Psych · Public and community psychiatry — rehabilitation and recovery services
Psychiatric rehabilitation and recovery services
Also known as Psychosocial rehabilitation · Psychiatric rehabilitation · Recovery-oriented services · Individual Placement and Support IPS · Supported employment mental illness · Assertive Community Treatment ACT · Intensive case management · Housing First mental health · Clubhouse model · Community mental health rehabilitation
Exam-exhaustive fellowship topic on psychiatric rehabilitation and recovery services: clinical, functional and personal recovery (CHIME); evidence-based packages including ACT/ICM, IPS supported employment, Housing First, family psychoeducation, IMR, cognitive remediation, peer support and Clubhouse; fidelity, stepped intensity and recovery-oriented service design. FRANZCP-primary, globally tagged.
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Red flags
- Using recovery language to justify under-treatment, premature discharge, or denial of evidence-based care
- Labelling a service ACT without low caseload, shared team responsibility, in-vivo outreach and high intensity
- Train-and-place vocational delays or cream-skimming only 'job-ready' clients when IPS is indicated
- Housing contingent on abstinence or treatment compliance that perpetuates homelessness (against Housing First logic)
- Discharging high hospital users or homeless people with SMI without intensity and housing plan
- Token peer roles or sheltered-only work without preference-based competitive employment pathways
Meet the patient
A 42-year-old man with residual schizophrenia tells his community team he wants to go back to work. His negative symptoms are mild, he is stable on a depot, and he can hold a conversation. The team's answer is eighteen months of "motivation and readiness" groups in a sheltered workshop. He has now been in those groups for two years. He is not working.[5][8]
The examiner's question writes itself: what should have happened instead? The answer is Individual Placement and Support — competitive work first, with support — because "train and place" keeps people training while place-then-train gets them hired.[5][8]
References18ShowHide
- [1]Stein LI, Test MA Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation Arch Gen Psychiatry, 1980.PMID 7362425
- [2]Bond GR, Drake RE The critical ingredients of assertive community treatment World Psychiatry, 2015.PMID 26043344
- [3]Dieterich M, Irving CB, Bergman H, et al. Intensive case management for severe mental illness Cochrane Database Syst Rev, 2017.PMID 28067944
- [4]Dixon LB, Dickerson F, Bellack AS, et al. The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements Schizophr Bull, 2010.PMID 19955389
- [5]Bond GR, Drake RE, Becker DR An update on randomized controlled trials of evidence-based supported employment Psychiatr Rehabil J, 2008.PMID 18407876
- [6]Burns T, Catty J, Becker T, et al. The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial Lancet, 2007.PMID 17905167
- [7]Bond GR, Drake RE, Becker DR Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US World Psychiatry, 2012.PMID 22295007
- [8]Modini M, Tan L, Brinchmann B, et al. Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence Br J Psychiatry, 2016.PMID 27103678
- [9]Tsemberis S, Gulcur L, Nakae M Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis Am J Public Health, 2004.PMID 15054020
- [10]Leamy M, Bird V, Le Boutillier C, et al. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis Br J Psychiatry, 2011.PMID 22130746
- [11]Slade M, Amering M, Farkas M, et al. Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems World Psychiatry, 2014.PMID 24497237
- [12]Le Boutillier C, Leamy M, Bird VJ, et al. What does recovery mean in practice? A qualitative analysis of international recovery-oriented practice guidance Psychiatr Serv, 2011.PMID 22193795
- [13]Mueser KT, Corrigan PW, Hilton DW, et al. Illness management and recovery: a review of the research Psychiatr Serv, 2002.PMID 12364675
- [14]McFarlane WR, Dixon L, Lukens E, et al. Family psychoeducation and schizophrenia: a review of the literature J Marital Fam Ther, 2003.PMID 12728780
- [15]Wykes T, Huddy V, Cellard C, et al. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes Am J Psychiatry, 2011.PMID 21406461
- [16]Kane JM, Robinson DG, Schooler NR, et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program Am J Psychiatry, 2016.PMID 26481174
- [17]Davidson L, Bellamy C, Guy K, et al. Peer support among persons with severe mental illnesses: a review of evidence and experience World Psychiatry, 2012.PMID 22654945
- [18]Deegan PE, Drake RE Shared decision making and medication management in the recovery process Psychiatr Serv, 2006.PMID 17085613