Visioning Recovery in a Day Program

Schizophrenia Rehabilitation Day Program

Otto Lim, RSW

Reprinted from "Self-Management" issue of Visions Journal, 2003, 1 (18), p. 34

When individuals encounter their first episode of psychosis or face a diagnosis of schizophrenia, they often ask, “will I ever get better?” They will have also experienced difficulties with school or work, conflict and isolation from their family and friends, disruption or loss of activities and interests, or loss of housing. Despite these difficulties and losses, they can begin navigating their way towards recovery by having their experiences acknowledged and their goals and needs recognized and respected.

Since its inception in 1987, the Schizophrenia Rehabilitation Day Program (SRDP) at UBC Hospital, has gradually evolved from the original form of a weekly question-and-answer group, with a physician and nurse, to the current model of a full-time five-day-a-week program, complete with a multidisciplinary team of occupational therapists, nurses, a psychiatrist, and a social worker.

The mission of SRDP is the rehabilitation of clients with schizophrenia or psychosis. With psychosocial rehabilitation, the goal is to promote recovery, to empower individuals with skills to increase self-worth and a sense of control over their lives. In more concrete terms, recovery ultimately means to move forward with one’s life by maintaining health and avoiding hospitalization in order to succeed with meaningful activity and relationships, to reclaim the self from illness. This often means returning back to school or work, volunteering or engaging in a social life. Numerous studies have shown that psychosocial rehabilitation, along with medications, can lead to better outcomes such as improved rate of recovery, decreased severity of symptoms, decreased relapse rates and fewer hospitalizations, reduced suffering of the individual and family, and better quality of life.

Recovery from illness, as the saying goes, is a process rather than an event. It requires motivation and patience to accomplish short-term goals that will ultimately lead to larger successes. Psychosocial rehabilitation is more than a treatment model but also a philosophy that is client-centred — that is, it focuses on the individual and his or her strengths rather than deficits — and helps the individual deal with specific environments or settings that may be important to them like home, family, social networks and community. The approach also encompasses the key element of maintaining hope.

Psychosocial rehabilitation within the SRDP focuses on groupbased skills training to enable the individual to self-manage their illness. In particular, skills training focuses on three areas: social/living skills, stress management and relapse prevention. Social and living skills include problem-solving, goal-setting, assertiveness and communication techniques to assist in overcoming social and daily barriers. Also falling within the sphere of social and living skills is the need to develop routine and structure for the person. Stress management involves the use of simple relaxation techniques such as breathing exercises, progressive muscle relaxation, and visualization to manage stress and anxiety. Relapse prevention includes education about the illness such as medication and side-effect information, symptom recognition, warning signs and crisis planning. Cognitive-behavioural therapy is used to help people understand and manage the links between their symptoms and their thoughts, feelings and behaviours. Recently, SRDP has developed two new modules to address the concerns and/or goals of clients: weight management and

The practice of psychosocial skills training is achieved through the use of modelling, role-playing, social reinforcement (e.g. peer, therapist and video feedback), goal-setting, and problem-solving. Homework is assigned to incorporate the skills and strategies learned from the groups. Vocational rehabilitation is also used to identify individual goals and to assess aptitudes, interests and barriers to employment or school. Drug and alcohol counselling and interventions may also be offered. In addition, support and education for family members and significant others are also critical elements of recovery to strengthen the support network for the individual.

Informal feedback given by clients who have engaged in psychosocial rehabilitation in the SRDP have indicated that they found medication, goal-setting, social and physical activities, stress management, and peer support as useful elements in attaining self-management of their illness.

Currently, the SRDP is conducting an ongoing outcome study to review the effects of psychosocial rehabilitation offered within the program. The preliminary results show that after one year of graduating from the program, the majority of clients:

  • are involved in productive activity (e.g. work, school, volunteering, vocational training)

  • participate in social activity at least once per week and maintain regular social contacts

  • report minimal or no symptoms

  • experience no hospitalizations

  • take medications and see their mental health follow-up appointments regularly

  • report moderate to very good satisfaction of life

In sum, psychosocial rehabilitation enables the individual to become the expert in developing skills and making the decisions that help them manage their illness, accomplish their goals and move towards recovery.

 
About the author

Otto is a clinical social worker with the Early Psychosis Intervention Program/Schizophrenia Rehabilitation day Program at UBC Hospital, Vancouver Coastal Health Authority

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