Psychiatric rehabilitation in Europe

Abstract

To describe the core elements of modern psychiatric rehabilitation. Based on selected examples we describe the discussion about values in mental health care with focus on Europe. We present outcome data from studies, which have tried to implement care structures based on this value discussion. In the second half of the 20th century, mental health care in all European and other high-income countries changed conceptually and structurally. Deinstitutionalisation reduced the number of psychiatric beds and transferred priority to outpatient care and community-based services, but community mental health programs developed differently across and within these countries. High-income countries in Europe continued to invest in costly traditional services that were neither evidence-based nor person-centered by emphasising inpatient services, sheltered group homes and sheltered workshops. We argue that evidence-based, person-centred, recovery-oriented psychiatric rehabilitation offers a parsimonious solution to developing a consensus plan for community-based care in Europe. The challenges to scaling up effective psychiatric rehabilitation services in high-income countries are not primarily a lack of resources, but rather a lack of political will and inefficient use and dysfunctional allocation of resources.

“Placement Budgets” for Supported Employment—Impact on Quality of Life in a Multicenter Randomized Controlled Trial

“…On the contrary, over six assessment points there is an improvement of the participants' QoL. It seems that entering such a SE program gives increasingly hope to the participants, as “hope” is a strong force in the rehabilitation process (1, 18). …”

“…In the original IPS model, support provided to find and keep employment is continued indefinitely. However, one of the major barriers for introducing SE in standard care in European countries is the unlimited provision of SE, which does not comply with health and social service legislation in many European countries (18). Since the main principle of IPS is “place first, then train,” one could argue that constraints on the time budget for selection of a job could impose stress on the participant.…”

‘Placement budgets’ for supported employment: impact on employment rates in a multicentre randomised controlled trial

“…1,8 In spite of these obvious advantages, most European countries continue to 'Placement budgets' for supported employment invest in costly traditional services like sheltered workshops, which are neither evidence based nor person centred. 2 One of the barriers to be overcome is that the IPS model, which demands indefinite support for the search and maintenance of competitive employment, is incompatible with health and social statutory service legislation in Europe. This is what our study was designed to investigate, i.e.…”

“…1 In Europe, the most common vocational services in the community are sheltered workshops, which aim at preparing affected persons to enter the competitive job market. 2 Unfortunately, sheltered workshops often turn out to be a dead end for those affected because the step to competitive employment is too large. 2,3 Currently, the most effective vocational rehabilitation model for job (re-)entry is supported employment according to the individual placement and support (IPS) model.…”

Scientific bases of the organization of psychiatric care: development of a conceptual framework of modern mental health services

“…Психосоциальная реабилитация -один из важнейших компонентов психиатрической помощи, направленный на интеграцию в общество лиц с тяжелыми психическими заболеваниями, восстановление их полного гражданства, улучшение качества жизни. Несмотря на то что в литературе достаточно подробно описаны концептуальные подходы к психосоциальной реабилитации [4,36,37], ее теоретический и практический базис нуждается в серьезных дальнейших разработках. В частности, на современном этапе психосоциальную реабилитацию следует рассматривать в качестве необходимого компонента системы планирования и разработки политики в сфере психического здоровья.…”