Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions

Abstract

The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incur high health care costs, and experience poor treatment outcomes. Given these barriers, questions remain about the extent to which siloed and fragmented care, as opposed to the complex nature of the illnesses themselves, contribute to poor outcomes. If given the opportunity to receive well-integrated, consistent, and personalized care, can patients with historically difficult-to-treat comorbid medical and mental illnesses make progress? This article describes an innovative model of care called functional rehabilitation that is designed to address existing barriers in treatment. The functional rehabilitation program seeks to disrupt the escalating effects of interacting comorbidities by offering highly collaborative treatment from a small team of clinicians, personalized interventions using a shared decision-making framework, multipronged treatment options, colocation in a large hospital system, and significant 1:1 time with patients. The article includes a case example with longitudinal outcome data that illustrates how progress can be made with appropriate programmatic supports. Future research should examine the cost-effectiveness of this model of care.

Acute onset of mania and psychosis in the context of long-COVID: A case study

“…She was referred to the Functional Rehabilitation Program within the Department of Psychiatry & Behavioral Health for an intensive, 5-week outpatient program known for working with complex co-occurring medical and psychiatric conditions ( Orme et al, 2022 ). Her treatment program included psychiatry consultation, intensive individual therapy from a panel of collaborating providers, and group therapy (e.g., psychoeducational, creative arts, and experiential/process groups).…”