Volume 5 Issue 2 Feb 2015
World Health report (2001) states ‘Rare is the family that will be free from an encounter with mental disorders’. One person in every four will be afflicted with a mental disorder at some stage of life.
Mental illnesses are among the leading contributors to disability. A person with mental illness may become disabled due to a combination of factors including lack of awareness about treatment, medication non-adherence, adverse social circumstances, denial of opportunities due to stigma, disruption in formative years of one’s career and demoralization. As rightly quoted by Hippocrates ‘Healing is a matter of time; at times, it is also a matter of opportunity’, the disability can be prevented in many by facilitating early access to treatment, ensuring medication adherence, presence of supportive family and environment.
Many people report that the experience of mental illness influenced their values, aspirations and meaning in life. Many face the challenge of accepting limitations posed by the illness, medication side-effects and lost opportunities. Helping them lead a meaningful, hopeful and contributing life is the goal of psychiatric rehabilitation. Therapeutic relationship, hope for a better tomorrow and ability to learn from failure are its vital ingredients. Rehabilitation is a slow journey of building upon incremental benefits accrued over a period of time.
Psychiatric rehabilitation is a discipline utilizing set of strategies/ techniques to meet needs of persons disabled due to mental illness. Rehabilitation assessment is aimed at understanding the lived experience of mental illness, the strengths of the person, family and environment. The rehabilitation professional helps the person with psychiatric disability prioritize life goals. Subsequently, the person is assisted in preparing a plan to achieve the life goals. Execution of the plan requires fruitful coordination between different stakeholders like family, friends, neighbors, teachers, employers, NGO’s, colleagues at workplace and mental health professionals.
Nature of rehabilitation inputs vary widely according to strengths and priorities of the person with disability. For e.g., a person who could not complete college education may need help in joining a course according to interest, ability and availability. A homeless mentally ill person will need safe shelter, treatment, tracing family address and reuniting with them. A person unemployed due to stigma of mental illness will require job placements & training in livelihood options according to abilities and qualifications.
‘Perceived need for change’ on part of the person with disability is a vital pre-requisite. Unless the person is ‘rehabilitation ready’, the interventions are unlikely to be successful. Also, the therapist needs to be non-egoistic, persistent, innovative, flexible and optimistic in the recovery journey. An experienced therapist understands that one can only assist in the process of rehabilitation and cannot forcefully rehabilitate a person against their wishes.
A community based rehabilitation approach facilitates community reintegration of the concerned individual. When community sees a person with mental illness regain valued social roles and contribute to society, it shatters many myths and misconceptions about mental illness. To conclude, rehabilitation is definitely a help in holistic care of patients with psychiatric illness.
Dr T. Sivakumar. MD (Psychiatry), Assistant Professor of Psychiatric and Neurological rehabilitation, Psychiatric Rehabilitation Services, Department of Psychiatry, NIMHANS, Bangalore-560029
