Psychosocial Rehabilitation. Presenter : Vikash Ranjan Sharma Mentor: Dr.Triptish Bhatia

Transcription

1 Psychosocial Rehabilitation Presenter : Vikash Ranjan Sharma Mentor: Dr.Triptish Bhatia

2 Definition A comprehensive process that offers the opportunity for individuals who are impaired, disabled or handicapped by a mental disorder to reach their optimal level of independent functioning in the community. WHO,1995 Rehabilitation refers to a process aimed at enabling persons with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychiatric or social functional levels. RCI, ACT 1992

3 Terms To Know: Impairment Any loss or abnormality of psychological, physiological, or anatomical structure or function. e.g: Hallucination, Delusion, Depression

4 Cont. Disability Any restriction or lack of ability to perform an activity and / or role in the manner or within the range considered normal for a human being ( resulting from an impairment ). e.g : Lack of work adjustment skills,social Skills or Activities of daily living Skills,which restricts one s residential, education, vocational and social roles.

5 Cont. Disadvantage/Handicap A lack of opportunity for a given individual that limits or prevents the fulfillment of a role that is normal (depending on age, sex, social, or cultural factors) for that individual (resulting from an impairment and / or a disability ). e.g. : Discrimination and poverty, which contribute to unemployment and homelessness. ( Anthony, Cohen & Farkas ;1990)

6 Goals ofrehabilitation Improve individual competencies Introduce environmental change (Wallace,1986)

7 Phases of Rehabilitation Assessment of the individual competencies. Identification of the environmental demands and support Planning of rehabilitation where priorities are set, depending on the needs, client motivation, likeli hood of achieving the goals, and effectiveness of the intervention procedures Implementation of treatment methods that will improve competencies, reduce demands and increase supports

8 Assessment Dever Community Mental Health Questionnaire (Ciaro & Rehman,1977), Social Stress & Functioning Inventory for Psychotic Disorder (Serban,1978 ), Rehabilitation Evaluation of Barker & Hall, 1983, Life Skill Assessment ( Farkas, Rogers &Thyrer, 1985 ) WHO Disability Assessment Schedule II (2001) Indian Disability Evaluation & Assessment Scale (IDEAS), IPS,2002

9 IDEAS Schizophrenia, Bipolar Disorder, Dementia, O.C.D Duration; 2yrs Administered only on Primary Care Givers Diagnosis; ICD-10 or DSM IV Re-certification; after every 2 yrs Items: Self-care, Interpersonal Activities (Social Relationships),Communication and Understanding and Work- Performing in work/job/housework/school/college

10 Cont. Score for each items: 0- No,1- Mild, 2- Moderate,3- Severe, 4- Profound Total Score Range ; 0-20 MI 2Y:< 6 months : score to be added is months : add months :add 3 >18 months :add 4 Global Disability Score: Total Disability+MI2Y score For the purpose of welfare benefits, 40% will be the cutoff point.

11 Behavioral Assessment Behavioral assessment; Excessive, Deficits and Assets behavior Antecedent, Behavior, Consequences (A-B-C) Motivational Analysis ; material, activity and social reinforcement Developmental analysis Analysis of self-help Analysis of social relationships Analysis of socio-cultural environment

12 Types of Rehabilitation in Psychiatry Medical involving restoration of function Vocational - capacity to earn a livelihood Social restoration of family & social relationship Psychosocial restoration of personal dignity & confidence Cognitive restoration of cognitive function

13 Primary Focus of Mental Health Services Impact of severe mental illness Mental health services & outcome Impairment (Symptoms) Disability (Role dysfunction) Disadvantage (Limited opportunity) Treatment (Symptom Relief) Crisis Intervention (safety) Case Management Rehabilitation (Role functioning) Enrichment (self development) Rights protection (Equal opportunity) Basic Support (Survival) Self help (Empowerment) Kennard et.al. (1992)

14 Social Skill Training (SST) Modules, Liberman et.al.,1988 Basic SST Model- via active-directive teaching of target behavior, through - role-plays & behavioral rehearsal (Eckman et al,1992)

15 SST-Medication Management Information about antipsychotic medication Process to self-administration of medication & evaluation Identification of side-effects & distinguishing between benign & serious ones Information about negotiating with health care previous, and Benefits of using long-acting depot neuroleptic agents Eckman et al, 1992

16 SST-Symptom Management Identify the warning signs of relapse, Intervene early when symptoms appear, Cope with persistent psychotic symptoms & Avoid alcohol or drugs abuse

17 SST-Other Modules Recreation for leisure Job finding Social- problem solving Community re-entry Grooming and self-care Basic conversational skills

18 SST Techniques Role-playing Modeling Feedback Attention focusing procedure Positive reinforcement Problem solving techniques (PST) etc. Liberman et al,

19 Methods to Enhance Skills Basic Living/Personal Hygiene Skills ; Brushing, Bathing, Dressing, Grooming (hair & nail), Eating Independent Living Skills ; Basic House Keeping, Money Management, Traveling, Leisure time activity Conversational Skills Social Skills Work Behavior Skills

20 Other Intervention Strategies Supportive Counseling Activity Scheduling Recreation therapy Vocational Training and Job Placement Psycho-education for Care-givers

21 Facilities for the Mentally Disabled A- Residential Facilities Hospital Half way Homes Foster Homes Hostels Long-term Facilities

22 Cont. B- Non-Residential Facilities Day-hospitals Day care center Sheltered workshop Vocational Rehabilitation Centers (VRCs)

23 Legal Issues Incorrect psychosocial rehabilitation diagnosis of a client, leading to improper service placement Improper work supervision, exposing the client to possible work risks Failure of staff to monitor psychiatric care or prevent adverse psychotropic drug side effects due to lack of intercommunication between mental health care agencies involved in the treatment and rehabilitation of the client. Madianos M.,2006

24 Ethical Issues: The ethical codes could be broken When the staff member disrespects the patient s autonomy with the development of paternalistic behavior. Decision making by the client and freedom of programme s choice, are fundamentals of the ethical principle of autonomy. If there is a breach of confidentiality e.g. reporting patient s diagnosis of treatment details to a possible employer and when therapeutic work procedures are videotaped or recorded for education or research purposes, without a previous written informed consent, by the rehabilitation service clients. Another important ethical issue is the challenge by the staff the client s system of cultural values and beliefs, when these are involved in the rehabilitation process. Madianos M.,2006

25 Thank you