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Introduction to the special issue emerging issues in psychiatric rehabilitation.

Psychiatric rehabilitation is multidisciplinary and broad, cross-cutting field, with disciplines such as social work, psychology, psychiatry, and rehabilitation counseling which have focused their efforts on improving services and systems for people who have psychiatric disabilities. Each discipline offers unique contributions to the field, united around a common purpose. Rehabilitation counseling has typically focused on vocational rehabilitation services and employment outcomes. Understanding of psychiatric rehabilitation varies across disciplines, services, and systems. Psychiatric rehabilitation is much more than 'counseling' or 'treating' people who have been diagnosed with mental health disorders, it involves promoting full recovery, facilitating community integration, and developing or improving functioning in preferred life roles (Anthony, Cohen, Farkas, & Gagne, 2001; USPRA, 2009).

New issues are emerging in the field of psychiatric rehabilitation that particularly interest rehabilitation counselors, researchers, and educators, such as a heightened awareness of the concerns of veterans returning from Iraq, high mortality rates of people with psychiatric disabilities due to co-occurring physical health conditions, and the complications in employment and other life domains posed by co-morbid conditions such as traumatic brain injury, substance use disorders, and physical health problems. These issues renew our attention to addressing the challenges in enhancing rehabilitation for people with psychiatric disabilities in meaningful community participation. This issue focuses on some of these emerging issues that are facing psychiatric rehabilitation and rehabilitation counseling.

In 2006, the National Council on Rehabilitation Education (NCRE) approved the development of the Council on Psychiatric Rehabilitation. The co-authors of this Introduction to the Special Issue have served as the first Chairs of the Council beginning with Dr. Connie McReynolds in 2006, Dr. Michael According in 2007-08 and Dr. Kim MacDonald-Wilson in 2008-10. The Council on Psychiatric Rehabilitation provides a forum for professionals dedicated to psychiatric rehabilitation education to share information, exchange ideas to promote research in psychiatric rehabilitation, and enhance the education and training of rehabilitation counselors to improve rehabilitation outcomes for people with psychiatric disabilities. In addition, the Council fosters networking and dissemination of information about psychiatric rehabilitation, and sponsors special programs during the annual NCRE conference.

As an outgrowth of the priorities established by the Council, dissemination of information related to psychiatric rehabilitation in rehabilitation counseling is one of the primary objectives. From this focal point came the development of this special issue dedicated to Emerging Issues in Psychiatric Rehabilitation. This special issue includes the following articles particularly relevant to this topic: veterans with psychiatric disabilities, Vocational Rehabilitation (VR) consumers with psychiatric disabilities and substance use disorders, and people with co-morbid psychiatric and physical health conditions.

The first article by Burke, Degeneffe, and Olney on Iraq war veterans with traumatic brain injuries and post-traumatic stress disorders discusses the complications experienced by returning veterans with a combination of TBI and PTSD. The article describes various interventions, initiatives in the Veterans Administration (VA) to respond to veterans with TBI and PTSD, and issues for veterans in accessing and using needed services to recover and reintegrate into meaningful life roles back in the U.S. Implications for rehabilitation counselors to address the unique needs of Iraq veterans with TBI and PTSD are described.

With the increased focus on veterans with psychiatric disabilities, efforts are underway to incorporate recovery-oriented approaches into psychiatric rehabilitation services. However, measures of recovery used with other consumers diagnosed with psychiatric disorders have not been validated with veterans with psychiatric disabilities. In the second article by Kaczinski, Rosenheck, and Resnick, recovery in veterans with psychiatric disabilities is examined with measures of empowerment and confidence. The authors discuss the implications of the findings for the conceptualization of the recovery construct.

In the third article, Gill, Murphy, Burns-Lynch, and Swarbrick explore the competencies needed by veterans working as Peer Specialists in the Veterans Administration. Since 2005, people who have experience as consumers have worked as Consumer Providers (CPs) in the VA delivering services to veterans with psychiatric disabilities such as providing support, teaching knowledge and skills to manage symptoms in order to live, work, learn, and socialize in the community. Gill et al. describe a process to identify the specific role competencies of CPs in the VA that can then be used to develop effective academic training programs for CPs.

In the fourth article, Donnell, Mizelle, and Zheng examine the VR services of consumers with psychiatric and substance use disorders. Estimated co-occurrence of these disorders is as high as 50% and is believed to significantly affect employment outcomes. Using the Longitudinal Study of the Vocational Rehabilitation Services Program database, (LSVRSP; Cornell University ILR School, Employment and Disability Institute, 2003), Donnell et al. examine the characteristics, employment outcomes, recovery-related outcomes, and the relationships between these variables for people diagnosed with both psychiatric and substance use disorders served in the state VR system.

In the fifth article, Gill, Murphy, Zechner, Swarbrick, and Spagnolo describe the challenges and strategies in working with people who have both psychiatric and physical health disorders. People with psychiatric disabilities are dying on average 25 years earlier than the general population, in large part due to co-occurring health conditions such as diabetes, obesity, cardiovascular disorders, etc. These medical co-morbidities not only shorten their life span, but affect the pursuit of personal goals in interpersonal relationships, higher education, independent living, and employment. Rehabilitation professionals serving persons with psychiatric disabilities can learn and implement interventions that improve overall health and promote a wellness lifestyle.

In closing, the articles contained within this Special Issue are designed to stimulate discussion among practitioners, administrators, scholars, and educators to promote an increased awareness of the emerging issues faced by individuals with psychiatric disabilities. It is further hoped this Special Issue will serve as an incentive for further research and dissemination of psychiatric rehabilitation in the field of rehabilitation counseling.


Anthony, W., Cohen, M., Farkas, M., & Gagne, C. (2001). Psychiatric rehabilitation, 2nd edition. Boston, MA: Center for Psychiatric Rehabilitation, Boston University. USPRA. (2009). Advancing a recovery-based practice. Retrieved on March 30, 2009 from


1. Burke, H. S., Degeneffe, C. E., & Olney, M. F. A new disability for rehabilitation counselors: Iraq war veterans with TBI and PTSD.

2. Kaczinski, R. Rosenheck, R. A., & Resnick, S. G. A psycho metric study of empowerment and confidence among veterans with psychiatric disabilities.

3. Gill, K. J., Murphy, A. A., Burns-Lynch, W., & Swarbrick, M. Delineation of the job role of peer support specialists in the Veterans Administration.

4. Donnell, C. M., Mizelle, N. D., & Zheng, Y. (2009). Consumers of vocational rehabilitation services diagnosed with psychiatric and substance use disorders.

5. Gill, K. J., Murphy, A. A., Zechner, M. R., Swarbrick, M., & Spagnolo, A. B. Co-morbid psychiatric and medical disorders: Challenges and strategies.

Kim L. MacDonald-Wilson

University of Maryland--College Park

Connie McReynolds

California State University San Bernardino

Michael P. Accordino

Springfield College

Kim L. MacDonald-Wilson, Assistant Professor, Rehabilitation Counseling, Director, Psychiatric Vocational Rehabilitation Programs, University of Maryland--College Park, 3214 Benjamin Building, College Park, MD 20742. Email:
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Author:MacDonald-Wilson, Kim L.; McReynolds, Connie; Accordino, Michael P.
Publication:The Journal of Rehabilitation
Article Type:Editorial
Geographic Code:1USA
Date:Jul 1, 2009
Previous Article:Psychiatric Rehabilitation (2nd ed.).
Next Article:A new disability for rehabilitation counselors: Iraq war veterans with traumatic brain injury and post-traumatic stress disorder.

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