Psychiatric Rehabilitation Programs: Putting Theory into Practice.

This book is true to its title. The authors focus on putting a theory of psychiatric rehabilitation into practice by outlining the focus, values, principles, and programmatic elements of this approach to rehabilitation. They then proceed to illustrate this approach in action through the description and analysis of a number of state-of-the-art case examples.

The first chapter of this book, written by Farkas, Anthony, and Cohen, presents the theoretical perspective of psychiatric rehabilitation that is built largely around the work of the authors and their colleagues who are affiliated with the Boston University Center for Psychiatric Rehabilitation. This chapter is noteworthy for clearly explicating the psychiatric rehabilitation approach and by emphasizing its pragmatic aim of promoting the functioning of clients so they can be more successful and satisfied in their daily lives. The use of methods that build client skills and environmental supports also are outlined in this chapter.

The next five chapters operationalize this theory. The authors of each of these chapters discuss a substantive area relevant to daily living in which psychiatric rehabilitation can be applied to enhance client skill development as well as to develop and strengthen the environmental supports of clients. These five areas are housing, work, education, mental health systems, and supports.

The structure of these five chapters is exemplary and gives balance and symmetry to each chapter achieved through a consistent design. One section is devoted to a general overview of the particular substantive aspect of psychiatric rehabilitation while a second section is devoted to the presentation of case studies. A third section addresses barriers to the implementation of psychiatric rehabilitation within the specific substantive area as well as strategies for overcoming these constraints. Another section presents evaluation data concerning the impact of psychiatric rehabilitation and a final section identifies emerging concepts, issues, and models. By the time readers complete these chapters they not only will have a good understanding of psychiatric rehabilitation theory but they also will have a good sense of how this theory is implemented in practice.

Chapter Two is written by Carling and Ridgway and is devoted to housing. The authors identify major challenges to the creation of housing alternatives that respond to client preferences and that offer supports to enable people to be successful within their housing choice. Several case studies involving the creation of housing alternatives are then presented and evaluated. Consistent with the practice orientation of this volume, these case studies are authored by professionals who are incorporating psychiatric rehabilitation principles into their work.

The third chapter focuses on vocational rehabilitation and is written by Danley, Rogers, and Nevas. These authors discuss the importance of working with clients to develop a vocational identity including that of worker, member of an occupation, and an employee. A conceptual framework of vocational maturation is presented by combining these various forms of vocational identity with the key vocational steps of choosing, getting, and keeping employment. The four case studies taken directly from actual psychiatric rehabilitation programs illustrate how this model is implemented in action by demonstrating how psychiatric rehabilitation programs define vocational preparation or entry into the workforce as work and not as treatment, by emphasizing a "real world" orientation, and by clearly delineating the vocational objectives of clients.

Chapter Four is devoted to the emerging area of psychiatric rehabilitation through education. the author, Karen Unger, illustrates how clients can improve their community living skills as well as increase their career awareness and preparation through participation in educational programs actually based in continuing education, adult education, community college, or university settings. This chapter depicts psychiatric rehabilitation as unfolding through an educational process rather than through a treatment process using the core psychiatric rehabilitation methods of skill development and environmental support. Case studies illustrate the implementation of psychiatric rehabilitation within eduational settings. These case studies are taken from actual practice with one demonstrating the use of an educational model within a clubhouse setting and another one demonstrating the use of this model within the context of a university setting.

Chapter Five, written by Cohen, addresses the issue of integrating psychiatric rehabilitation into mental health systems. This chapter is especially relevant to administrators who are seeking to phase out traditional mental health services and to adopt a psychiatric rehabilitation model. The use of administrative functions such as planning, funding, management, program development, human resource development, coordination, evaluation, and advocacy are identified as tools to achieve structural change and to move mental health systems toward the incorporation of psychiatric rehabilitation principles. The case studies contained in this chapter outline the use of these system change functions and the use of technical assistance, knowledge utilization, and knowledge dissemination as a means of realizing and institutionalizing change.

Chapter Six, written by Nemec and Furlong-Norman, presents the use of environmental supports within the context of the psychiatric rehabilitation approach. Three supports are identified involving the provision of support through social networks, through case management, and through client and system advocacy. The case studies highlight these areas. One case study is devoted to the examination of a specific approach to case management that emphasizes continuing support of the client, service coordination, and advocacy. Another case study examines the involvement of ex-patient groups as mutual support systems. A third case study addresses the involvement of families and family-professional collaboration in psychiatric rehabilitation.

The final chapter written by Anthony and Farkas synthesizes the content and findings of the previous case study chapters and addresses the issue of "putting theory into practice." The theme of this chapter focuses on the design of psychiatric rehabilitation programs around client choices and preferences and the provision of the requisite resources to assist clients in attaining their desires and in fulfilling their needs. According to the authors, to achieve these ends, programs must be designed to achieve client outcome goals and not system outcome goals.

This volume represents a major contribution to the field of psychiatric rehabilitation. Administrators, practitioners, and consumers and their significant others will find this volume very practical and informative. Several strengths of this volume stand out. The emphasis placed by the editors and contributors on individualization, the achievement of client preferences, direct skills teaching, functional assessment, environmental support, and a tangible outcome orientation give the volume a distinctive, unique, and relevant character.

Nevertheless, there are some salient weaknesses. The advocacy component of the volume can be strengthened especially as this type of support delivered by psychiatric rehabilitation programs interfaces with formal rights protection and advocacy programs. Addressing this interface is important given recent developments in federal funding of state programs dedicated to rights protection.

Another weakness involves the sensitivity of psychiatric rehabilitation to certain client subgroups for whom the approach may need to be modified somewhat. These groups include people who are elderly, people coping with homelessness, young adults who may not want to] be involved in formal and highly structured programming, and people coping with both psychiatric and developmental disabilities. The content of the volume can be strengthened by addressing the needs of some of these groups.

Finally, despite its emphasis on client involvement, some consumers or ex-patients may argue that psychiatric rehabilitation may still involve the delivery of services by professionals who are dominant over clients by virtue of their ability to define the programmatic structure within which psychiatric rehabilitation occurs. This issue is implied somewhat by the case study addressing the role of expatient groups; yet, it is not discussed explicitly within the volume.

For those readers who are interested in serving and supporting people coping with psychiatric disabilities this volume is an excellent addition to professional libraries. I recommend it highly and I applaud the contributors for advancing our knowledge of psychiatric rehabilitation not only in terms of theory but also in terms of the translation of this theory into actual practice.

David P. Moxley, Ph.D., Associate Professor, School of Social Work, Wayne State University, Detroit, Michigan.