Psychosocial Rehabilitation and Recovery Model

1. Psychosocial Rehabilitation and Recovery Model Suchada Sakornsatian, OTR. Consultant, Srithunya Psychiatric Hospital

2. PSYCHOSOCIAL REHABILITATION • Psychosocial rehabilitation is a process initiated by the family of a person with severe mental disorder, in collaboration with the community’s natural support system which includes the health professional, that seeks to maximize their socio occupational functioning of the patient with the final stated objective of preventing marginalization.

3. Guiding Models • Medical Model : Curative Model • Disability Model : Emphasis on adaptation/ Re adaptation • Skills Model : Developing skills (Anthony and Coworker’s) • Needs Model : Individual tailoring (Conning and Rowland 1992) • Role Model : Social role model (Lam and Power 1991)

4. The important framework • The rehabilitation is the process which link the rehabilitation service between hospital and community • The rehabilitation process must consider the one who seek service as consumer. • The ultimate goal of rehabilitation service is to help consumerto be able to communicate with other people have a job and earning some money.

5. The important framework • The rehabilitation service in the hospital must be provided by multidisplinary professional. • Collaboration with outside organization in order to prepare community and establish networks. • The implementation of rehabilitation in community is emphasize on create the networks which is close to home. • The provision of alternate services in community is aim to provide continuity service to consumer.

6. Procedure • Change concept and attitude of rehabilitation professional so they can consider target group as human being with capability. • The rehabilitation in community focus on create networking in community. • Adaptation of rehabilitation activities in congruence with consumer’s symptoms, way of life and market

7. Procedure • There is the process of activity analysis and synthesis to explore how it influence to rehabilitation process for consumer. • There should be variety of activities for consumer to choose. • There should be periodically evaluation process of consumerin order to change to appropriate activity. • There should have the establishment of continuous rehabilitation system.

8. Content (Knowledge, Skills and activity) • Consumer should have knowledge and skills in taking care of their own self care, can help in some domestic tasks, taking medicine continuously,aware of warning sign that need to see the doctor and communication skills. • Relatives/Family members should have knowledge and skills in observation, surveillance of warning sign of symptoms, assign simple domestic task for consumerto take responsibility.

9. Content (Knowledge, Skills and activity) • Community should have knowledge and skills in observation, surveillance of warning sign of symptoms, andlearning to communicate with consumer.

10. PSR SERVICES Services focus on development of behaviors and abilities that allow the person to: • fully participate in community living • maximize independence • enhance interpersonal relationships • develop support systems • Participate in meaningful recreation and socialization • activities that are appropriate to the age and interest of • the person

11. Areas of Service Providing • Self care • Communication • Independent living skills • Work related • Self esteem/Motivation • Leisure activities • Dealing with delusions, Hallucinations and aggressive behavior

12. What is Recovery • Recovery is the process in which people are able to live, work, learn, and participate fully in their communities. • Recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

13. RECOVERY MODEL • Psychiatric rehabilitation programs based on recovery model are founded on the principles of member choice and the active involvement of a member in his/her rehabilitation.

14. RECOVERY MODEL • The practice of psychiatric rehabilitation is composed of three strategies: • • Helping persons identify goals. • • Helping persons plan strategies and acquire the necessary skills to reach and maintain the desired goals. • • Helping persons develop necessary supports to maintain those goals.

15. Background on the Mental Health Recovery Movement • Emerged in the 1980’s • Inspired by the writings of mental health consumers • Consumers who had recovered and wrote about their experiences • Coping with symptoms • Getting better • Gaining an identity • Fueled by Longitudinal Research • Evidence of a more positive course for the majority of people with severe mental illness

16. Defining Recovery " Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness." William Anthony, Director of the Boston Center for Psychiatric Rehabilitation (1993)

17. RECOVERY MODEL • Recovery is not an end-point but a continuing journey – people are not ‘recovered’, they are ‘recovering’. • Recovery is not the same as ‘getting better’ – people are not recovering from illnesses, but recovering meaningful and valuable lives, whether or not their problems are eliminated.

18. URBAN AREA RURAL AREA

19. DIFFERENT WAYS OF LIFE • Environment • Technology • Transportation • Food sources • Jobs opportunity • Leisure activities

20. ENVIRONMENT The environment is very natural, which a lot of trees. There are barely any electronic decorations like in urban area.

21. TECHNOLOGY • The technologies in rural life is not as developed as the technologies in urban life. People make things turn fascinating by weaving while in urban life, people make things turn fascinating by using electricity and so on.

22. Transportation

23. Food Sources Vegetables are grown in from of the villager’s house. People usually cooks their food In urban places, people buy vegetable from market, there are lots of places selling food compared to in rural places.

24. JOB IN RURAL AREA

25. JOB IN URBAN AREA

26. LEISURE ACTIVITIES IN RURAL AREA

27. LEISURE ACTIVITIES IN URBAN AREA

28. PSR MODEL IN RURAL AND URBAN AREA SIMILARILY DIFFERENCE • Context of service in each areas in • Independent • living skills • Work related • Social support • Service Focus • Service area • Self care • Communication • Independent living skills • Work related • Self esteem/Motivation • Leisure activities • Dealing with delusions, Hallucinations and aggressive behavior

29. POINTS TO CONSIDERATION • population needs, such as the unique needs of populations, farming families and urban community. • geographic factors, including the distances between communities and difficulties in accessing some remote communities • resources, including the limited community services and resources in some areas and difficulties in providing PSR

30. PSR IN URBAN AREA • the public services are often available at higher service levels in urban communities, such as water & sewage, public transportation, public health. and even hospital services. • Urban communities survive from the urban commerce, its members works in commerce, industries, • Urban communities tend to have manufacturing, trading, and/or service based economies.

31. PSR IN RURAL AREA • Rural communities depends on the land of their territories to survive, working on agriculture and livestock. They sell their products to the neighboring towns. • Based around farming and agriculture and Rural communities have resource or agriculture based economies, that is the main employment is farming or mining as well as those businesses required to support those efforts.

32. INDEPENDENT LIVING SKILLS • Use of public transportation to access services • Provide transportation to access services Establish community mental health services

33. INDEPENDENT LIVING SKILLS • Manage to obtain food from various food source • Create own food sources

34. INDEPENDENT LIVING SKILL • Skills for using other public services e.g. bank, post office, etc. • Not necessary

35. WORK RELATED • Skills in Commercial, industries work • Apply supported employment approach • Skills in Farming and agriculture work

36. Supported Employment (SE) • It is a evidence based program • To help mental illness pt to get a job according their individuals interest • In open employment as soon as possible • With ongoing , continuous and time unlimited support from treatment team • Collaboration between treatment team and employers/work supervisors

37. Important component 1-Top to Bottom 2-Special Unit 3- Place and Train Model 4-Focus to competitive Employment 5-Zero exclusion 6-Rapid job search and consistent

38. Important component 7-Help clients ASAP 8-Help clients to plan a realistic aim. 9-With ongoing , continuous and time unlimited support from treatment team (both employment and clinical) 10-To help mental illness pt to get a job according their individuals interest 11-Help / support in every process of SE (depends on clients weakness, need and request)

39. OT as a Job Coach-role • As a bridge to connect persons with mental illness and employers • By providing support for both parties • Throughout the process of employment

40. Process of SE • Referral -from Dr. i/c of in pt,OPD and community unit, • Job interest -identifying the person skills ,preferences ,interests , support needs and work history. • Job Search -the very important component, rapid Job search -increase possibilities and opportunity to get job. -phone calls and follow by briefing to employers • Job analysis -to identify job requirement -Using Job analysis Form

41. SUPPORTED EMPLOYMENT PROGRAMME FLOW CHART REFERRAL ASSESSMENT SUITABLE NOT SUITABLE JOB INTEREST REFER TO SST/CRT/TE JOB SEARCH JOB ANALYSIS REFER TO JOB PLACEMENT JOB MATCH JOB INTERVIEW SUCCESS FAILED JOB PLACEMENT FAILED JOB COACH SUCCESS JOB VISIT SST-Social Skill Training CRT-Cognitive Remediation Therapy TE-Transitional Employment CONTINUOS SUPPORT 41

42. catalogue ,broachers and name card.

43. Job Search

44. Job search-activities Attending Job Fair organizing By Ministry Of Human Resource

45. SOCIAL SUPPORT • Use peer supported approach • Depend on family cohesiveness and neighbor

46. LIESURE ACTIVITIES Local products in local area should be recommended • Exercises should be recommended

47. THE GROWTH OF URBAN FARMING

48. SOCIAL ENTERPRISE

49. SUFFICIENT ECONOMY

50. SOCIAL SKILLS TRAINING (SST) • Consists of practicing specific skills such as self-care, conversational skills, conflict handling, making friends, and assertiveness. • Using positive reinforcement, goal setting, modeling and shaping. • The training initially involves smaller social tasks (such as responses to non-verbal social skills cues), and gradually built up into more complex social skills such as conducting a meaningful conversation.