Rehabilitation Centre in India

• 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.

Within a recovery framework, professionals conduct psychosocial rehabilitation. The recovery framework emphasises that recovery from mental illness is a process rather than an outcome. Recovery involves a personal journey where one rediscovers oneself while learning to live with an illness, rather than letting the illness define them.

 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.

The team designed the rehabilitation programme by considering the individualised needs of the patients. Psychoeducators educate patients about their illness. After gaining insight, they actively engage in setting goals and developing skills such as self-care, communication, problem solving, and interpersonal skills 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. Evidence-based psychosocial rehabilitation services are widely catered to patients living with mental illness due to their demonstrated effectiveness and recovery orientation.

Social skills training is an important aspect of rehabilitation in India

Social skills training is an important aspect of  rehabilitation. Rehabilitation centres provide social skills training. 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). The individual must acquire and preserve these skills for a long time to empower their performance of social roles and increase their 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 aimed 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 make themselves aware of their strengths and utilizing these assets helps them 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.