 17 informants with different professional backgrounds such as nurses, social workers, and social pedagogies. In addition, one nurse and one social worker participated in a semi-structured in-depth interview to judge validity.ResultsOur results may demonstrate deficits concerning mental health care on several levels. This understanding suggests firstly, that a person-centered perspective and involvement still are uncommon. Secondly, multidisciplinary work seems uncommon and only sporadically follows recommendations. Thirdly, family support is seldom involved. Lastly, firm leadership and knowledge about laws and regulations seems not to be systematically integrated in daily care.ConclusionTaking these matters together, the improvement of a person-centered perspective implies cooperation between different services and levels in mental health care. In order to bring about improvement the health care workers must critically consider their own culture, coordination of competence must be increased, and leadership at an institutional and organizational level must be improved so that scarce rehabilitation resources are used to the optimal benefit of people with a mental illness.

Current health policy assumes better quality services lead to better outcomes. To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.