Mental Illness and Psychosocial Rehabilitation Explained.

Content

Introduction
Mental Illness and Disability
Clinical Characteristics of Psychiatric disability
Prominent Severe Mental Illness

Chronic Schizophrenia
Bipolar Affective Disorder

Psychological Rehabilitation
Goals
Values
Overarching Principles
The psychiatrist's social worker's role in a multidisciplinary team.

Introduction

In the domain of disability, mental illness is not a new concept. A person suffering from a severe mental disorder is frequently unable to conduct even everyday regular duties. Along with medical treatment, psychosocial rehabilitation is an effective way to overcome this illness. Psychosocial rehabilitation is the process of restoring a person's social functioning and wellbeing after suffering from a mental disease. This module goes to great length about mental illness and the disabilities that might result from it. Participation of the community is required for the effectiveness of psychosocial rehabilitation. The student will also comprehend how the family and the community can assist the person suffering from mental illness. The module will conclude by discussing the roles of the social worker, counselor, and family therapist in the treatment of mental illness.

Mental Illness and Disability:

The Persons with Disabilities (Equal Opportunities, Protection of Rights, and Full Participation) Act of 1995 expanded the term of disability to include "mental disorders." The Act defines mental illness as any mental disease other than mental retardation. Mental illness is a broad phrase that refers to a variety of mental and emotional problems. Mental diseases that result in disability are long-term and chronic in nature. Chronic schizophrenia, long-standing bipolar illness, persistent depression, delusional disorder, and dementia are now classified as severe mental illnesses that necessitate psychosocial rehabilitation.

Disability caused by serious mental disease is frequently referred to as psychiatric disability. This handicap is described as a significant restriction in the main life activity (Liberman, 1998). According to the World Health Organization (WHO), this handicap is defined as the inability to participate or perform at a socially desirable level in activities such as self-care, social relationships, work, and situationally appropriate behavior.

Clinical Characteristics of Psychiatric Disability:

Severely mentally ill people differ widely in many ways depending on age, gender, education, career, income, socio-cultural background, diagnosis, and other factors. They do, however, share a number of characteristics. These common characteristics, which are typically observed in people suffering from severe mental illness, are classified as handicapping factors into three categories: intrinsic, extrinsic, and secondary variables.

1-Intrinsic or primary causes include persistent mental symptoms that are parts of the illness itself, such as thinking disorder, delusions, and psychomotor slowness.

One-third to two-thirds of chronic schizophrenia patients who are discharged are seriously impaired by psychiatric symptoms.

2-Extrinsic elements include pre-morbid handicaps such as a lack of social or vocational skills, as well as intellectual or physical disability. Several studies have found that 20 to 50% of people with severe mental illnesses have no acquaintances, and only a small percentage are involved in the community. Those who are married and working, or who have a lively social life, are far less likely to enter the ranks of those suffering from severe mental illness. Even when they do fall into this category, they tend to perform better than those who are unmarried, unemployed, or socially isolated.

3-Secondary factors, which include loss of self-esteem, low self-confidence, helplessness, and inactivity, are maladaptive reactions to the illness rather than being part of the illness itself.

Prominent Severe Mental Illnesses:

1-Chronic Schizophrenia:

Two major severe mental disorders, chronic schizophrenia, and bipolar affective disorder are particularly prevalent and are addressed in the psychosocial rehabilitation of the severely mentally ill. The following are the clinical characteristics of chronic schizophrenia or persistent schizophrenic illness:

A chronically deteriorating course;
Disorganized behavior such as violence, inappropriate effect, self-neglect, wandering, and thought disorder.

In terms of management, schizophrenia symptoms are divided into two categories. There are both good and negative symptoms. Positive signs indicate an overabundance or distortion of typical functions Positive symptoms are easier to manage and less disabling than negative symptoms.

2-Bipolar Affective Disorder:

Bipolar Affective Personality Disorder (BAPD) frequently manifests as episodes with intervals of normalcy and improvement in between. Furthermore, the sufferer is affected by cyclic episodes of mania and sadness. Mania is characterized by elation-euphoria, excessive activity, grandiosity, a reduced need for sleep, and interfering behavior. Depressed mood, psychomotor slowness, hopelessness, lack of energy, and decreased food and sleep are all symptMild symptoms, irritation, mood changes, and psychosocial dysfunction have been observed throughout the intervening times.

A typical severely mentally ill individual could be assumed to have coms of depression.

Diagnosis of schizophrenia or significant affective psychosis;
At least two admissions in the previous year or six months; and
Significant functional impairments in at least two of the following areas:

Basic literacy, self-care, f
financial assistance (including money management),
housing (poor quality or unstable),
lack of social support,
lack of occupation or employment, and difficulties with interpersonal relationships are all factors to consider.

Liberman (1998) highlighted four key areas of psychiatric disability identified by the Social Security Administration of America. These are as follows:

1. Daily living activities (for example, grooming hygiene, household maintenance, and economic management),

2. Social functioning (for example, with family, friends, community, and in the workplace)

3. Concentration, pace, and task perseverance (ability to work for 6 to 8 hours without supervision), and

4. Tolerance for competitive work.

Psychosocial Rehabilitation:

Psychosocial rehabilitation is a procedure that allows people who are impaired, disabled, or handicapped by a mental disorder to achieve their optimal level of independent functioning (Rangnathan, 1999).

Psychosocial rehabilitation attempts to improve the functioning of individuals and society while minimising disabilities and handicaps by emphasising individuals' choices about how to live productively in the community (Rangnathan, 1999).

Psychosocial rehabilitation aims, values, and principles have been defined by mental health experts and organisations (IAPSRS, 1996). The identified goals, values, and guiding principles can be described as follows:

Goals:

1-In terms of symptom management, recovery from mental illness is a crucial prerequisite of psychosocial rehabilitation. Medication adherence is greatly aided by the support of family and the treating psychiatrist. Medication noncompliance slows the pace of psychological rehabilitation.
2-Integration in the family and community: This is a major goal that must be attained via all efforts of psychosocial rehabilitation. Integration of a person with severe mental illness into the family and community is a critical factor of psychosocial rehabilitation success.

3-Better quality of life: It must be ensured on par with members of the family and community by providing psychosocial rehabilitation assistance to people suffering from serious mental illnesses.

Values:

A rehabilitation professional who is actively involved in psychosocial rehabilitation adheres to specific ideals that allow goal attainment in integrating the person with severe mental illness into the family and assuring her or his better quality of life. These are the values:

Self-determination,
Dignity and worth of every human,
Individual capacity to learn and evolve, and
Cultural awareness

Overarching principles:

Individualization of services: Psychosocial rehabilitation services should be planned to meet the individual needs of people suffering from severe mental illnesses based on demographic characteristics such as age, gender, education, location, socioeconomic status, and cultural background, the nature of the illness, and function level in day-to-day work. Specific programme planning of psychosocial rehabilitation services for two people with the same disease may differ in terms of their individual psychosocial rehabilitation needs.
Maximum involvement and consideration should be given to the preferences and choices of people suffering from serious mental illnesses: To guarantee maximal involvement, the decision and preferences of the individual with severe mental illness should be prioritised. In the guise of psychological services, nothing can be imposed on her or him.
Normalized and community-based services: The scope of community-based psychosocial rehabilitation services is broader, as this is known as door-to-door service delivery with the goal of reaching the unreached. Such services are not only in demand, but are also recognised as a critical need of the day, particularly for broader reach in rural areas and wider coverage of the severely mentally ill population.
Focus on your strengths: The severity of mental illness is likely to result in a large number of losses. What has been lost as a result of severe mental illness should not be the main focus. The remaining positive potentials of a person with severe mental illness in terms of cognition, emotion, motor activity level, and social interaction should be the emphasis of the total rehabilitation process.
Situational assessment: There is a situational factor to remaining good potential. To ensure favorable situational assistance, the person's psychosocial milieu, such as family setup, job place, person's social living situations, and so on, may need to be properly recognised.
The holistic approach to treatment, rehabilitation, and integration: Treatment, rehabilitation, and community inclusion are all intertwined and interdependent. They should not be addressed in isolation. A comprehensive strategy to psychosocial rehabilitation for the treatment of serious mental illness is required.
Ongoing, accessible, and coordinated services: Psychosocial rehabilitation services should be organized so that they do not overlap. They should be easily accessible in order to meet the needs of people suffering from serious mental illnesses who require ongoing care.
Skill development and vocational focus: Severe mental illness impairs an individual's behavior, performance, cognition, and social interaction. Certain skill deficiencies are visible in the major types of serious mental diseases. They are the focus of psychological rehabilitation intervention. In the rehabilitation process, there is a continuum of skill training. This includes activities of daily living skills, social skills, and, finally, vocational skills. Through the learning of these skills, a vocational focus should be maintained in order to place the individual in a remunerative position. This gives the individual the impression that he or she is also a contributing part of society.
Environmental modification assistance: Changing the environment can sometimes help with the rehabilitation process. Support for such environmental change should be made available so that it can be used in a flexible manner.
Partnership with the family: The individual with severe mental illness in the family is not the only sufferer; rather, the intensity of the illness has a large impact on the entire family. This adds to the stress of having to care for someone on a regular basis. As a result, the family must be involved in the psychosocial recovery process.
Evaluative assessment with outcome focus: It is vital to evaluate progress in order to determine the outcome of rehabilitation. Typically, development is hampered by relapse, necessitating an evaluative assessment of the outcome.

The Psychiatric Social Worker's Role in the Multidisciplinary Team:

A Psychiatric Social Worker plays an important part in the rehabilitation of people suffering from mental illnesses. The Psychiatric Social Worker gathers the individual's historical background, the episode, the treatment received thus far, primary and secondary caregivers, and familial resources such as family support and financial resources in the family to support the ill person for treatment and rehabilitation. Members of the interdisciplinary team then refer the individual for further evaluation. Identifying personal resources such as attention, IQ, memory, mood, activity level, and so on may be part of the assessment. To conduct assessments, the psychiatric social worker assembles a multidisciplinary team that includes a Psychologist, Psychiatrist, Neurologist, Occupational therapist, Physician, physiotherapist, Psychiatric Nurse, and trainees from several disciplines.

Psycho-education is provided by the psychiatric social worker, in which the social worker communicates the facts regarding the condition to the mentally ill person and her or his family members. Many times, people suffering from serious mental illnesses are unable to comprehend them. It is critical to educate family members about the nature, genesis, course of treatment, and prognosis of the disease. Explain the significance of drug adherence, its side effects, and the negative repercussions of noncompliance. The cost of treatment and the necessity for ongoing care must be addressed to the family.

Family members may wish to learn about the services, concessions, facilities, and bends available to the seriously mentally ill under government provisions, which must be communicated to them.

Furthermore, the Psychiatric Social Worker is responsible for ensuring that the individual is supported by primary caregivers in the implementation of rehabilitation plans and the prevention of relapse. When working with mentally ill people, psychiatric social workers must always uphold the ideals and ethics of the social work profession.

Along with the interdisciplinary team's coordination and reports, the psychiatric social worker plays a critical role in the rehabilitation of people with mental illnesses. To work in the rehabilitation sector under the PWD Act, 1995, the psychiatric social worker must be registered with the Rehabilitation Council of India in the Central Register as a 'Rehabilitation Social Worker.'

Conclusion

A brief overview of mental disorders and psychosocial rehabilitation is provided, including the meaning, clinical characteristics, conspicuous severe mental illnesses, psychosocial rehabilitation, the extent of the problem, and the function of the psychiatric social worker and multidisciplinary team. In the following modules, specific information regarding different characteristics of disability will be explained one by one in order to establish a greater understanding of each aspect of disability in the learner.