Overcoming barriers to individualized psychosocial rehabilitation in an acute treatment unit of a state hospital

Introduction by the column editors: Psychiatric Psychiatric rehabilitation begins during the acute stages of psychiatric disorder and continues throug hout the person's lifetime, with the types of services flexibly keyed to th e person's phase of illness, needs, and personal goals, During periods of r elapse and exacerbation of symptoms, when hospitalization is often required , psychiatric rehabilitation; should include the following five objectives: Clarify-how the person's own goals in life, such as a desire for more self- control, freedom of choice,privacy, and time with friends and family, can b e served by inpatient treatment and symptom stabilization. Educate the patient about the nature of his or her illness and how medicati ons work to restore self-control. Teach the patient about side effects and self-monitoring and negotiating ab out medication and its effects in a collaborative way with the psychiatrist :and other members of the treatment team. Connect with the family or other natural supports:that the person has in th e community Enable the patient-to make appropriate aftercare plans for residential and continuing treatment needs after discharge. When rehabilitation is viewed from the vantage point: of these objectives, the inexitricable interweaving of "treatment" with "rehabilitation" becomes clear. Treatment and rehabilitation are two sides of the same coin. It is much easier to integrate psychiatric rehabilitation into more traditi onal methods-of treatment than it is to reorganize a treatment program or f acility so that it blends rehabilitation with:prevailing treatment imperati ve es of pharmacotherapy, supervision, and security and safety. In previous Rehab Rounds columns, we have described examples of creative methods for b ringing the principles and practices of psychiatric rehabilitation into the treatment milieu (1-3). Faced with regulatory criticism from governmental agencies, Dr. Dhillon and his colleagues at Eastern State Hospital in Williamsburg, Virginia, launch ed a vigorous initiative to bring psychiatric rehabilitation into the. fore front of their clinical enterprise. To enable readers to learn from their s uccessful experience and adapt some of the administrative and clinical proc edures that worked in Virginia, Dr. Dhillon and Ms. Dollieslager describe t he operational details of their odyssey. We believe that their effectivenes s in changing a traditional institution can be duplicated in many other pla ces-in units within general hospitals or other community-based settings-as well, as in state psychiatric hospitals, where acute treatment has been lim ited to pharmacotherapy and recreational and diversional activities.