Foundations & Goals - Rehab Roadmap
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Key Domains - Life Skills Toolkit
| Domain | Key Interventions & Focus |
|---|---|
| Daily Living Skills | Training in fundamental Activities of Daily Living (ADLs) & complex Instrumental ADLs (IADLs). |
| Social Functioning | Social Skills Training (SST): Focus on improving conversation, assertiveness, and conflict resolution abilities. |
| Vocational Functioning | Vocational Rehabilitation: Utilizes Individual Placement and Support (IPS) model (📌 IPS = I Place Soon), supported employment, and sheltered workshops. |
| Cognitive Functioning | Cognitive Remediation Therapy (CRT): Aims to improve core cognitive deficits: attention, memory, executive functions. |
| Family Environment | Family Psychoeducation: Educates families to reduce relapse rates and enhance coping mechanisms. |
⭐ Individual Placement and Support (IPS) has the strongest evidence base for helping people with SMI find and keep competitive employment.
Models & Methods - Support Structures
Key approaches to provide ongoing support and skill development:
| Feature | Assertive Community Treatment (ACT) | Clubhouse Model |
|---|---|---|
| Target | Severe mental illness (SMI), high service needs | Adults with history of mental illness |
| Team | Multidisciplinary, low patient-staff ratio (e.g., 10:1) | Staff as generalists, work with members |
| Services | In-vivo (community), 24/7 crisis care, assertive | Centre-based, work-ordered day, voluntary |
| Focus | Symptom stability, daily function, crisis intervention | Strengths, peer support, vocational rehab |
| Governance | Team-led | Member-run, shared decision-making |
- Examples: Halfway homes, supervised apartments, group homes.
- Day Treatment Programs / Partial Hospitalization: Structured therapy & activities during the day.
- Occupational Therapy (OT): Focuses on improving daily living skills, vocational skills, and community integration.
⭐ ACT teams are highly effective in reducing hospitalizations and improving housing stability for individuals with severe and persistent mental illness.
Indian Context & Hurdles - Desi Challenges
- Major Hurdles:
- Widespread stigma & low awareness.
- Resource scarcity: ↓ trained manpower, ↓ infrastructure.
- Significant family burden.
- Key Initiatives & Legal Framework:
- National Mental Health Program (NMHP) & District Mental Health Program (DMHP): Aim to improve rehab access.
- Mental Healthcare Act, 2017: Protects rights, ensures rehab provisions.
- NGOs & community participation: Play a vital role.
⭐ The Mental Healthcare Act, 2017, mandates the government to provide access to a range of rehabilitation services.
High‑Yield Points - ⚡ Biggest Takeaways
- Goal: Optimal functioning & community integration, not just symptom reduction.
- Components: Pharmacotherapy, psychosocial interventions (CBTp, family therapy, social skills training), vocational rehabilitation.
- Supported employment (e.g., Individual Placement and Support - IPS) is superior to traditional vocational rehab.
- Assertive Community Treatment (ACT) for high-need individuals, reducing hospitalizations.
- Early intervention in psychosis services improves long-term outcomes.
- Family psychoeducation reduces relapse rates and caregiver burden.
- Cognitive Remediation Therapy (CRT) targets cognitive deficits, improving functional outcomes.
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