Psychiatric Rehaiblititation

## **History**

The deinstitutionalization of mental health patients was a big shift for the United States. This began in the 1950’s with large numbers of patients from state hospitals being discharged into the community. Many of these patients were diagnosed with severe mental illnesses such as major depression, schizophrenia, and bipolar disorder. These patients were transferred into the community with limited skills, only given their prescriptions for medication. As this occurred, there was a rise in community mental health to make sure these people clients would be able to get the services they would need. The surge in community mental health led to the rise of many services to help patients in this category.

One of the treatments that arose was Psychiatric Rehabilitation. It emerged in the 1970s and 1980s as a field of practice and study in response to deinstitutionalization. Psychiatric rehabilitation aimed to help individuals who were deinstitutionalized integrate into the community and learn independence skills. In the late 1980s and early 1990s, professors from Boston University and Syracuse University led education and research in psychiatric rehabilitation.

## **Psychiatric Rehabilitation**

Psychiatric rehabilitation is a field of academic study that focuses on helping consumers get back to an optimal level of functioning and helping them achieve their life goals. It promotes recovery, full community integration, and improved quality of life for persons who have been diagnosed with any mental health condition that seriously impairs their ability to lead meaningful lives. It focuses on the service utilized by individuals with long-term psychiatric disabilities, such as depression, bipolar disorder, schizophrenia, and other severe mental challenges.

Psychiatric rehabilitation services are person-directed, collaborative, and individualized. The services are focused on developing skills and accessing the resources needed to increase their capacity to be successful and satisfied in the living, working, and social environments of their choice. In this service, Psych Rehab staff helps participants set specific goals for themselves, and achieving those goals through teaching, coaching, and planning.

## **The Process**

The psychiatric rehabilitation process helps people to choose their goals and then get the necessary skills and supports they need to reach their goals. Next, they are helped with identifying what they need to do or what they can do well and what they have or need in order to achieve their goals. This means examining their skills, supports, and the resources around them. They then learn how to develop those skills and/or supports they need to reach their goals.

The most common model used in psychiatric rehabilitation is the Choose-Get-Keep process. This process helps clients choose their goals, get or achieve their goals, and/or keep their goals. Research about psychiatric rehabilitation shows that a person’s self-determined goals and the presence of skills and supports necessary to reach those goals relates most strongly to rehabilitation outcomes.

## **Principles**

Psychiatric rehabilitation includes a few core goals. These goals include helping people feel hopeful, empowered, skilled, and supported:

* Hopeful: People can feel demoralized due to their condition; rehabilitation focuses on helping clients feel hopeful about the future
* Empowered: Individuals show feel power and autonomy as they set their own goals and are able to pursue them
* Skilled: Teaching people skills to manage their condition and live the life they want is the aim of rehabilitation.
* Supported: People should be offed support by to build relationships and connections in the community

The Key principles that guide how professionals working in psychiatric rehabilitation include:

* Everyone has potential that can be developed
* Everyone has a right to self-determination
* The emphasis should be on strengths instead of symptoms
* Everyone’s needs are different
* Services should occur in as normal of an environment as possible
* There is a focus on the present and not the past

## **Boston University**

In 1979, Boston University opened the Center for Psychiatric Rehabilitation. The purpose of the center was to bring rehabilitation concepts and practices from other areas of disability services to individuals with psychiatric conditions. The school received their funding from the National Institute of Handicapped Research for research and training in psychiatric rehabilitation. In the 1980s, the center developed curricula and helped solidify the values, principles, and practices of psychiatric rehabilitation. They also partnered with the International Association of Psychiatric rehabilitation Services (later changed to Psychiatric Rehabilitation Association) to produce and manage the Psychiatric Rehabilitation Journal. The center also created the first model of supported education and developed the Recovery Education Program.

In the 1990s, the center developed and implemented training-consultation programs in psychiatric rehabilitation. The center was notable for its use of the “Choose-Get-Keep” model and was using this their work. In the 2000s, the center expanded its recovery-focused research to examine vocational recovery, spirituality, and recovery-promoting competences. They were studying this to attempt to create services to address psychical well-being.

## **Choose-Get-Keep Process Model**

A common model used in psychiatric rehabilitation sit he Choose-Get-Keep process model. This model was developed at the Center for Psychiatric Rehabilitation at Boston University. This process occurs as practitioner’s diagnoses, plan, and interview to help individuals with psychiatric disabilities develop the skills and supports needed to be successful and satisfied in their chose roles or environments. This model focuses on facilitation a specific practitioner and client process to guide the client to choose, get, and keep a rehabilitation goal.

The choose-get-keep process model has essential ingredients that have been identified in through research.  The elements of this model are focused on the rehabilitation mission, the planning process of rehabilitation, the intervention process, the rehabilitation environment. The client has an opportunity to think about the ingredients of these elements (such as assessing priorities, defining goals, and establishing a network) and continue choose, get, and keep his goals.

## **Psychiatric Rehabilitation Association**

The Psychiatric Rehabilitation Association (PRA) is the preeminent association for the development, support, and dissemination of information about the practice of psychiatric rehabilitation and recovery. In the Early 1970s directors of the original Psychosocial Rehabilitation Centers met to talk about establishing an association to help advance the practice of psychiatric/psychosocial rehabilitation services (PSR). The group of 13 directors wanted to make an international association that would promote optimistic strengths-based and community-based services for people with persistent and severe mental illnesses. In 1974, the International Association of Psychosocial Rehabilitation Services (IAPSRS) was incorporated as a nonprofit association.

In 1982, the IAPSRS and the Center for Psychiatric Rehabilitation at Boston University entered a partnership to co-publish the Psychiatric Rehabilitation Journal. This gave researchers a platform to publish findings and build an evidence base for psychiatric rehabilitation practices. This helped with continuing to spread the word about the outcomes being achieved. At this time, universities were also beginning to integrate rehabilitation principles into their curricula.

As methods of psychosocial rehabilitation were starting to be applied in other mental health settings and validated by research institutions, standards of best practice emerged. The IAPSRS worked with mental health professionals who were early integrators of these methods as they developed these standards. They were able to collectively develop a code of ethics, recovery language guidelines, and core principles and values for psychiatric rehabilitation. Putting this in place solidified psychiatric rehabilitation as an integral community-based treatment.

An increase in practitioners using Psychiatric Rehabilitation occurred as the practices were used in multiple settings. This led to an increased number of self-identified practitioners claiming to use Psychiatric Rehabilitation. At this time, there was a rich tradition of mentoring and agency training in the field. To ensure the quality and effectiveness of rehabilitation practitioners, a Registry of Registry of Psychiatric Rehabilitation Practitioners was established. This would later be followed by the Certified Psychiatric Rehabilitation Practitioner (CPRP) credential which is used now.

As Psychiatric Rehabilitation took hold in Canada, it became evident that Canada would need a separate national entity to help with funding. In 2004, the IAPSPS changed its name to the United States Psychiatric Rehabilitation Association (USPRA) and the Psychosocial Rehabilitation Canada/Réadaptation Psychosociale Canada (PSR/RPS Canada) was formed.

In 2013, the association became the Psychiatric Rehabilitation Association (PRS) to remove the geographic limits from the organization. This was associated with the organization’s meeting to helping the recovery workforce work grow and train. The organization believed this name change would ensure ongoing quality and investment in an expanding credentialing program to help seize a leadership role in the provision of career-spanning education and training offerings. Currently, the PRA is meeting this goal. They are the largest psychiatric rehabilitation organization.

## References

1. ↑ Anthony, W. A., & Farkas, M. D. (2009). A Primer on the Psychiatric Rehabilitation Process. Center for Psychiatric Rehabilitation.
2. ↑ 2.0 2.1 2.2 Cherry, K. (2020, April 28). *What is Psychosocial Rehabilitation?* Verywell Mind. https://www.verywellmind.com/psychosocial-rehabilitation-4589796
3. ↑ White Swan Foundation. (2015, June 30). *What is psychiatric rehabilitation?*https://www.whiteswanfoundation.org/mental-health-matters/understanding-mental-health/what-is-psychiatric-rehabilitation
4. ↑ *All about psych rehab*. (n.d.). Skills of Central PA. https://www.skillsofcentralpa.org/everything-about-psych-rehab/
5. ↑ 5.0 5.1 5.2 *History*. (2021, January 13). Boston University Center for Psychiatric Rehabilitation. https://cpr.bu.edu/about/history/
6. ↑ 6.0 6.1 Rogers, E. S., Anthony, W. A., Farkas, M. (2006). The Choose-Get-Keep Model of Psychiatric Rehabilitation: A Synopsis of Recent Studies. Rehabilitation Psychology, 51(3), 247-256.
7. ↑ 7.0 7.1 7.2 *Our history*. Our History | PRA - Psychiatric Rehabilitation Association. (n.d.). from https://www.psychrehabassociation.org/about/who-we-are/our-history#:~:text=Founded%20In%201975%2C%20the%20Psychiatric,and%20leading%20the%20recovery%20movement.