Rehabilitation is an important component of health. Psycho social rehabilitation refers to the rehabilitation of chronic mentally ill patients. Psychosocial rehabilitation (PSR) involves three components of assessment of disability, medical intervention and rehabilitation services in different care settings for the mentally ill. The process of psycho social rehabilitation involves four stages namely assessment, planning, intervention and evaluation. Rehabilitation of mentally ill is undertaken by both governmental and non governmental agencies. Social workers have a crucial role to play in the psycho social rehabilitation of mentally ill.
Key words: Psycho social rehabilitation; Process of rehabilitation; Role of social workers in PSR.
Rehabilitation is an important component of health. Rehabilitation services are required for a number of problems either due to illness, handicaps, unforeseen disasters etc apart from the rehabilitation needs of socially and economically deprived population. In the current article, the author focuses on rehabilitation needs of mentally ill people. Studies all over the world have reported that minimum 1% of population suffer due to major mental illness. This figure is the same across the world and is true in the Indian context too. A number of epidemiological studies from India have concurred that minimum of 1% population in India too suffer from major mental illness. Mentally ill people suffer from not just mental illness but also the sting of stigma. This makes the life of not just mentally ill but that of care givers also miserable.
There are different types of mental illnesses. One of the simple types of classification is to classify mental illness into two types namely Psychosis or major mental illness and Neurosis or minor mental illnesses. Mental illnesses are treatable due to the advances made in the field of medicine in the past century. Advent of anti psychotics paved the way for treating chronic mental illnesses effectively. Yet research studies have shown that a nearly 33% of chronic mentally ill do not recover fully from major mental illnesses. These non responders or poor responders to treatment, remain with some deficits and handicaps which require rehabilitation services.
Chronic mentally ill patients usually suffer from symptoms of mental illnesses called as residual symptoms. Some of these negative symptoms are apathy or lack of emotionality, disinterest in the surroundings, amotivation, alogia or poor speech output, poor social skills, poor personal hygiene, poor vocational functioning etc. These symptoms are severe enough to be categorized under handicap. The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act 1995, identifies handicap due to mental illness as one of the categories under various disabilities listed under types of disabilities. These chronic patients who are on treatment for long duration and suffer due to ill controlled mental illness require rehabilitation services.
Rehabilitation may be defined as the combined and coordinated use of medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functioning ability. Rehabilitation includes Medical rehabilitation, occupational/ vocational rehabilitation, social rehabilitation, psychological rehabilitation and Psycho social rehabilitation in its gamut of services according to the discipline where it is used.
Psycho Social Rehabilitation can be defined as a process initiated by a health or mental health professional in collaboration with the patient’s families and community and supported by the policy planner, focused at developing and implementing an individualised programme that seeks to maximise the patient’s assets and minimise his disabilities in the area of socio- occupational functioning.
In 1996 World Association for Psychosocial Rehabilitation (WAPR) and the World Health Organization (WHO) jointly issued a “consensus statement” which defined psychosocial rehabilitation as a strategy that facilitates the opportunity for individuals impaired or disabled by mental disorder to reach their optimal level of functioning in the community, by improving individuals’ competencies and introducing environmental changes (www.wapr2012.org.)
Objectives of Psycho Social Rehabilitation for people with psychiatric disability includes - reducing symptomatology; Improving social competence; Enhancing vocational competence; Strengthening social support; Reducing discrimination and stigma and Consumer empowerment. The process of psycho social rehabilitation centers on the philosophy of mobilising and utilising available resources in the community with the final objective of mainstreaming the client. This process involves not just the affected individual but also his family and the community along with the support providers namely the Government, NGOs and professionals.
The components of psycho social rehabilitation include
The field of psycho social rehabilitation has two important stake holders namely the patient himself and the care giver apart from all other professionals. The informed voluntary consent of the patient and care giver is very essential for the success of the psycho social rehabilitation programme. It is to be noted that the psycho social rehabilitation requires constant effort and encouragement from the care givers to meet with notable success. The families are a great source of strength and support for people with mental illness. The families need lot of professional help in taking up the role of care giver for the mentally ill. Psycho social rehabilitation professionals should always keep the requirements of the family while giving intervention to the client.
Some of the areas requiring interventions among psychiatrically disabled are - Personal hygiene and self care; work habit formation; activities of daily living; money management skills; interpersonal skills; relapse management; management of medication and its side effects; home management; enhance motivational levels; resource mobilisation; interpersonal relationship etc.
Principles of psycho social rehabilitation as given in the Canadian Association of Psycho Social Rehabilitation Professionals include the following:
BANYAN, an NGO which started a mission to rescue wandering mentally ill women from the streets of Chennai, has given very effective model for rescue and rehabilitation of wandering mentally ill all over the world. National Mental Health Programme of 1982 envisaged a greater role for NGOs in the rehabilitation of mentally ill. Such policy initiative has led to a number of NGOs opening shelters for mentally ill. Manasa Karuna Trust, Mysore under the aegis of Vivekananda Girijana Kalyana Kendra (VGKK) has opened a rescue and care shelter for wandering mentally ill women at Mysore. Advocacy for the rights of the mentally ill is one area which is still in nascent stages in our country. ACMI (Action for mentally Illness), a registered organization of care givers of mentally ill has been taking up the issues related to advocacy, care and rehabilitation mentally ill.
At present, rehabilitation centres are governed by the Mental Health Act of 1987. License to open rehabilitation centres, from State Mental Health Authority, is a must under this Act. In case of residential rehabilitation centres, the board of visitors must visit the centres regularly, to ensure humanitarian treatment for mentally ill patients. The rehabilitation professionals are strongly advocating for separate rules to govern the rehabilitation centres and not to equate rehabilitation centres with mental hospitals as it has been put under Mental Health Act.
The staff at rehabilitation centres includes social workers, psychologists, rehabilitation professionals, vocational trainers, occupational therapist and volunteers. The clients usually have their personal psychiatrists for consultation and treatment. The centres usually do not have in-house psychiatrists or nurses as the main focus of intervention is psycho social rehabilitation. Under Mental Health Act, there is insistence on having in-house Psychiatrist and Psychiatric nurse which are not required as for as psycho social rehabilitation is concerned.
Social Workers have lot of scope for practicing as psycho social rehabilitation professionals. This field offers good openings for social workers. Case work, group work and community organization methods of social work can be very effectively used in psycho social rehabilitation. Advocacy and community based rehabilitation interventions are very much required for the large number of mentally ill who have no access to treatment.
A number of social workers with M.Phil in Psychiatric Social Work are working in the field of psycho social rehabilitation as consultants and House in Charges of residential rehabilitation settings. This field gives the professional satisfaction to the social workers in terms of bringing smiles to those who are stigmatized due to mental illness. Professional rehabilitation inputs provided by trained Social Workers can indeed make a great difference to the quality of life of mentally ill people.
Anthony, W.A., Cohen, M., Farkas, M, & Gagne, C. (2002). Psychiatric rehabilitation, 2nd edition. Boston: Boston University, Center for Psychiatric Rehabilitation.
Shekar et al. Handbook of Psychiatric Social Work. NIMHANS Publication. 2007.
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Dr. Suman K Murthy., MSW., M.Phil(PSW)., Ph.D
Associate, Professor & Head, Dept in Social Work, Pooja Bhagavat Memorial Mahajana Post Graduate Centre, KRS Road, Metagalli, Mysore.
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