What Is Psychosocial Rehabilitation (PSR) ?
People with mental illnesses and other psychiatric concerns often need help in different aspects of their lives including work, living, social, and learning environments. One approach that can help people manage symptoms and improve functioning is known as psychosocial rehabilitation (PSR).
PSR is a treatment approach designed to help improve the lives of people with disabilities. The goal of psychosocial rehabilitation is to teach emotional, cognitive, and social skills that help those diagnosed with mental illness live and work in their communities as independently as possible.
History of Psychosocial Rehabilitation
Prior to the 1960s and 1970s, it was not uncommon for people with serious mental illnesses to be institutionalized. The approach to the treatment of mental health issues has changed considerably since that time, which has led to de-institutionalization.
Today there is an emphasis on helping people with mental health conditions live as independently as possible and to become fully integrated into the communities in which they live.
While the stigma surrounding mental illness still exists, PSR strives to help reduce prejudice and foster social inclusion.
PSR utilizes what is known as the recovery model of mental illness. Full recovery is frequently the goal, but full recovery is seen as a process rather than an outcome. This approach is centered on the person's potential for recovery and focused on providing empowerment, social inclusion, support, and coping skills.
Everyone's journey is individual and unique, and PSR can help people find meaning, hope, and growth no matter their abilities or the effects of their illnesses.
Principles of Psychosocial Rehabilitation
No matter what form psychosocial services take, core goals include helping people feel:
Hopeful: People may be left feeling demoralized as a result of their condition; rehabilitation focuses on helping clients feel hopeful about the future.
Empowered: Each individual needs to feel that they are able to set their own goals and have the power and autonomy to pursue those aims.
Skilled: Rehabilitation aims to teach people skills to help them manage their condition and live the life they want to live. This includes living skills, work skills, social skills, and others.
Supported: Mental health professionals should offer support and help clients build relationships and social connections in their community.
There are a number of key principles of psychosocial rehabilitation that help guide how mental health in this field approach their work. Theses principles include:
All people have potential that can be developed.
People have a right to self-determination.
The emphasis is on the individual's strengths rather than their symptoms.
Each person's needs are different.
Professional services should be committed and take place in as normalized an environment as possible.
There is a focus on a social model of care (as opposed to a medical model).
It is centered on the present rather than fixated on the past.
PSR treatments are multidisciplinary and often biopsychosocial in nature. This perspective recognizes that mental illness impacts multiple areas of life including the biological, social, and psychological systems. Not only are each of these systems affected by mental conditions but they are also inextricably interlinked. When something affects one area, it is bound to have an influence on other areas as well.
In light of this, PSR takes a whole-person approach and recognizes that other mental health professionals and physicians may be needed to make contributions to the treatment process. Individual care may require a mixture of services and effective treatment. This often requires the facilitation of access to care from different domains.
For example, a person with a mental illness may need psychosocial rehabilitation services that target basic living and social skills, but they might also need treatment involving medication and psychotherapy.
A team approach ensures that the person has access to the tools and resources needed to achieve the stated goals.
The treatment of the condition targets the person’s specific symptoms, while rehabilitation focuses on the recovery and reintegration process.
Who Can Benefit From Psychosocial Rehabilitation?
Many people can benefit from psychosocial rehabilitation, but not all people with mental illness require it. For some people, medication, therapy, or a combination of the two treatments may be sufficient to restore functioning. Rehabilitation can be useful when people need additional recovery assistance to help them restore functioning.
Those who might benefit from PSR include:
People who need help restoring their full functioning after treatment
Those who are disabled and need ongoing assistance in multiple life domains
Individuals who, while functional, feel that they need a boost of support and assistance
People who lack the supportive environment and resources they need to achieve full functioning
People with chronic and severe psychiatric conditions can benefit from PSR services.
Rehabilitation can help them learn basic skills that will allow them to function and cope with their condition. People with intellectual and cognitive disabilities can benefit from learning life, social, and self-care skills.
The time following the diagnosis of a mental health condition is a period of major transition. Patients may lose some functionality but new approaches may allow them to better manage their condition. Their condition may have made it difficult to go to school, to work, or to maintain supportive relationships with others. Many aspects of life can be affected, including the person's employment status, housing situation, and family life.
Once the underlying condition has been addressed through treatment, the rehabilitation process can focus on helping people find the skills and support they need to live full and satisfying lives.
Approaches Used in Psychosocial Rehabilitation
Psychosocial rehabilitation is based on the key idea that people are motivated to achieve independence and are capable of adapting in order to achieve their goals.
Current approaches used in PSR are a combination of evidence-based best practices as well as emerging, promising practices. No matter what specific strategies are used, the focus is on restoring social and psychological functioning.
Specific psychosocial rehabilitation treatments can vary considerably from case to case depending upon a person's needs and the resources available. The process is highly individualized, person-centered, and collaborative.
Effective rehabilitation involves a comprehensive plan that addresses the client’s life and functioning, and a PSR professional is usually only one part of the process. The plan is usually overseen by a psychiatrist, clinical psychologist, or licensed counselor. The rehabilitation process typically involves working with the client individually and in community settings.
PSR Builds on the Person’s Strengths
Rather than simply focusing on areas of weaknesses, psychosocial treatments focus on empowering clients and building on their existing capabilities. These abilities help form a foundation upon which other important life skills can be developed through observation, modeling, education, and practice.
Some specific areas that psychosocial rehabilitation might address include skills training and experiences designed to boost:
Resilience and mental toughness
Problem-solving
Self-esteem
Social skills
Stress management
This might be accomplished through one-on-one educational sessions that focus on specific skills, or it might involve incorporating training and experience in other life domains such as cooking or recreation. Such experiences allow people to practice their abilities in a safe environment with supervision and support from their PSR professional.
PSR Is Holistic
Psychosocial rehab strives to address areas of the person’s life that contribute to overall mental and physical well-being.
Professionals who work in psychosocial rehabilitation provide a range of individual and community-based psychological services.
In determining each patient's needs, mental health professionals look at the physical and social environment, develop a service plan, and collaborate with other professionals.
PSR professionals will look at each client's situation and help determine what they need in order to live and function as independently as possible in their community. This frequently involves determining what services the client needs, locating those services in the community, and coordinating the delivery of those services.
PSR Is Person-Oriented
The client plays a role in setting goals for what one hopes to accomplish. Each client’s goals are individualized based upon their specific needs or concerns.
The rehabilitation process is not about the therapist deciding what the client's goals should be. Instead, the person is able to determine what they want to accomplish. The focus is then on providing the support and resources they need in order to achieve these goals.
Areas of Concern
Key domains addressed through psychosocial rehab include basic living skills, family relationships, peer and social relationships, employment, education, recreation, health, and wellness.
Work
Work has beneficial effects on mental wellness and can help people feel productive, which is why vocational assistance is an important component of psychosocial rehabilitation.
Finding and maintaining work can often improve social connections, boost self-esteem, and improve overall quality of life.
Psychosocial rehabilitation workers also assist clients with finding and maintaining employment. This can include helping clients develop vocational skills, connecting the client to employment services in the community, assisting with career planning, and providing transportation assistance.
This aspect of the PSR process may include assistance with filling out job applications or practicing job interviews. In other instances, clients may work in temporary or supported work settings where they are able to develop and practice skills.
Housing
PSR may involve connecting clients with safe, affordable, and appropriate housing. Clients may live independently in their own homes or in family homes. Other housing situations may include group homes, residential services, and apartments.
A continuum of support exists depending upon the client's individual needs, ranging from fully-staffed, round-the-clock supportive care to minimally staffed or fully independent living.
Relationships
Social skills and interpersonal functioning are important parts of psychosocial rehabilitation. Skills training may focus on helping people better function in their social worlds, including family, work, school, friendships, and romance. This is accomplished by teaching skills related to emotional understanding, interpersonal problem-solving, verbal and conversational abilities, and nonverbal communication.
Community Functioning
One of the overriding goals of psychosocial rehabilitation is to help those with mental illness become better integrated within their community. For this reason, PSR professionals often work with clients in community settings and locations.
For example, a child receiving PSR services may work with a mental health professional in school settings, but the child may also spend time on social outings to local businesses, doctor's offices, libraries, and other situations. Practicing social and life skills in these settings allows clients to gain experience and to rehearse interactions they might face as part of daily life.
The goal of PSR is to help clients engage in their communities as fully as they possibly can, and many of the strategies used in the process are aimed at helping clients become fully integrated within their communities. Doing so not only improves a client's quality of life but also helps create a network of ongoing social support.
Effectiveness of Psychosocial Rehabilitation
Research investigating the outcomes and effectiveness of PSR treatments is still ongoing, but there is evidence indicating these approaches have an overall beneficial effect.
PSR Can Improve Life Skills
A study of patients with schizophrenia and affective disorders found that psychosocial rehabilitation was linked to significant benefits in a variety of skill areas including family relations, communication, community participation, self-care, money management, transportation, and vocational abilities.
PSR Can Benefit Overall Wellness
Research has shown that PSR can be helpful for improving a client's well-being and outlook. In one study published in Research on Social Work Practice, 78% of children with serious emotional disturbances showed significant improvements in psychological symptoms and psychosocial functioning after 13 months of psychosocial rehabilitation.
PSR May Help With Serious Psychiatric Conditions
A review of psychosocial treatments suggested that these approaches also showed promise in schizophrenia recovery. Rehabilitative strategies such as social skills training and cognitive remediation, which are often used in PSR, were found to be helpful in addressing important areas such as social functioning, work recovery, and independent living.
Excerpts from an article by: Verywell Mind
By Kendra Cherry Medically reviewed by Steven Gans, MD Updated on April 28, 2020