Psychiatric Rehabilitation: An Empowerment-Based Approach to Mental Health Services

********** As services to people with serious mental illness have moved to the community over the past 40 years, social workers have expanded their roles in the field of mental health (Vourlekis, Edinburg, & Knee, 1998). Social workers are now the major providers of mental health services in the United States (Substance Abuse and Mental Health Services Administration [SAMHSA], 1999). More social workers are employed by community support programs for people with mental illness than any other profession (Rapp, Shera, & Kisthardt, 1993). At the same time, advances in research-based knowledge about serious mental illness have resulted in improved and radically different treatment models (Nathan & Gorman, 1998). Research on the brain has provided better knowledge of the symptoms and characteristics of psychiatric disorders, allowing for more accurate diagnosis. New psychotropic drugs provide better symptom control without the devastating side effects of previous medications. With better control of symptoms, people with serious mental illness are able to participate fully in life--as workers, spouses or partners, parents, and community members--and are demanding the services that allow them to do so. Innovative treatment and vocational programs, designed to promote recovery and using principles of psychiatric rehabilitation, help people with serious mental illness develop meaningful relationships, participate in employment or vocational interests, and live successfully in the community. Social workers must become familiar with recovery-oriented psychiatric rehabilitation principles, because this method is encouraged by funding sources and demanded by consumers. Contemporary social workers, educated with an empowerment perspective, will find recovery-based psychiatric rehabilitation programs consistent with social work values and practice models. Despite its well-established inclusion in community mental health treatment programs and the extensive involvement of practicing social workers in its early development (Pratt, Gill, Barrett, & Roberts, 1999; Rubin, 1996), psychiatric rehabilitation has received little attention in the discipline-specific social work literature. The only article discussing the interface between social work and psychiatric rehabilitation was published over a decade ago (Peterson, Patrick, & Rissmeyer, 1990). Even at that time, Peterson and colleagues expressed concern that psychiatric rehabilitation had "not been widely articulated in the social work literature" (p. 468). Since then, only a few social work doctoral dissertations and articles use the terminology of psychiatric rehabilitation, and these focus on very specific areas of service. It is important to note that social workers have made strong contributions to the development of research-based knowledge that can be viewed in a psychiatric rehabilitation framework. Among these are Mowbray and colleagues' work on supported education (for example, Mowbray, 1999) and on the life domain of parenting (for example, Mowbray, Schwartz, & Oyserman, 2000); Hogarty, Anderson, and colleagues' long-term work on interdisciplinary research teams on family psychoeducation and skills training in schizophrenia (for example, Hogarty, Anderson, & Reiss, 1991); Test and colleagues' work on assertive community treatment (for example, Test & Stein, 2000); and Solomon and colleagues' work on case management (for example, Solomon & Draine, 1996a, 1996b). However, publications describing this research have appeared primarily in interdisciplinary journals. There is still a significant lack of literature on this topic in peer-reviewed social work journals. One area of psychiatric rehabilitation-related social work literature that has seen a modest increase since Peterson et al.'s 1990 article is in books, primarily used as texts in social work education. Some examples of psychiatric rehabilitation-related books and book chapters are Moxley's (1997) chapter on clinical social work in psychiatric rehabilitation, which appeared in Brandell's Theory and Practice in Clinical Social Work; several chapters in Williams and Eli's (1998) Advances in Mental Health Research; Rapp's (1998) The Strengths Model: Case Management with People Suffering from Severe and Persistent Mental Illness; and Jackson's (2001) recent use of the clubhouse model to illustrate a wide range of generalist social work values, theory, and skills. …