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Social Work Psychiatric Rehabilitation
by
Phyllis Solomon, Lisa T. Schmidt
  • LAST REVIEWED: 28 April 2017
  • LAST MODIFIED: 14 December 2009
  • DOI: 10.1093/obo/9780195389678-0109

Introduction

Psychiatric rehabilitation is the use of systematic strategies and interventions to assist adults with psychiatric disabilities to become fully integrated into their communities of choice, to improve their quality of life, and to promote their own process of recovery. An adult with a psychiatric disability is an individual with a mental disorder, such as schizophrenia, a major affective disorder, or bipolar disorder, who is functionally impaired due to that disorder. Consequently these functional impairments result in these individuals being unable to achieve commonly accepted age-appropriate milestones in primary life domains, including educational attainment, employment, and intimate relationships like marriage. Psychiatric rehabilitation services are a broad spectrum of services, programs, and approaches that teach skills, modify environments, offer supports, access resources, and develop supportive networks that are necessary for increasing an individual’s capacity to assume normal roles and to be satisfied in living, working, learning, and social environments of his or her choosing. The five psychosocial evidence-based practices for persons with severe mental illness are assertive community treatment, illness management and recovery, supported employment, family psychoeducation, and integrated dual diagnosis treatment. In addition there are emerging best practices, such as peer-provided services. These service approaches incorporate the principles, values, and practices of self-determination; respect and dignity of all persons; and person-centered, strengths-based, and collaborative partnerships. Services are designed to meet an individual’s need and are sensitive to his or her cultural norms and values. These principles, values, and practices are consistent with those of social work practice. The provision of such services frequently requires combating societal stigma and discrimination directed at persons with mental disorders. These services are provided by a diversity of professional disciplines, including psychiatrists, psychologists, social workers, and rehabilitation counselors.

Introductory Works

This section includes an overview volume describing the competencies of the contemporary psychiatric rehabilitation practitioner, Salzer 2006. Two volumes of collected works, Spaniol, et al. 1994 and Spaniol, et al. 1997, capture the emergence of psychiatric rehabilitation goals, values, and principles as published in the literature from 1970 to 1990.

  • Salzer, Mark. 2006. Psychiatric rehabilitation skills in practice: A CPRP preparation and skills workbook. Linthicum, MD: US Psychiatric Rehabilitation Association.

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    Describes how psychiatric rehabilitation practitioners help people with serious mental illness develop the skills, resources, and supports needed to live successfully in the community. It identifies core competencies of the profession, examines case scenarios highlighting practice situations, and provides training exercises for people preparing for recognition as a certified psychiatric rehabilitation practitioner.

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  • Spaniol, LeRoy, Mary Alice Brown, Laura Blankertz, Darrell J. Burnham, Jerry Dincin, Katy Furlong-Norman, Noel Nesbitt, et al., eds. 1994. An introduction to psychiatric rehabilitation. Columbia, MD: International Association of Psychosocial Rehabilitation Services Publications Committee.

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    A compendium of fifty-seven articles by notable consumers, policy makers, researchers, and practitioners. It reflects the seminal ideas of the founders of psychiatric rehabilitation practice and is a valuable resource for understanding the original context and scope of the field.

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  • Spaniol, LeRoy, Cheryl Gagen, and Martin Koehler, eds. 1997. Psychological and social aspects of psychiatric disability. Boston: Boston University Center for Psychiatric Rehabilitation, Sargent College of Allied Health Professions.

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    An interesting collection of reprints from the 1980s and 1990s, including many notable figures from the formative years of the field.

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Textbooks

As the field of psychiatric rehabilitation has coalesced into a cohesive body of principles and practices, a number of textbooks designed to meet the needs of undergraduate and graduate curricula in psychiatric rehabilitation have emerged. Pratt, et al. 2007 is geared toward the undergraduate student and is best suited for an overview course that focuses on the goals, values, principles, practice models, and settings of the psychiatric rehabilitation practitioner. It has extensive reference lists at the end of each chapter, making it easy to quickly search for works related to a specific topic. Corrigan, et al. 2008 takes a more comprehensive view of the knowledge, values, and skills required of those who work with people with serious mental illness as well as the research to support each domain of practice. It is geared toward graduate-level education or an advanced undergraduate course. It contains over one hundred pages of references that will allow the interested scholar to delve deeply into a topic of interest. Anthony, et al. 2002 describes the Boston University model of psychiatric rehabilitation and includes a major emphasis on service system advocacy and policy development to promote systems transformation, which distinguishes it from the other texts. Liberman 2008 is self-described as a manual for translating evidence-based approaches into everyday practice-based services.

  • Anthony, William, Mikal Cohen, Marianne Farkas, and Cheryl Gagne. 2002. Psychiatric rehabilitation, 2d ed. Boston: Boston University Center for Psychiatric Rehabilitation, Sargent College of Allied Health Professions.

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    Anthony is perhaps the psychiatric rehabilitation professional with greatest name recognition. His background in rehabilitation counseling is evident in his approach to environmentally specific assessment, skills teaching, resource modification, and support development. This text reflects what is referred to as the “Boston University model” of psychiatric rehabilitation.

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  • Corrigan, Patrick W., Kim T. Mueser, Gary R. Bond, Robert E. Drake, and Phyllis Solomon. 2008. Principles and practices of psychiatric rehabilitation: An empirical approach. New York: Guilford.

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    The authors reflect the multidisciplinary roots of the field: psychology, psychiatry, rehabilitation, and social work. Individually they are expert in numerous specialty areas that contribute to psychiatric rehabilitation philosophy and practice, including stigma reduction, illness management, dual diagnosis, family psychoeducation, vocational rehabilitation, and consumer-delivered services.

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  • Liberman, Robert Paul. 2008. Recovery from disability: Manual of psychiatric rehabilitation. Washington, DC: American Psychiatric Association.

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    Liberman’s manualized skills training programs are widely implemented. This textbook is a compilation of the knowledge gained by many years of research and clinical practice at the University of California, Los Angeles. It includes chapters on functional assessment, vocational rehabilitation, collaboration with families, and treatment of refractory disorders and older adults.

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  • Pratt, Carlos W., Kenneth J. Gill, Nora M. Barrett, and Melissa M. Roberts. 2007. Psychiatric rehabilitation, 2d ed. San Diego, CA: Elsevier Academic.

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    Emphasizes the practical application of psychiatric rehabilitation principles and values by identifying settings where psychiatric rehabilitation is practiced and describing program models, such as day programs, case management, residential programs, dual diagnosis treatment, self-help centers, and family psychoeducation programs.

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Journals

There are no social work journals that deal specifically with psychiatric rehabilitation. There are three journals that are specific to the domain of psychiatric rehabilitation, American Journal of Psychiatric Rehabilitation, International Journal of Psychosocial Rehabilitation, and Psychiatric Rehabilitation Journal. These journals include practice, program, and research articles related to psychiatric rehabilitation. The other journals listed, Psychiatric Services, Community Mental Health Journal, and Journal of Behavioral Health Services and Research, contain many research articles of relevance to psychiatric rehabilitation.

Day Programs

Therapeutic programs in which people with serious mental illness can participate on a full- or half-day basis at least a few days a week have been available since the 1950s. While these programs are prevalent throughout the United States, there is not a strong body of empirical support for their purported effectiveness. A specific, widely adopted, psychosocial day program model, the clubhouse, originated at Fountain House in New York City. Thus the citations in this section, such as Jackson 2001 and the International Center for Clubhouse Development, convey the early 21st-century principles, practices, and standards of the clubhouse model. Pratt, et al. 2007 describes the various types of day programming, and the films by Lichtenstein and Peoples 2003 and by Fountain House 2004 provide a glimpse of the day-to-day activity of the Fountain House program.

  • Fountain House.

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    Describes the history of clubhouse development and current services offered and also includes articles, reports, newsletters, and links to other important resources related to this topic.

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  • Fountain House, producer. 2004. Opening the door: The story of fountain house.

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    Available from Fountain House, 425 West 47 Street, New York, NY 10036, this film, made on location at Fountain House, shows what it is like to be a clubhouse member.

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  • International Center for Clubhouse Development.

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    An organization that has developed standards for clubhouse operations and certifies programs as meeting these standards. Their website lists and maintains the standards and offers information about staff development, a complete directory of certified clubhouses worldwide, and an extensive bibliography of articles on issues related to clubhouse services and policy.

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  • Jackson, Robert L. 2001. The clubhouse model: Empowering applications of theory to generalist practice. Belmont, CA: Brooks Cole Thomson Learning.

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    This reference will provide the interested reader a comprehensive examination of the philosophy, principles, dynamics, and staff competencies required to work and successfully participate in a clubhouse.

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  • Lichtenstein, Bill, and June Peoples, producers and directors. 2003. West 47th Street.

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    Available from Lichtenstein Creative Media, Inc., 25 West 36 Street, 11th Floor, New York, NY 10018, this independent film chronicles the lives of four adults who experienced varying degrees of success as members of Fountain House around the time the club was celebrating its 50th anniversary. It realistically depicts the triumphs, the struggles, and the losses experienced by people with serious mental illness.

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  • Pratt, Carlos W., Kenneth J. Gill, Nora M. Barrett, and Melissa M. Roberts. 2007. Psychiatric rehabilitation, 2d ed. San Diego, CA: Elsevier Academic.

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    See chapter 6 for a complete discussion of the various types of day programming and also for a bibliography of articles regarding this service starting on p. 188.

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Case Management

Case management services provide ongoing, individualized support to ensure that people with serious mental illness are connected to needed treatment, resources, and support. The Corrigan 2008 chapter reviews the various models of case management, which vary by caseload size, frequency of contact, where contact takes place, and degree of direct service provided by the case manager. Rapp and Goscha 2006, written by two social workers, demonstrates the intersection of psychiatric rehabilitation and social work principles and practices, and Goscha and Rapp 2004 discusses the principles of effective case management. Although many behavioral health systems throughout the United States have funded case management programs to help reduce hospital utilization, there is some controversy regarding their effectiveness. The Cochrane review of case management—Marshall, et al. 1998—clearly outlines this controversy and summarizes the evidence regarding case management outcomes.

  • Corrigan, Patrick W. 2008. Case management. In Principles and practice of psychiatric rehabilitation. Edited by Patrick W. Corrigan, Kim T. Mueser, Gary R. Bond, Robert E. Drake, and Phyllis Solomon, 137-159. New York: Guilford.

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    This chapter reviews the various models of case management and the empirical base. The chapter offers an extensive list of references on case management.

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  • Goscha, Richard J., and Charles A. Rapp. 2004. The principles of effective case management of mental health services. Psychiatric Rehabilitation Journal 27, no. 4: 319–333.

    DOI: 10.2975/27.2004.319.333Save Citation »Export Citation » Share Citation »

    This review article identifies the primary outcomes of strengths-based case management service and describes the ten practice principles that are thought to contribute to these outcomes.

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  • Marshall, M., A. Gray, A. Lockwood, and R. Green. 1998. Case management for people with severe mental disorders. Cochrane Database of Systematic Reviews, issue 2, article no. CD000050.

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    The Cochrane Database of Systematic Reviews is an excellent source for identifying randomized controlled trials related to health care. The Cochrane Library is available online. This reference addresses case management outcomes for people with psychiatric disorders.

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  • Rapp, Charles A., and Richard J. Goscha. 2006. The strengths model: Case management with people with psychiatric disabilities. New York: Oxford Univ. Press.

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    This book details the methods for assessing and developing client strengths in order to promote community integration and recovery. It provides a strong foundation for understanding why holistic and client-centered approaches reflect core principles of psychiatric rehabilitation.

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Self-Help Centers

Consumer operated services (COS) refers to a collection of support initiatives that are planned, developed, and delivered by people who have personal experience with mental illness. Self-help centers, also known as drop-in centers, are one type of consumer operated service that is expanding in the United States, and the American Journal of Community Psychology recognized this growth in 2008 with a special issue (Brown, et al. 2008). Van Tosh and del Vecchio 2000 marked a watershed for wider government funding for these alternatives and adjuncts to professionally delivered services.

  • Brown, Louise D., Matthew D. Shepherd, Scott A. Wituk, and Greg Meiseen, eds. 2008. Special issue: Mental health self-help. American Journal of Community Psychology 42, nos. 1–2: 105–202.

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    The nine articles in this special issue examine the evidence base for self-help, including the values inherent in these programs, the processes that lead to participant outcomes, and the relationship of self-help to conventional mental health services.

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  • Van Tosh, Laura, and Paolo del Vecchio. 2000. Consumer/survivor-operated self-help programs: A technical report. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

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    Reviews the mental health self-help movement and the findings and recommendations of thirteen demonstration projects from across the United States supported by the Substance Abuse and Mental Health Services Administration (SAMHSA).

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Evidence-Based Psychiatric Rehabilitation Practices

One of the forces behind the emergence of psychiatric rehabilitation as a model for systems transformation has been the body of empirical evidence that supports the efficacy of practice as measured by a variety of valued client outcomes. The citations listed in this section introduce the reader to the process of establishing an evidence base to support clinical practice. Some of the issues surrounding them are discussed in Norcross, et al. 2006. Drake, et al. 2005 delineates the six evidence-based practices (EBPs) for persons with severe mental illness, and McHugo, et al. 2007 introduces the issues in implementing these evidence-based practices in the routine practice arena. Bond, et al. 2000 provides the methods for the development of fidelity measures for implementation of evidence-based practices.

  • Bond, Gary, Jane Williams, Lisa Evans, Michelle Salyers, Hea-Won Kim, Heather Sharpe, and H. Stephen Leff. 2000. Psychiatric rehabilitation fidelity toolkit. Cambridge, MA: Human Services Research Institute.

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    This is an excellent resource for the development of fidelity measures and can be ordered directly from the Human Services Research Institute (HSRI) website.

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  • Drake, Robert E., Matthew R. Merrens, and David Lynde, eds. 2005. Evidence-based mental health practice: A textbook. New York: Norton.

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    Offers an introduction to the methods used to establish a body of evidence regarding the effectiveness of practices associated with treating mental illness. It concludes with a description of evidence-based practices, including assertive community treatment, cognitive-behavioral strategies, family psychoeducation and support, illness management, recovery, integrated dual diagnosis treatment, and supported employment.

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  • McHugo, Gregory J., Robert E. Drake, Rob Whitley, Gary R. Bond, Kikuko Campbell, Charles A. Rapp, Howard H. Goldman, Wilma J. Lutz, and Molly T. Finnerty. 2007. Fidelity outcomes in the national implementing evidence-based practices project. Psychiatric Services 58: 1279–1284.

    DOI: 10.1176/appi.ps.58.10.1279Save Citation »Export Citation » Share Citation »

    Describes the degree to which providers of the National Implementing Evidence-Based Practices Project were able to adhere to fidelity standards of one of the five practices currently identified as effective in helping people with serious mental illness. Considerations for successful implementation of new practices are also reviewed.

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  • Norcross, John. C., Larry E. Beutler, and Ronald F. Levant, eds. 2006. Evidence-based practices in mental health: Debate and dialogue on the fundamental questions. Washington, DC: American Psychological Association.

    DOI: 10.1037/11265-000Save Citation »Export Citation » Share Citation »

    A provocative journey into many aspects of the study of the effectiveness of therapeutic interventions. It includes diverse opinions and perspectives on the validity of the evidence-based best practice literature.

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Assertive Community Treatment

Assertive community treatment (ACT) employs a rehabilitative model of teaching clients social and functional skills to live in the environment of their choice. Numerous reviews, including a Cochrane review (Marshall and Lockwood 1998) determined its effectiveness based on reduced hospitalizations and consequently its cost effectiveness. Allness and Knoedler 2003, written by a social worker and a psychiatrist, respectively, who worked with the original assertive community treatment program in Wisconsin, delineates the components of the program and the means for implementation. Stein and Santos 1998 is important, as Stein was one of the three originators of assertive community treatment. Burns and Firn 2005 gives a more international view of this intervention. The Assertive Community Treatment Association website is important, as it offers information related to this program model and sponsors an annual conference that attracts international presentations and participants. Assertive community treatment videos from HealthHaven offer useful tools for classroom use.

  • Allness, D. J., and W. H. Knoedler. 2003. A manual for ACT start-up: Based on the pact model of community treatment for persons with severe and persistent mental illnesses. Arlington, VA: National Alliance on Mental Illness.

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    A manual for implementing assertive community treatment (ACT) developed by two of the early implementers of the Program for Assertive Community Treatment (PACT) in Wisconsin.

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  • Assertive Community Treatment Association.

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    Offers much information about the assertive community treatment model, including fidelity standards, annual conference proceedings, and a bibliography.

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  • Burns, Thomas, and Mike Firn. 2005. Assertive outreach in mental health: A manual for practitioners. New York: Oxford Univ. Press.

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    Addresses common issues and obstacles to supporting people with serious mental illness who are living independently in the community. It also includes a description of the roots of assertive community treatment in England and offers general information about how to start an assertive community treatment program.

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  • HealthHaven.

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    The assertive community treatment (ACT) videos available at this website offer first-person accounts and expert lectures, among other things, regarding assertive community treatment.

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  • Marshall, M., and A. Lockwood. 1998. Assertive community treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews issue 2, article no. CD001089.

    DOI: 10.1002/14651858.CD001089Save Citation »Export Citation » Share Citation »

    This reports the results of a systematic review to determine the effectiveness of assertive community treatment.

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  • Stein, Leonard I., and Alberto B. Santos. 1998. Assertive community treatment of persons with severe mental illness. New York: Norton.

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    The authors’ work with discharged patients from psychiatric hospitals in the late 1960s led to the development and evolution of the assertive community treatment (ACT) model in the United States.

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Cognitive-Behavioral Strategies

Mental illness interferes with cognitive functioning, ranging from information processing and executive functioning to the formation of delusional thinking and hallucinations. Emerging nonpharmacological interventions hold promise for both improving cognitive functioning and compensating for cognitive deficits. The references in this section reflect the latest strategies put forth by the two leading experts in this area of practice. Beck, et al. 2009 assesses and offers therapy techniques for the symptoms of schizophrenia; Beck is the founder of cognitive therapy. Bellack, et al. 2006 addresses behavioral treatments for substance abuse.

  • Beck, Aaron T., Neil A. Rector, Neal Stolar, and Paul Grant. 2009. Schizophrenia: Cognitive theory, research, and therapy. New York: Guilford.

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    Beck and his colleagues conceptualize the various symptoms of schizophrenia, such as delusions, hallucinations, negative symptoms, and disordered thoughts, within a cognitive framework. They then offer assessment and therapy techniques to address each type of symptom.

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  • Bellack, Alan S., Melanie E. Bennett, and Jean S. Gearon. 2006. Behavioral treatment for substance abuse in people with serious and persistent mental illness: A handbook for mental health professionals. New York: Routledge.

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    Describes a behaviorally oriented approach to helping people with co-occurring substance use and psychiatric disorders. It includes the theoretical foundation and clinical skills associated with relapse prevention, including motivational interviewing, goal setting, contingency management, social skills, and drug refusal training.

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Family Psychoeducation and Support

Family psychoeducational interventions are one of the five psychosocial evidence-based practices for adults with severe mental illness based on numerous reviews, including one by Cochrane (Pharoah, et al. 2006) that concluded that these interventions reduce psychiatric hospitalizations. The research has not shown that any one particular model of family psychoeducation is more effective than another. Anderson, et al. 1986, Falloon, et al. 1984, and McFarlane 2002 present different models of family psychoeducation. There are other family interventions, such as family education, advocacy, and support, which are discussed in “Family interventions” in Corrigan, et al. 2008. Mueser and Gingerich 2006 provides information relevant for family members with different relationships with a relative with a severe psychiatric disorder.

  • Anderson, Carol M., Douglas J. Reiss, and Gerald E. Hogarty. 1986. Schizophrenia and the family: A practitioner’s guide to psychoeducation and management. New York: Guilford.

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    Anderson and her colleagues present their specific model of psychoeducation for families of adults with severe mental illness, which was developed by two social workers. This model includes a survival skills workshop and integration of social and vocational rehabilitation. Although the book is old, this intervention is still implemented.

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  • Corrigan, Patrick W., Kim T. Mueser, Gary R. Bond, Robert E. Drake, and Phyllis Solomon. 2008. Family interventions. In Principles and practices of psychiatric rehabilitation. By Patrick W. Corrigan, Kim T. Mueser, Gary R. Bond, Robert E. Drake, and Phyllis Solomon, 234–262. New York: Guilford.

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    This chapter delineates the various models of family psychoeducational interventions and family educational interventions and provides an empirical base for the effectiveness of these interventions.

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  • Falloon, Ian R. H., Jeffrey L. Boyd, and Christine W. McGill. 1984. Family care of schizophrenia. New York: Guilford.

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    Presents the behavioral family therapy model for severe psychiatric disorders that offers training in problem solving, communication skills, and strategies for families to manage and cope with the illnesses of their relatives. Others, such as McFarlane 2002, and even purely educational interventions for families have borrowed some from this model.

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  • McFarlane, William R. 2002. Multifamily groups in the treatment of severe psychiatric disorders. New York: Guilford.

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    Examines the most widely implemented of the family psychoeducation models and its application to a variety of disorders. The Substance Abuse and Mental Health Services Administration (SAMHSA) tool kit Illness management and recovery employs this model. This model heavily borrows from other models, such as Anderson, et al. 1986, but uses a multifamily approach.

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  • Mueser, Kim T., and Susan Gingerich. 2006. The complete family guide to schizophrenia. New York: Guilford.

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    Reviews a range of treatment and support options for persons with schizophrenia. Chapters deal with relevant issues for those with different relationships to someone with schizophrenia, such as parent, sibling, or partner.

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  • Pharoah F., J. Mari, J. Rathbone, and W. Wong. 2006. Family intervention for schizophrenia. Cochrane Database of Systematic Reviews, issue 4, article no. CD000088.

    DOI: 10.1002/14651858.CD000088.pub2Save Citation »Export Citation » Share Citation »

    A report of the systematic review of family psychoeducational interventions for relatives of an adult with schizophrenia.

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Illness Management

The citations in this section represent the various foci of practices related to coping with psychiatric symptoms and substance use disorders. Bellack, et al. 2004 and the US Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) toolkits offer manualized approaches to skills teaching for professional group leaders. Mueser, et al. 2002 provides the empirical evidence that supports these approaches. Copeland 2002, however, is aimed at individual self-help strategies for managing symptoms and promoting wellness. Witkiewitz and Marlatt 2007 is included here because it describes both professionally led and self-help-oriented applications of the relapse prevention model to a broad spectrum of behavioral disorders.

  • Bellack, Alan S., Kim T. Mueser, Susan Gingerich, and Julie Agreats. 2004. Social skills training for schizophrenia: A step-by-step guide, 2d ed. New York: Guilford.

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    Provides guidelines for understanding and assessing social skills deficits in people with schizophrenia. It offers curricula for training groups of people who need to improve skills ranging from basic communication to conflict management, communication in social settings and the workplace, and collaborating with health care providers.

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  • Copeland, Mary Ellen. 2002. Wellness recovery action plan. Dummerston, VT: Peach.

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    Copeland describes a self-help system of recovery that empowers people with mental illness to identify triggers for relapse, tools for staying well, and advanced directives in the event of a psychiatric emergency. Copeland also has a series of self-help workbooks tailored to specific diagnoses online.

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  • Mueser, Kim T., Patrick W. Corrigan, David W. Hilton, Beth Tanzman, Annette Schaub, Susan Gingerich, Susan M. Essock, et al. 2002. Illness management and recovery: A review of the research. Psychiatric Services 53, no. 10: 1272–1284.

    DOI: 10.1176/appi.ps.53.10.1272Save Citation »Export Citation » Share Citation »

    Examines and summarizes the results of ninety-one randomized control trials of psychiatric illness management strategies. It supports the idea that people with a serious mental illness can participate in their own treatment by using psychoeducation, coping skills training, and relapse prevention strategies.

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  • US Department of Health and Human Services. Substance Abuse and Mental Health Services Administration (SAMHSA). 2003. National Mental Health Information Center. Illness management and recovery.

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    This implementation resource kit is available for free download. It includes a manual explaining how to implement this evidence-based practice and a practitioner’s workbook offering a psychoeducational teaching curriculum and educational handouts.

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  • Witkiewitz, Katie A., and G. Alan Marlatt, eds. 2007. Therapist’s guide to evidence-based relapse prevention. New York: Elsevier Academic.

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    The opening chapters of this edited volume detail the relapse prevention model developed by Marlatt and his colleagues, which was originally designed for people who abuse alcohol. The remaining chapters discuss numerous evidence-based applications of this model that help people with a variety of behavioral health disorders learn to manage their illness and reduce relapse.

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Recovery

Contrary to what was once thought of as a downward spiraling course of the disease, numerous longitudinal studies of people with schizophrenia suggest that recovery is possible, particularly when people in recovery feel empowered (Linhorst 2006). This has led to much discussion regarding the definition of recovery (US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration [SAMHSA] 2004), the personal journey of recovery (Davidson, et al. 2005–2006), and how approaches to treatment and rehabilitation promote or inhibit this process (Ralph and Corrigan 2004). The citations in this section reflect this discussion and also describe some of the evidence-based practices now known to foster recovery.

  • Davidson, Larry, Courtenay Harding, and LeRoy Spaniol, eds. 2005–2006. Recovery from severe mental illness: Research evidence and implications for practice, 2 vols. Boston: Boston Univ. Center for Psychiatric Rehabilitation, Sargent College of Health and Rehabilitation Sciences.

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    A hefty two-volume collection of articles first published between 1975 and 2005 that includes first-person accounts of the process of recovery, longitudinal outcomes studies, descriptions of evidence-based services, interventions, and systems change strategies.

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  • Linhorst, Donald M. 2006. Empowering people with severe mental illness: A practical guide. New York: Oxford Univ. Press.

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    One of the guiding principles of psychiatric rehabilitation is to maximize clients’ involvement, preferences, and choices regarding the services they receive and the overall direction of their lives. Linhorst provides a comprehensive examination of the concepts, implications, and practices that impact this principle.

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  • Ralph, Ruth O., and Patrick W. Corrigan, eds. 2004. Recovery in mental illness: Broadening our understanding of wellness. Washington, DC: American Psychological Association.

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    This edited volume presents various models of recovery.

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  • US Department of Health and Human Services. Substance Abuse and Mental Health Services Administration (SAMHSA). Center for Mental Health Services. 2004. National consensus statement on mental health recovery.

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    This website documents the definition of recovery and the ten principles associated with it as developed by 110 expert panelists who participated in the National Consensus Conference on Mental Health Recovery and Mental Health Systems Transformation on 16–17 December 2004.

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Integrated Dual Diagnosis Treatment

Nearly half of all the people who have a serious mental illness also experience problems with substance use. The citations in this section promote an integrated approach to treatment that acknowledges the interactional nature of these co-occurring disorders. Doyle and Spaniol 2002 gives context for the development of this approach. Mueser, et al. 2003 provides the foundation for the evidence-based practice tool kit on integrated dual diagnosis treatment endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA). Mueser, et al. 2005 offers a useful framework for interpreting empirical research of the outcomes of this intervention. The annotated bibliography by Cacciola and Dugosh 2003 conveniently offers hundreds of citations related to this area of treatment.

  • Cacciola, John, and Karen Dugosh. 2003. Co-occurring substance use and mental disorders: An annotated bibliography.

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    A comprehensive annotated bibliography of empirical studies of co-occurring mental illness and substance use disorders that additionally includes a review of relevant data resources. It is intended for use by treatment providers, policy makers, researchers, and evaluators.

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  • Doyle Pita, Dianne, and LeRoy Spaniol, eds. 2002. A comprehensive guide for integrated treatment of people with co-occurring disorders. Boston: Boston Univ. Center for Psychiatric Rehabilitation.

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    This large edited volume (768 pages) collects articles that reflect the seminal thinking and late 20th-century best practices of the fields of psychiatric rehabilitation and addictions treatment.

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  • Mueser, Kim T., Douglas L. Noordsy, Robert E. Drake, and Lindy Fox. 2003. Integrated treatment for dual disorders: A guide to effective practice. New York: Guilford.

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    Written by some of the pioneers in dual disorder treatment, this book provides a foundation for understanding the nature of having the dual disorders of substance abuse and serious mental illness. It offers clinical assessment and treatment guidelines and contains an extensive list of comprehensive references.

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  • Mueser, Kim T., Robert E. Drake, Stacey C. Sigmon, and Mary F. Brunette. 2005. Psychosocial interventions for adults with severe mental illnesses and co-occurring substance use disorders: A review of specific interventions. Journal of Dual Diagnosis 1, no. 2: 57–82.

    DOI: 10.1300/J374v01n02_05Save Citation »Export Citation » Share Citation »

    This review article distinguishes the various interventions used in randomized controlled trials (RCTs) of the outcomes associated with integrated treatment. Specific evidence of effectiveness is then judged for each of the individual, group, and family modality types of interventions and for the structure, process, and procedures of the interventions.

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Supported Employment

People with serious mental illness experience high rates of unemployment due to the effects of significant psychiatric and social impairments that lead to vocational disability. Becker and Drake 2003 provides the foundation for the evidence-based practice tool kit on supported employment (SE), referred to as the individual placement and support model of supported employment, endorsed by the US Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) Supported Employment. The affiliated Dartmouth Supported Employment Center offers training and technical assistance to those interested in implementing this service approach. The Virginia Commonwealth University Research and Training Center on Workplace Supports and Job Retention website focuses on vocational services implementation strategies for a broader range of people with disabilities. The Employment Intervention Demonstration Project (EIPD) website offers comparisons of the effectiveness of various other models of supported employment.

Emerging Best Practices in Psychiatric Rehabilitation

Innovations that improve the participation of people with serious mental illness in all aspects of normal adult life often spring from everyday trial and error. Both practitioners and people who experience mental illness firsthand have found strategies that promise to improve access to education, housing, and self-help. This section includes citations related to promising practices that are starting to generate evidence of effectiveness but have not yet met the criteria for being included as evidence-based best practices and are sometimes referred to as “emerging best practices.”

Peer Provided Services

Psychiatric rehabilitation has a growing tradition of including the participation of people who have personal experience with mental illness in all aspects of service planning, delivery, and evaluation. Chamberlin 1978 provides an important context for peer-provided services. Clay 2005 and Mowbray, et al. 1997 address the variety of programs and direct service roles of peers as providers. As the unique skills and foci of peer support are conceptualized and operationalized, an emphasis on developing and delivering training to people interested in becoming peer providers has also emerged; for example, see Mead 2005. In addition there are several self-directed workbooks for people interested in exploring their own path to recovery. Probably the most widely recognized of these is Copeland 2002, a depression workbook also cited in the Illness Management section of this entry. In this section are two other self-help workbooks of interest, Ridgeway, et al. 2004 and Spaniol, et al. 1994. These workbooks are not specific to a diagnosis and can be used by individuals in their personal pursuit of recovery or with groups of consumers in a mutual support format.

  • Chamberlin, Judi. 1978. On our own: Patient-controlled alternatives to the mental health system. New York: Hawthorn.

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    Chamberlin’s historical and often-cited book has raised consciousness of the iatrogenic effects of conventional psychiatry, such as coercive treatment methods, involuntary and depersonalizing hospitalization, overmedication, and mentalism. It gives context to the evolution of self-help and peer provided services.

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  • Clay, Sally, ed., with Bonnie Schell, Patrick W. Corrigan, and Ruth O. Ralph. 2005. On our own, together: Peer programs for people with mental illness. Nashville, TN: Vanderbilt Univ. Press.

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    Offers a history of self-help for mental illness and describes in detail the federally funded Consumer Operated Services Program research design and study program participants. It also includes a fidelity measure for developing and evaluating peer programs.

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  • Copeland, Mary Ellen. 2002. Wellness recovery action plan. Dummerston, VT: Peach.

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    Copeland describes a self-help system of recovery that empowers people with mental illness to identify triggers for relapse, tools for staying well, and advanced directives in the event of a psychiatric emergency. Copeland also has a series of self-help workbooks that are tailored to specific diagnoses at Mary Ellen Copeland.

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  • Mead, Shery. 2005. Intentional peer support: An alternative approach. Plainfield, NH: Sherry Mead Consulting.

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    Mead’s training curriculum and self-help workbook represents a transformative approach to mental health support that is based on the experiential knowledge gained by peer providers over the last twenty years of the 20th century.

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  • Mowbray, Carol T., David P. Moxley, Colleen A. Jasper, and Lisa L. Howell, eds. 1997. Consumers as providers in psychiatric rehabilitation. Columbia, MD: International Association of Psychosocial Rehabilitation Services.

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    This is perhaps the most comprehensive collection of descriptions of the depth and breadth of peer roles and programs in the United States that existed in the 1990s.

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  • Ridgway, Priscilla, Diane McDiarmid, Lori Davidson, Julie Bayes, and Sarah Ratzlaff. 2004. Pathways to recovery: A strengths recovery self-help workbook. Lawrence: Univ. of Kansas School of Social Welfare.

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    This workbook offers a range of self-exploration activities designed to help the person in recovery discover his or her values, hopes, strengths, and abilities. It facilitates personally relevant examination of recovery, cognitive-behavioral strategies for change, motivation builders, social support development, and relapse prevention.

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  • Spaniol, LeRoy, Martin Koehler, and Dori Hutchinson. 1994. The recovery workbook: Practical coping and empowerment strategies for people with psychiatric disability. Boston: Boston Univ. Center for Psychiatric Rehabilitation.

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    Offers structured activities related to empowerment and recovery that can be accomplished through self-help or in professionally led groups.

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Supported Education

The education of people with a serious mental illness is often disrupted because of that illness, which frequently begins at about the same time that young adults are attending college. Supported education (SEd) services help students with psychiatric disabilities successfully attend college or trade school. Mowbray, et al. 2000 and Mowbray, et al. 2005 reflect the work of the originators of supported education for people with mental illness. The University of Kansas Supported Education Group website contains the most current information in this area.

  • Mowbray, Carol T., Kaaren Strauch Brown, Kathleen Furlong-Norman, and Anne Sullivan-Soydan. 2000. Supported education and psychiatric rehabilitation: Models and methods. Columbia, MD: International Association of Psychosocial Rehabilitation Services.

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    Reviews the academic support needs of people with psychiatric disabilities and describes the variety of supported education programs operating across the United States.

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  • Mowbray, Carol T., Mary E. Collins, Chyrell D. Bellamy, Deborah A. Megivern, Deborah Bybee, and Steve Svilvagyi. 2005. Supported education for adults with psychiatric disabilities: An innovation for social work and psychiatric rehabilitation practice. Social Work 50, no. 1: 7–20.

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    Gives a concise description of the mission, principles, and service components of supported education. It also covers the literature regarding the effectiveness of this new service model.

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  • University of Kansas School of Social Welfare, Office of Mental Health Research and Training. Supported Education Group.

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    Website containing articles, bibliographies, and other resources related to supported education training curricula, research, technical assistance, and program evaluation.

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Supported Housing and Housing Models

People with a serious mental illness often lack decent, affordable housing, which significantly impacts the quality of their lives and presents barriers to recovery. Nearly half have experienced homelessness at some point in their lives. Finding ways to end homelessness and offer desirable housing options to people with disabilities has been a priority for problem solving and coalition building across multiple governmental sectors, as described in Conrad, et al. 1999 and US Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) Transforming housing for people with psychiatric disabilities report. There is debate about how to best help people with mental illness reintegrate into residential communities. Yanos, et al. 2004 offers the housing first approach to this problem, and Rog 2004 evaluates outcomes of various approaches to addressing the problem.

  • Conrad, Kendon J., Michael D. Matters, Patricia Hanrahan, and Daniel J. Luchins, eds. 1999. Homelessness prevention in treatment of substance abuse and mental illness: Logic models and implementation of eight American projects. New York: Haworth.

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    Presents eight homelessness prevention programs for people with dual disorders of substance abuse and mental illness that were funded by the Substance Abuse and Mental Health Services Administration. It includes descriptions of the population served, the setting of services, the interventions provided, and the underlying rationale for the design of the program. Outcome measures are also included.

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  • Rog, Debra J. 2004. The evidence on supported housing. Psychiatric Rehabilitation Journal 27, no. 4: 334–344.

    DOI: 10.2975/27.2004.334.344Save Citation »Export Citation » Share Citation »

    Reviews the evidence base for supported housing and future directions for research. It also describes the principles and practices associated with the supported housing model.

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  • US Department of Health and Human Services. Substance Abuse and Mental Health Services Administration (SAMHSA). 2006. Transforming housing for people with psychiatric disabilities report. HHS Pub. no. 4173. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

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    Discusses the need to shift funding from board and care facilities to community residential settings that facilitate the recovery process for people with serious mental illness. It lists ten recommendations for enacting this reform.

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  • Yanos, Philip T., Susan M. Barrow, and Sam Tsemberis. 2004. Community integration in the early phase of housing among homeless persons diagnosed with severe mental illness. Community Mental Health Journal 40, no. 2: 133–150.

    DOI: 10.1023/B:COMH.0000022733.12858.cbSave Citation »Export Citation » Share Citation »

    A qualitative study of recently homeless individuals entering housing. The authors note that, after a long period of homelessness, housing results in improved community integration for some and others encounter challenges that can complicate the process of integration.

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Mental Health Policy

Mental health policy considers who, when, where, and how to treat and care for those with mental illness, including the scope of clinical practice, appropriate providers, and methods of payment. The early 21st-century emphasis on a recovery orientation is consistent with the values and orientation of psychiatric rehabilitation. While Carling 1995 is old, it provides a good orientation to community integration. Similarly Grob 1991, by a noted mental health historian, offers a seminal analysis of events and policies leading up to deinstitutionalization. Frank and Glied 2006 and Mechanic 2008 are more recent mental health policy books. Levin, et al. 2004 is an edited volume that takes a public health perspective on mental health services systems, targeting special populations.

  • Carling, Paul J. 1995. Return to community: Building support systems for people with psychiatric disabilities. New York: Guilford.

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    Offers a philosophical and historical foundation for one of the overarching goals of psychiatric rehabilitation services: community integration. Carling advocates a coordinated system of care in the community for people with serious mental illness that includes the empowered participation of consumers and family members.

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  • Frank, Richard G., and Sherry A. Glied. 2006. Better but not well: Mental health policy in the United States since 1950. Baltimore, MD: Johns Hopkins Univ. Press.

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    Described by a reviewer as a book that provides a wealth of information—but the information is well contextualized and is not a dense read.

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  • Grob, Gerald N. 1991. From asylum to community: Mental health policy in modern America. Princeton, NJ: Princeton Univ. Press.

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    Grob’s book is a seminal analysis of the events and policies in the United States leading up to the era of deinstitutionalization of patients from long-term psychiatric hospitalization to community living.

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  • Levin, Bruce Lubotsky, John Petrila, and Kevin D. Hennessy. 2004. Mental health services: A public health perspective, 2d ed. New York: Oxford Univ. Press.

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    Takes a public health perspective on mental health service system issues. It has specific sections on children, adolescents, the elderly, and alcohol and drug abuse services.

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  • Mechanic, David. 2008. Mental health and social policy: Beyond managed care. Boston: Pearson Education.

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    Offers a multidisciplinary approach to mental health policy and includes empirical information relating to evidence-based practices. It includes coverage of the federal reports, disparities in mental health care, and criminalization of mental illness.

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Stigma and Mental Illness

The public, perhaps informed by sensational media coverage and popular culture, has consistently viewed people with mental illness as dangerous, untrustworthy, and incompetent. These stigmatizing perceptions have oppressed people and disenfranchised them from needed treatment and from opportunities for full participation as citizens of the community. The citations in this section examine stigma from the various perspectives of a service consumer, Corrigan 2005; a service provider, On Our Own of Maryland n.d.; American society, Wahl 1995; and culture, Arbodela-Florez and Sartorius 2008.

  • Arbodela-Florez, Julio, and Norman Sartorius. 2008. Understanding the stigma of mental illness: Theory and interventions. Hoboken, NJ: Wiley.

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    Takes an international perspective in its examination of the many sources of the stigma of mental illness and how it is experienced at the individual, institutional, and social levels, and also evaluates programs designed to eliminate stigma.

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  • Corrigan, Patrick W., ed. 2005. On the stigma of mental illness: Practical strategies for research and social change. Washington, DC: American Psychological Association.

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    A compilation of the research endeavors of the Chicago Consortium for Stigma Research. It also includes first-person accounts of experiences with the stigma of mental illness.

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  • On Our Own of Maryland. n.d. Stigma in our work, in our lives.

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    Available from the Anti-Stigma Project of On Our Own of Maryland, 1521 South Edgewood Street, Suite C, Baltimore, MD 21227, this thirty-minute film explores sources of stigma in behavioral health care settings and raises the viewer’s consciousness about the insidious nature of the problem of stigma.

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  • Wahl, Otto F. 1995. Media madness: Public images of mental illness. New Brunswick, NJ: Rutgers Univ. Press.

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    Discusses the influence of popular novels, television, and film on public perceptions of people with mental illness as “lunatics” and mass murderers.

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Behavioral Health Systems Transformation

In response to the President’s New Freedom Commission on Mental Health report, 2003 that required a major overhaul of the American mental health service delivery system, the federal government, specifically the Substance Abuse and Mental Health Services Administration, issued an agenda for this transformative process. The major reports issued by the federal government are listed in this section. The del Vecchio and Frickes 2007 special issue of Psychiatric Rehabilitation Journal is included because it delineates new practices, particularly from a consumer perspective, as del Vecchio, a social worker, and Frickes are both consumers.

Research and Education Centers

The National Institute on Disability and Rehabilitation Research (NIDRR), part of the US Department of Education, sponsors thirty-three Rehabilitation Research and Training Centers (RRTCs) that coordinate research aimed at developing new knowledge about effective services that “promote maximum social and economic independence for persons with disabilities.” The Rehabilitation Research and Training Centers at Boston University, the University of Illinois at Chicago, and the University of Pennsylvania are dedicated specifically to people with serious mental illness. The US Department of Veterans Affairs funds ten Mental Illness Research, Education and Clinical Centers (MIRECCs) that aim to improve health care and mental health care for veterans with mental illness. Two centers with resources particularly relevant to psychiatric rehabilitation are the Veterans Affairs Desert Pacific Healthcare Network Mental Illness Research, Education and Clinical Center, which is devoted to psychotic disorders, and the Veterans Affairs Capitol Health Care Network Mental Illness Research, Education and Clinical Center, which is focused on schizophrenia.

Information Centers

This section identifies Internet sites that offer accurate and current information on issues related to psychiatric rehabilitation and the treatment of behavioral disorders. Two university-sponsored sites are listed here, the UCLA Center for Research on Treatment and Rehabilitation of Psychosis and the Assertive Community Treatment (ACT) Center of Indiana, which is hosted by Indiana University–Purdue University, Indianapolis. These centers specialize in specific areas of psychiatric rehabilitation practice and can tend to be somewhat rigorous even for scholars. Information and resources for a more general audience can be found at HealthHaven and the National Rehabilitation Information Center. The federally funded US Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) National Mental Health Information Center and Center for Mental Health Services offers comprehensive information about treatment services, diagnosis facts, and research regarding mental illness and co-occurring substance use disorders. These sites offer resources for all levels of inquiry, from consumer or caregiver to provider or scholar.

Professional Organizations

Several US and international professional organizations represent the interests of psychiatric rehabilitation practitioners and their service recipients. The oldest organization, founded in 1974, was originally called the International Association of Psychosocial Rehabilitation (IAPSRS), but in 2002 it split to form two national organizations, the US Psychiatric Rehabilitation Association (USPRA) and Psychosocial Rehabilitation Canada/Réadaptation Psychosociale Canada (PSR/RPS Canada). The World Association of Psychosocial Rehabilitation was formed in France in 1986.

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