Mental illnesses when become chronic, creates more burden to the family members. Other than medical treatment, the mentally ill persons require multiple therapeutic approaches to bring them back to normal functionality through rehabilitation activities. Rehabilitation services are provided in different settings, viz., half-way-homes, day-care centers and vocational rehabilitation centres. This article highlights the need of rehabilitation for the mentally ill persons and its importance in making the person self dependent; and need of the trained persons in this field.
Key words: Mental illness, rehabilitation, vocational rehabilitation, half-way-homes, Day-care center.
Mental illnesses are the most devastating and disabling health problems affecting the mankind, giving the victims and their families a life of suffering, trauma and travail. Nearly one percent of humanity is suffering from this malady, of which nearly 20% would become chronic. The facilities available in our country are meager to meet the requirements and these do not touch even the fringe of the problem.
Due to the nature of illness, mentally ill persons experience disability. The long term medication and its side effects make patients maladjusted to their family or community environment. Sometimes due to the long-term hospitalization, patients develop institutional neurosis, Social Break Down Syndrome, deterioration of personal habits etc. Some social factors like poverty, unhealthy family atmosphere, and social isolation also cause disability. Treatment factors like long term medication, side effects of antipsychotic drugs, inadequate treatment, lack of proper follow up in the treatment, non compliance with the treatment will also cause disability. The society considers mentally ill persons as a burden and not putting efforts to utilize their potentialities or putting adequate efforts to change them again into a productive member of the society. The problem with illness like schizophrenia is even more. The patients isolate themselves from social mainstream, and such patients not only need medical intervention but also a multiple therapeutic approach to bring them back even to normal functionality. To improve the quality of life of these persons, rehabilitation centers are needed. These can provide them with vocational training to give them hope, to work on bringing back motivation, to remove their apathy and lack of drive and to make them capable to start earning. The Government alone cannot meet the demands of such people and so it is for the NGOs to come forward to help such people in creating alternative living system for the chronically mentally ill people. The concpet of "Home away from Home" is need of the hour.
Rehabilitation has been 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 functional ability”. Rehabilitation does not reverse or undo the damage caused by illness, but rather helps to restore the individual to optimal health, functioning, and well-being.
Four areas of concern in rehabilitation:
Stages in Rehabilitation:
a) Comprehensive assessment and formulation of appropriate plan to diagnose the psychiatric illness, planning pharmacological and non pharmacological management of the illness.
b) Remedial measures to restrict the disability through skills training which includes social skills training, self care skills, vocational training, medication management skills, leisure skills.
c) Supportive and conducive environment by providing education to the family, creating conducive environment in the family and to enable the patient to adjust with family and by enhancing healthy interaction among the family members.
d) Community based facilities like day-care centers, half-way-homes, recreation centers, vocational and rehabilitation centers.
Thus, rehabilitation process has three stages: assessment, planning and intervention with a focus on the particular individual’s needs at each part of the process.
Psychosocial Rehabilitation: According to WHO which defined the concept as a process of linking mental health services to a complex and ambitious social perspectives that encompasses different sectors and levels, from hospitals to homes and work place, with a central aim of ensuring full citizenship for people irrespective of their disabilities. The most accepted definition of the term Psycho Social Rehabilitation is given by Cnaan et al as the process of facilitating an individual’s restoration to an optimal level of independent functioning in the community. It encourages people to participate actively with others in the attainment of mental health and social competence goals.
Main Objectives of Rehabilitation:
Half-way-home: It is a home away from home. This is a place which is used to bridge the gap between the patient and his family after long term hospitalization. The family members too need some time to accept the patient and adjust with him/her in the family. Compare to hospitals, half- way- home gives more freedom, carries less stigma and fasters recovery.
Day-care-center: Half way homes are fairly costly as they are run by NGOs, the most economical way of rehabilitation is to receive services in day-care centre. Most of the time a patient who is local and staying with family and having a fairly good family support can be managed in a day care centre which also has the same objectives as that of half-way-home which is more economical compare to a half-way-home. It is a place which provides a chance to get professional help and engage them throughout the day productively and through this to bring down the negative symptoms in the patient.
Vocational rehabilitation: Vocational rehabilitation consists of interlinked set of activities starting from assessment of the skills of the patient, assigning the appropriate area for work, making the person to adjust with the work, training, sheltered employment, providing suitable jobs, and continuously follow-up the patient. Vocational rehabilitation process is influenced by various factors such as the physical and intellectual abilities of the patient, his social and economic relations with the family members and community, social values and norms, the organization which is providing vocational rehabilitation services, legislative measures of the government.
Benefits of rehabilitation: The major benefits of rehabilitation are a) it is an opportunity provided to meet like-minded people and do things socially, overcoming the painful isolation and loneliness experienced. b) faster recovery is seen in the patients c) regular treatment and follow-up is possible outside the hospital set up d) greater family involvement in treatment; and social support e) family burden is shared by these centers f) improved interpersonal relationship among the family members g) reintegration of the patient into the main stream of the society h) it improves the level of confidence, and develop the social network, communication and vocational skills in the mentally ill persons.
Mentally ill persons and their families are confronted with additional challenges throughout the course of mental illness and recurrent episodes of illness. Rehabilitation programs are cost-effective and can be sustained when there is strong community support and involvement in running them, reinforced by quality medical and social services from nearby facilities. Major challenges remain in scaling up income generation, and meeting needs of the rapidly increasing number of affected families. The Government should provide social security to patients by establishing increased number of rehabilitation centers in each district to meet the needs of such people. The role of a professional social workers trained in these areas is very crucial. Unfortunately we lack such trained manpower in these areas.
Prashant R. Patil
M.S.W M.A M.Phil
Psychiatric Social Worker, Dharwad Institute of Mental Health and Neuro Sciences, Dharwad- 580008 (Karnataka)
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