Mental health disorders cover a wide spectrum of illness which includes schizophrenia, bipolar disorder, substance addiction, depression, organic disorders etc. According to DSM V, Mental illness is defined as “a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning”.
Mental illness can be explained with the help of four D`s i.e Deviance, Distress, Dysfunction, and Danger. Patterns of psychological disturbance are typically Deviant (aberrant, unusual and atypical) Distressing (unpleasant and upsetting to the person), Dysfunctional (interfering with the person’s ability to function appropriately in a constructive manner) and Danger (to the individual or others). Symptoms of mental illness may be persistent, relapsing, remitting, or occur as single episodes. Severe mental illness greatly affects an individual’s ability to function normally. Rehabilitation is the process of restoration of functioning of the individual and is widely used in the field of mental health. Psychiatry rehabilitation specifically encompasses the restoration of the psychological and social functioning of individuals with mental illness. It is a process that facilitates the opportunity for individuals who are impaired, disabled or handicapped by a mental illness to reach their optimal level of independent functioning. Rehabilitation centre helps in the process of enhancing the recovery of individuals with severe mental illness by teaching or restoring psychological, emotional, behavioural and social skills that will enable them to function in their community and by promoting that endeavour through a continuum of services such as pharmacological management, psychotherapy, cognitive retraining, skill development, family psychoeducation and illness management. Psychosocial rehabilitation is suitably carried out for a patient with mental illness in a residential setting in a rehabilitation centre. The services begin as soon as patient is admitted for residential treatment and is provided incessantly thereafter and is constantly modified according to the need and progress of the individual patient. The services are provided by a team of specialized professionals (Psychiatrists, Clinical Psychologists, Rehabilitation Psychologists, Counsellors, Psychiatric social workers and Addiction counsellors) who utilise concentrated programs and techniques to assist individuals with mental illness in achieving their maximum potential and functional independence.
Need for Rehabilitation Centre in Delhi, Gurgaon NCR:
People with severe and chronic psychiatric illnesses such as bipolar disorder, schizophrenia, OCD, organic mental disorder etc may be mentally disabled by their condition, and require rehabilitation to learn basic skills. In the case of disorders such as mental retardation, a process of habilitation is ensued to help patients learn skills necessary for daily functioning. The process of rehabilitation aims to help the patient develop social and cognitive skills which will enable them to reintegrate with the society. This helps the person find a meaningful role for themselves and making gradual improvement in various aspects of life. It also helps in reducing the hostility of patients towards their family members and vice – versa. Rehabilitation supports the patient by improving skills, providing opportunities, and preventing stigma and discrimination against mental illness.
Goals Of Rehabilitation:
- Recovery from mental illness– focusing on the reduction of symptoms and management of illness.
- Reintegration of the patient– reintegration of patient with mental illness in the family and community.
- Better quality of life– need to ensure improved quality of life for the patient.
Psychosocial rehabilitation is conducted within a recovery framework. The recovery framework emphasises that recovery from mental illness is a process rather than an outcome. Recovery is a personal journey that is about the rediscovery of self in the process of learning to live with an illness rather than being defined by the illness. At an individual level, it is about the development of hope and a vision for the future. At the community level, it is about supporting engagement and participation through provision of opportunity and making connection with the person rather than the illness. Rehabilitation programme is designed by keeping in mind the individualised need of the patients. Patients are psychoeducated about their illness. After development of insight, they engage in goal setting and skill development( self-care, communication, problem solving, inter-personal etc are fostered through individual and group sessions. Active participation in leisure activities such as reading, painting, light exercises, indoor and outdoor sports and yoga provides patients with experiences that enhance their wellbeing and enables them to experience alternative ways of attaining contentment and enjoyment. The focus is on helping patients with mental illness develop skills and make use of assets they require in order to thrive and be content in their way of living, learning and social environment and include a wide spectrum of services and supports. As we are aware that patients afflicted with conditions such as schizophrenia, Bipolar disorder, Substance addiction etc are likely to have some degree of impairment in cognitive functioning (in areas such as working memory, verbal memory, attention and concentration). To a large extent these impairments contribute to the severity of disability in people with mental illness and tend to predict the outcomes of treatment. Psychosocial rehabilitation helps in minimizing these impairments by actively engaging the patients in various activities by promoting a sense of fulfilment and accomplishment. Even though recovery is an individual journey, it transpires within an interpersonal context i.e in a Psychiatric hospital. Consequently, facilitating effective collaboration and coordination between the patients with mental illness, health professionals, family and caregivers. Psychosocial rehabilitation services are evidence based and due to their demonstrated effectiveness and recovery orientation, these approaches need to be widely catered to patients living with mental illness.
Social skills training is an important aspect of rehabilitation. Social skills training is provided at rehabilitation centres. These are behavioural techniques or learning activities that enable individual with mental illness to establish or resurrect pragmatic skills in fields needed to meet the demands of interpersonal relationships, self care , vocational and other requisites to live in a society. Social skills are also important for showing specific responses required during various social interactions. They include verbal skills (e.g., use of suitable tone, rate and volume) and nonverbal skills(e.g., gestures and facial expressions).These skills are to be acquired by the individual and also to be preserved for long time to empower the performance of social roles of the individual and increase the level of quality of life. Increasing social skill competence and improving social role functioning has been a major focus of rehabilitation.
here is sufficient evidence to suggest that social skill training, when meticulously designed and implemented, can expand patient’s knowledge and skill level and reduce the relapse rates. Social skills training is designed to alleviate issues encountered in daily life such as enhancing personal hygiene, as well as broader issues involving medication compliance, interpersonal relationships, problem solving and conflict resolution. Social skill training encompasses following interventions in rehabilitation centre:
Problem definition: Providing training to the patient to identify his/her deficits in behaviour in order to let him/her recognize and understand the problematic areas of his/her behavioural repertoire which need intervention and planning the appropriate intervention to resolve the problem.
Inventory of assets: Enabling the patient to recognize his/her strengths. Patient usually suffer from a negative self-image and are not in a position to recognize their strengths. They are made aware of their strengths and utilising these assets helps to improve their problem-solving capacity.
Goal setting: Helping the patient to focus his/her attention on specific areas and not to disperse in the pursuit of sometimes unachievable expectations.
Behavioural rehearsal: Patients usually do not achieve a high degree of proficiency in their skills from the beginning, the tasks require lengthy rehearsal, usually by means of role playing.
Shaping: Shaping is the building of complex sequences and chains of social behaviour through successively reinforcing small step along the way.
Prompting: It is a technique which enables patients to reinforce positive elements even before such elements actually occurred with the help of various types of prompts.
Modeling: Demonstrating to the patient specific behaviour or skill as an example, in such a form that the patient may understand and rehearse it.
Cognitive Rehabilitations: Presence of neuro cognitive deficits in long term mental illness such as Schizophrenia, Bipolar disorder, Substance addiction has provoked clinicians to focus on neuropsychological rehabilitation. In cognitive rehabilitation there are mainly three general targets:
(a)Restoration: Cognitive training and exercises directed towards strengthening and restoration of cognitive function.
(b)Substitution: Compensatory strategies are directed towards substitution of lost functions and promoting conservation of affected brain functions.
(c)Restructuring: Cognitive restructuring, or cognitive reframing, is a therapeutic process that helps the client discover, challenge, and modify or replace their negative, irrational thoughts.
Rehabilitation is a multidimensional therapeutic intervention which requires active participation and coordination among inter-disciplinary team of professionals to promote optimum level of functioning of the patients with mental illness in a Psychiatric hospital. Psychosocial rehabilitation is a comprehensive approach that includes numerous therapeutic elements such as emphasis on medication compliance, insight generation, self-care, cognitive retraining, skill development and community living by focusing on the strengths of the individual suffering from mental illness. Rehabilitation, especially for long-term patients, does not end with discharge. On the contrary, it is intensified as the patient come face to face with the realities and problems of life in the community. Constant support from trusted professional team is essential during the bridging phase as the experiences gained at earlier stages of programme are to be consolidated and augmented, as the person successfully integrates back to the community.