Treatment and rehabilitation of severe mental illness.

Spaulding, W. D., Sullivan, M. E., & Poland, J. S. New York, NY: Guilford Publications 2003, 386 pages, $45.00 cloth

In just 386 pages, this book takes the reader through a comprehensive review of the field of psychiatric rehabilitation, using an integrated paradigm for the treatment of individuals with severe mental illness that incorporates all of our current knowledge of rehabilitation and recovery. Both historical and current psychological theories and mental health concepts are described and the disparities of thought and practice that currently divide the mental health field are conveyed. The authors provide a concrete framework for a comprehensive team-approach to treating individuals with severe mental illness along with the rational for using such an approach and the steps to take if the team is not able to reach agreement. This framework, which includes the perspective of the individual with severe mental illness, allows for the incorporation of evidence-based practices as well as requirements to develop a cost-effective rehabilitation program.

The authors begin with an overview of 17th century "Moral therapy" and progress through the development of the medical model in the 19th and 20th century to the various paradigms of the second half of the 20th century that accompanied deinstitutionalization. After describing psychopathology, they explain deficiencies in the medical model and our current diagnostic system. The authors also explain concepts like therapeutic community, social learning theory, and psychiatric rehabilitation, as well as the effect of the development of psychotropic drugs and psychopharmacology.

This integrated paradigm incorporates a clinical approach, which uses a hypothetico-deductive model to develop a rehabilitation plan. It allows for the defining of multiple problems based on functional assessment and functional analysis of behavior with goals that are meaningful and measurable. Each problem is given a prescribed intervention and method for assessing results. Some problems are not addressable until the person with severe mental illness has reached certain levels of recovery (acute, post-acute, and residual stages). Progress, or the lack of progress, is then evaluated and the process continues with formulating, testing, and reformulating the problem and treatment plan. These problems may be neurophysiological, neurocognitive, sociocognitive, sociobehavioral, sociobehavioral, and/or socioenvironmental in nature.

The authors note that some mental health systems currently have the goal of stabilizing an individual with a severe mental illness and treating the person to prevent relapse back to the acute phase, which would require hospitalization. The goal of the integrated paradigm, which the authors present, goes beyond stabilization towards improvement of the personal and social functioning of the individual. The authors systematically address assessment and treatment techniques from the neurophysiological level to the level of person-environment interactions. The book includes a case study of an individual with a severe mental illness in chapter 2, which is then used as an example to discuss the integrated paradigm in chapters 4-10. Appendices 1-2 provide a detailed listing of the problems that were defined for this individual as well as the rehabilitation plan and progress evaluation documents. Appendix 3 provides an algorithm for treatment and rehabilitation of schizophrenia.

As a rehabilitation counseling student with a specialization in psychiatric rehabilitation, I have been working to comprehend the philosophy of recovery along with its theoretical and political overtones. Treatment and Rehabilitation of Severe Mental Illness has given me this understanding. From my perspective, the authors have managed to remain politically neutral in describing the current status of the field, while conveying an understandable and comprehensive framework that treats individuals with severe mental illness towards recovery. As a result, this book would be of interest to anyone involved in the treatment and rehabilitation of people with severe mental illness. This includes consumers, family members, policymakers (both public and private), mental health professionals (e.g., nurses, psychiatrists, psychologists, rehabilitation counselors, and social workers), and administrators of hospitals and rehabilitation facilities. Faculty and students who are interested in psychiatric rehabilitation could also benefit from reading this book.

Joanne Kundrat

Rehabilitation Counseling master's student

Pennsylvania State University