PSYCHIATRIC

REHABILITATION
Group C

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Definition
◉ Psychiatric rehabilitation:
◎ An aspect of treatment that focuses on helping the person return to
an optimal level of functioning and to achieve their life goals.
◎ This is brought about by providing medical, psychological and
social input.
◎ There is no strict boundary between treatment and rehabilitation.
◉ Aims of psychiatric rehabilitation:
◎ To help the patient develop the social and intellectual skills that
they will need to integrate with mainstream society.
◉ The rehabilitation process focuses on;
◎ Assessing what the person is capable of their skills, strengths and
abilities 2
◎ Accepting the limitations caused by the illness
Principles
◉ Enabling a normal life.
◉ Advocating structural changes for improved accessibility to pharmacological
services and availability of psycho-social services.
◉ Person-centered treatment.
◉ Actively involving support systems.
◉ Coordination of efficient services.
◉ Strength-based approach.
◉ Rehabilitation isn't time specific but goal specific in succeeding.

Liberman, R.P. (2008). "Principles and Practice of Psychiatric Rehabilitation". Recovery from Disability: Manual of Psychiatric
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Rehabilitation. Washington, DC: American Psychiatric Publishing. ISBN 978-1-58562-205-4. OCLC 672234137.
Principles
◉ Principle 1: Psychiatric rehabilitation practitioners convey hope and respect, and believe that
all individuals have the capacity for learning and growth.
◉ Principle 2: Psychiatric rehabilitation practitioners recognize that culture is central to recovery,
and strive to ensure that all services are culturally relevant to individuals receiving services.
◉ Principle 3: Psychiatric rehabilitation practitioners engage in the processes of informed and
shared decision‐making and facilitate partnerships with other persons identified by the
individual receiving services.
◉ Principle 4: Psychiatric rehabilitation practices build on the strengths and capabilities of
individuals.
◉ Principle 5: Psychiatric rehabilitation practices are person‐centered; they are designed to
address the unique needs of individuals, consistent with their values, hopes and aspirations.

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◉ Principle 6: Psychiatric rehabilitation practices support full integration of people in recovery
into their communities where they can exercise their rights of citizenship, as well as to
accept the responsibilities and explore the opportunities that come with being a member of
a community and a larger society.
◉ Principle 7: Psychiatric rehabilitation practices promote self‐determination and
empowerment. All individuals have the right to make their own decisions, including
decisions about the types of services and supports they receive.
◉ Principle 8: Psychiatric rehabilitation practices facilitate the development of personal
support networks by utilizing natural supports within communities, peer support initiatives,
and self‐ and mutual‐help groups.
◉ Principle 9: Psychiatric rehabilitation practices strive to help individuals improve the quality
of all aspects of their lives; including social, occupational, educational, residential,
intellectual, spiritual and financial.

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◉ Principle 10: Psychiatric rehabilitation practices promote health and wellness, encouraging
individuals to develop and use individualized wellness plans.
◉ Principle 11: Psychiatric rehabilitation services emphasize evidence‐based, promising, and
emerging best practices that produce outcomes congruent with personal recovery. Programs
include structured program evaluation and quality improvement mechanisms that actively
involve persons receiving services.
◉ Principle 12: Psychiatric rehabilitation services must be readily accessible to all individuals
whenever they need them. These services also should be well coordinated and integrated with
other psychiatric, medical, and holistic treatments and practices.

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Types of psychiatric rehabilitation activities
1. Psychosocial rehabilitation centres
2. Work skills training / vocational rehabilitation
3. Social skills training
4. Cognitive remediation therapy
5. Psychoeducation
6. Family support group

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1. Psychosocial Rehabilitation Centres

- Psychosocial rehabilitation is a process that facilitates the opportunity

of individuals who are impaired, disabled by mental disorder to reach
their optimal level of independent functioning in community

- Goal:
To help individuals with persistent and serious mental illness to
develop emotional, social and intellectual skills needed to live,
learn and work in community with least amount of professional
support

http://www.psychosocial.com/IJPR_10/Common_Problems_in_PSR_Sheth.html
 INDIVIDUALISED REHABILITATION PLAN is
developed- as a collaborative strategy
between:
- patient and family
- case manager
- consultant
. The team then offers a comprehensive
treatment through a variety of
interventions tailored to meet the
individual needs of our patients and their
families.

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http://www.scarfindia.org/psychosocial-rehabilitation/
- MENTARI is community based service which a new approach initiated by
the Ministry of Health Malaysia (MOH) to improve outreach and
re-integration of people with mental health problems. It provides
psychosocial interventions including counselling, psychotherapies and
psychoeducation
- Eve psychosocial rehabilitation centre help mental health patients recover and integrate
with society. The services include managing symptoms, strengthening self care skills
providing psychosocial treatment and help intergrating back to society

https://www.mhinnovation.net/organisations/mentari-malaysia

https://evecentre.com.my
2. Work skills training / vocational rehabilitation (VR) (1/2)
◉ VR is a process that a disabled individual goes through in order
to gain, maintain, or return to employment.
◉ Training is provided to patients through a centralised farm ward
system under the supervision of nursing and paramedic staffs:
◎ 1st type: patients need full-time supervision.
◎ 2nd type: semi-supervised, where a nursing counter is
placed between the facilities.
◎ 3rd type: built in an apartment style, patients are capable of
independent-living → receive support to obtain employment
outside the institution. 11
Getting a second chance at life, https://www.nst.com.my/news/nation/2017/07/262157/getting-second-chance-life
https://www.vocationaltraininghq.com/vocational-rehabilitation/#What_Is_Vocational_Rehabilitation
2. Work skills training / vocational rehabilitation (VR) (2/2)
◉ Training workshop:
◎ Follow a set of routines, eg: waking up in the morning,
brushing teeth and getting dressed on their own.
◎ Simple tasks: putting beads into a string in a certain colour,
handicraft, cooking, packing food, washing cars and etc.
◎ Working in fruit orchards, freshwater fish ponds and poultry
farms → sell at daily market.
◉ Job placement programme - identifies patients who need help
getting employment by finding jobs to match their skills and
contacting employers. 12
A patient hired to complete handicraft A patient working at the car wash at
products at Hospital Bahagia Ulu Kinta, Hospital Bahagia Ulu Kinta, Ipoh.
Ipoh

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A patient working at a farm ward.
 3. Social skills training (1 /4 )
Social skills is important in recovery process.
Social dysfunction is a defining characteristic of schizophrenia based on DSM-5
Social skills include:
● Verbal – such as the form, structure, content, context and amount of speech
● Nonverbal – Eye contact, facial expressions, posture and personal distance
● Paralinguistic – Volume, pace, tone and pitch
● Social perception – processing of social information to make appropriate decisions and
responses
● Assertiveness
● Conversational skills – such as starting and sustaining a conversation
● Expressions of empathy, affection, sadness, and similar emotions that are appropriate to the
context and expectations of the society
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https://www.whiteswanfoundation.org/article/social-skills-training-for-persons-with-mental-illness/
 3. Social skills training (2 /4 )
Social competence is based on 3 component skills :
1. Social perception / Receiving skills
2. Social cognition / Processing skills
3. Behavioral responses / Expressive skills

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Kaplan & Sadock's Synopsis of Psychiatry 11th edition (2015) by Benjamin J. Sadock, Pedro
Ruiz, Virginia A. Sadock. Walters Kluwer.
 3. Social skills training (3 /4 )
Expressive Behaviors ● Speech content
● Paralinguistic feature
● Voice volume
● Speech rate
● Pitch
● Intonation

Receptive Skills ● Attention to and interpretation of relevant cues

● Emotion recognition

Processing Skills ● Analysis of situation demands

● Incorporation of relevant contextual information
● Social problem
16 solving

Kaplan & Sadock's Synopsis of Psychiatry 11th edition (2015) by Benjamin J. Sadock, Pedro
Ruiz, Virginia A. Sadock. Walters Kluwer.
 3. Social skills training (4 /4 )
There are 4 major goals of social skills training :
1. Improved social skills in specific situations
2. Moderate generalization of acquired skills to similar situations
3. Acquisition or relearning of social and conversational skills
4. Decreased social anxiety

17

Kaplan & Sadock's Synopsis of Psychiatry 11th edition (2015) by Benjamin J. Sadock, Pedro
Ruiz, Virginia A. Sadock. Walters Kluwer.
4. Cognitive Remediation Therapy (1/3)

◉ Aim: to reduce cognitive deficits.

◉ Cognitive deficits:
a. Attention
b. Memory
c. Language
d. Executive functions
e. Social cognition
f. Metacognition

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https://www.hindawi.com/journals/isrn/2013/984932/
http://www.cognitive-remediation.com
4. Cognitive Remediation Therapy (2/3)
1. Approaches/techniques:
◎ Rehearsal learning/ drill and practice
◎ Strategy coaching
2. Methods:
◎ Clinician-administered CRT
◎ Computerised CRT
3. Computerised CRT is more commonly utilised nowadays as it is
standardised, more efficient and requires less staff.
4. The CRT programs resembles recreational computer games.

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https://www.hindawi.com/journals/isrn/2013/984932/
http://www.cognitive-remediation.com
4. Cognitive Remediation Therapy (3/3)
1. CRT is only viable to clinically stable patients.
2. Patients need to be able to concentrate and cooperate
during the therapy.
3. Before CRT, patients’ cognitive status must be accurately
assessed.
4. Cognitive remediation therapy (CRT) is a complementary
treatment.
5. CRT with psychotherapy or psychiatric rehabilitation is
more effective in improving real-world outcomes.

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https://www.hindawi.com/journals/isrn/2013/984932/
http://www.cognitive-remediation.com
5. Psychoeducation (1/3)
1. Psychoeducation is education about a certain situation
or condition that causes psychological stress.

2. Psychoeducation refers to the process of providing

education and information to those seeking or receiving
mental health services, such as people diagnosed with
mental health conditions and their family members.

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https://www.myvmc.com/treatments/psychoeducation/
5. Psychoeducation (2/3)
3. Once a person better understands a condition they feel more in control
of the situation and this in turn reduces the stress associated with it.
Thus it give the person suffering from the psychological condition a
better road map towards functioning in an optimal way without being
too impeded by their condition.

4. offers those individuals involved in a person’s care information on both

how to offer support and how to maintain their own emotional health
and overall well-being and provides them with the opportunity to
develop a thorough understanding of the mental health concern(s)
affecting their loved one.
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https://www.myvmc.com/treatments/psychoeducation/
5. Psychoeducation (3/3)
Goals

◉ Giving Information
◉ Release emotion/ stress
◉ Supporting Medication Treatments
◉ Teaching You To Help Yourself

Format Of Psychoeducation - depends entirely on the disorder, the developmental age of the
individual and their individual needs.

Psychoeducational can be group-based, family-based, parent-based or individually

implemented.

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https://www.myvmc.com/treatments/psychoeducation/
6. Family Support Group
FAMILY THERAPY
‘Family system orientation’ theory - The family becomes the patient.

The family systems theory proposes that a family is an interdependent, dynamic

system in which family members’ experiences are interrelated and can mutually
influence each other (Cox & Paley, 2003).

A family therapists’ goals

1. Determine role of patient is serving in family system
2. Help a family understand the crucial function of patient in maintaining the
family’s homeostasis
3. Increase awareness of cross-generational dynamics
4. Decrease blaming and scapegoating
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Cox, M. J., & Paley, B. (2003). Understanding families as systems. Current Directions in Psychological Science, 12, 193-196. doi:
10.1111/1467-8721.01259
 1. Systemic family therapy is concerned with the present functioning of the family,
rather than with members’ past experiences.
2. Eclectic family therapy focuses the present situation of the family and how the
members communicate with one another.

1. How does the family function?

● structure recorded in the genogram (e.g. single parent, a step-parent,)
● changes and events (e.g. births, deaths, departures, and financial problems)
●relationships (e.g. close, distant, loving, conflictual, etc.)
● patterns of interaction involving two or more people (e.g. a child who sides with one
parent against the other).
2. Are family factors involved in the patient’s problems? The family may be:
● reacting to the patient’s problems (note that there may be other, unrelated, problems)
● supporting the patient
● contributing to the patient’s problems (e.g. the problems of a daughter who cannot leave
her lonely mother).
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Shorter Oxford Textbook of Psychiatry. 7th edition

In schizophrenic patient;
Family therapy techniques can significantly decrease relapse
rates.
Multiple family groups, in which family with schizophrenic
patients discuss and share issues, have been particularly
helpful

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Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry. 6th edition

THANK YOU

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