The future of psychiatric rehabilitation

Systematic Review on End-Users' Perception of Facilitators and Barriers in Accessing Tele-Rehabilitation Services

Psychiatric rehabilitation is a therapeutic approach that encourages people with mental illness and intellectual disabilities to develop their inherent capacities through learning and environmental support. Psychiatric treatment (pharmacological and psychological) controls psychiatric symptoms; psychiatric rehabilitation focuses on functioning and role outcomes. The review aimed to explore the end-user's perception of facilitators and barriers in accessing psychiatric tele-rehabilitation services. Various electronic databases like Web of Science, Scopus, PubMed, Research Gate, Science Direct, ProQuest, Springer, Wolters-Taylors, Elsevier, PsycINFO, and Wiley online library were searched using Google scholar. Inclusion criteria were studies including psychiatric rehabilitation, web-based interventions, and facilitators and barriers in accessing psychiatric tele-rehabilitation services. A systematic search identified 13 studies, including quantitative, qualitative, and mixed-method approaches. The results identified were based on the facilitators and barriers in accessing telerehabilitation. The common themes identified in this review are (1) facilitators of telerehabilitation, (2) barriers of tele-rehabilitation, and (3) expectations in tele-rehabilitation. The facilitating factors include an internet-enabled device, cost/financial benefits, ehealthcare knowledge, technology as a valuable and accessible tool, motivational factors, satisfaction and willingness. The barriers include affordability to the internetenabled device, network connectivity, lack of technical skills, and digital literacy. Expectations include some modifications needed to carry out effective practices of psychiatric tele-rehabilitation. Effective tele-rehabilitation helps people with mental illness and intellectual developmental disorders for their optimal functioning/quality of life.

Change of home visit frequency by public health nurses predicts emergency escorts for psychiatric patients living in the community: A retrospective medical record review

Background

Improper or insufficient treatment of mental health illness harms individuals, families, and society. When psychiatric treatment shifts from a hospital-based to a community-based health care system, risk management is essential to the provision of effective care.

Objective

We examine whether an upgrade in home visit frequency of psychiatric patients as identified by public health nurses can predict the subsequent need for emergency escort services for medical treatment.

Design

A 2-year retrospective medical record review.

Settings

A district of New Taipei City in Taiwan.

Participants

A total of 425 patients with a diagnosed mental health illness cared for through home visits by public health nurses from January 2018 to December 2019.

Methods

We accessed the Ministry of Health and Welfare's psychiatric care management information system to identify a set of medical records, and analyzed these records using chi-square and regression analyses.

Results

The analyses indicated that the groups experiencing the greatest need for emergency escort services were: male, 35-49 years old, with a senior high school level of education, without a disability identification card, with a schizophrenia diagnosis, and had been reported by the nurse as having progressed to a serious level. Nurses' increased frequency of home visits (an indicator that the patient's overall condition was worsening) and nurses' reports of increased severity of problems were significant predictors of the need for emergency escort services.

Conclusions

The nurses' adjustment of visit frequency based on the results of the visit assessment predicts the need for emergency escort services for mental patients. The findings support not only the professional roles and functions of public health nurses, but also the importance of strengthening psychiatric health community support services.

"Why I stay in community psychiatric rehabilitation": a semi-structured survey in persons with schizophrenia

AIMS

Although community psychiatric rehabilitation plays an important role in returning persons with schizophrenia to the society, many patients in China stay in rehabilitation centers for longer periods of time and subsequently fail to integrate. This study is aimed to explore the underlying causes of this trend and identify possible solutions.

METHODS

This study used a qualitative descriptive design to examine the persons with schizophrenia who stay in rehabilitation centers for longer periods of time. The researchers conducted semi-structured telephone interviews with the patients recruited through purposeful sampling. The audio-recorded interviews were transcribed in transcripts in Chinese. Thematic analysis was performed using Colaizzi's 7-step method.

RESULTS

Most patients believe that they have gained knowledge, improved skills, friendship and social circles through community mental rehabilitation, with the sense of belonging and enriched life strongly attracting them to the rehabilitation centers. They felt that the difficulty of further integration into society is mainly because of social prejudice and rejection. In addition, the activities of community mental rehabilitation meet the needs of social communication, which also hinder patients from further entering the society.

CONCLUSIONS

Persons with schizophrenia with long-term stay in community mental rehabilitation centers meet their friendship, sense of belonging and social needs by participating in rehabilitation activities. Providing special social opportunity for these patients can get them out of the rehabilitation center. Overall, it is possible for patients to gradually return to society in a collective form.

Clubhouse Model of Psychiatric Rehabilitation in China to Promote Recovery of People With Schizophrenia: A Systematic Review and Meta-Analysis

Background: Whether the clubhouse model of psychiatric rehabilitation is well-implemented in China and whether patients with schizophrenia successfully achieve symptom remission and functional recovery through engaging in the clubhouse remain unclear. Methods: Seven electronic databases were searched for relevant articles from inception to April 21, 2021. Quality assessment, data synthesis, and subgroup analysis were performed on the included studies. Results: Seven randomized controlled studies with 682 participants were included in the present meta-analysis. The clubhouse model of psychiatric rehabilitation has a significant effect on promoting the remission of psychiatric symptoms, especially negative symptoms. However, it does not show a definite effect on promoting recovery of positive symptoms. The clubhouse model of psychiatric rehabilitation has a significant effect on promoting social functioning recovery, reducing the family burden, improving the quality of life, and promoting the remission of depressive and anxiety symptoms of patients with schizophrenia in China. Conclusions: Our findings suggest that the clubhouse model of psychiatric rehabilitation can promote the remission of symptoms and functional recovery of Chinese with schizophrenia. It may be suitable to address the urgent need for better mental health services in China.