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Table of Contents
Year : 2017  |  Volume : 14  |  Issue : 1  |  Page : 35-36

Evidence based best practices in psychiatric rehabilitation

1 Asst.Professor, ESIC college of Nursing, Indiaranagar, Bangalore, India
2 Head of the department, Department of Mental Health Nursing, MSRINER, Bangalore, India
3 Staff Nurse, NIMHANS, Bangalore, India

Date of Web Publication9-Jul-2019

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2231-1505.262421

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How to cite this article:
Vijayarani M, Balamurugan, Shindhe SS. Evidence based best practices in psychiatric rehabilitation. Indian J Psy Nsg 2017;14:35-6

How to cite this URL:
Vijayarani M, Balamurugan, Shindhe SS. Evidence based best practices in psychiatric rehabilitation. Indian J Psy Nsg [serial online] 2017 [cited 2023 Jun 1];14:35-6. Available from: https://www.ijpn.in/text.asp?2017/14/1/35/262421

  Introduction Top

Psychiatric rehabilitation has emerged as an important super speciality of psychiatry in last few decades[1].Psychiatric rehabilitation is rooted in the principles of physical rehabilitation, with its own knowledge base, philosophy and interventions[2]. There is a growing commitment to evidence-based practices in psychiatric rehabilitation. There is sufficient amount of literature, though not overwhelming, to have evidence based conclusions[1]. The term ‘psychiatric rehabilitation’ reflects the focus of this field on people with psychiatric disabilities and their improved abilities within their specific preferred role in the ‘real’ world, using the development of skills and supports as its primary types of interventions[1]. The overall purpose of a psychiatric rehabilitation service, as compared to other types of services, is to contribute to this outcome by enhancing functioning in a role valued by society and selected by the individual[2].The fundamental values of psychiatric rehabilitation, as integral an element of the field of rehabilitation as its evidence base, include the critical importance of empowerment and choice, partnership, hope, a focus on an individual’s strengths and interests as well as limitations, and an outcome or results orientation, among several others. Psychiatric Nursing has a long-established precedent of relying on tradition. Few psychiatric nurses can articulate the empirical basis for their actions, and much of their care is based on centuries-old wisdom and experiences passed down through the generations by word of mouth or in classic textbooks. While traditional modes of intervention are sometimes successful and certainly sincere, such interventions are seldom based on sound scientific data and principles[3].

Best Practices identified in Psychiatric Rehabilitation: Evidence-based practice is the systematic use of current best evidence to make clinical decisions for patient care[4]. Use of best evidence for clinical decision making improves patient outcomes, provides professional development opportunities, contributes to recruitment and retention of staff, and saves health care dollars[5]. Health care that is based on evidence has been found to lead to better clinical decisions and patient outcomes[6]. Reports reveals that the implementation of evidence-based practice was strongly associated with providers knowledge of evidence for specific interventions[7]. • Supported Employment: Helps consumers find meaningful jobs that fit their preferences, promoting the integration of consumers in the competitive job market.

Several Randomized controlled trials reveals that supported employment enhances competitive spirit, working hours and wages[1],[8].

  • Supported Housing: Clients rent or lease independent, affordable housing that is integrated into the community and it is separate from the mental health service agency. Randomized and quasi experimental studies highlights that supported housing helps the core strategy for realizing the goal of community integration[1].
  • Interpersonal Therapy: Studies shows that Interpersonal therapy was found superior to and more effective than CBT in reducing depressive symptoms. No differences were found between Interpersonal therapy and medication in treating depression, and the combination of IPT and medication was not superior to medication alone[9].
  • Illness Management and Recovery: Follows the principle of self-determination and believes that clients will make better decisions if they are in charge of their own lives and provided the means necessary to make informed choices. Randomized controlled trials shows that illness management and recovery increases awareness about illness, compliance, and coping and reduces relapse[1],[8].
  • Psychosocial Intervention: A range of psychosocial interventions are required, including psychological therapies such as cognitive–behavioural therapy adapted for psychosis, work with families to promote mutual understanding and reduce stress, art therapies and specific interventions for comorbid substance misuse, such as motivational interviewing. Wherever possible, interventions should involve self-management strategies[10].
  • Supported Education: Refers to a set of strategies for helping consumers pursue post- secondary education. Most uncontrolled studies reveals that Supported education interventions that focus on in vivo assistance may ultimately prove to be the most effective strategy[1].
  • Family psychoeducational: Systematic approach to educating families about mental illness and recovery. Randomized controlled trials shows that this intervention improves family relationships, awareness about mental illness, reduces family burdenand rates of relapse[1],[10].
  • Family interventions: Family interventions labelled family psycho education, behavioural family management, family aided assertive community treatment and multiple family group therapy are designed to actively engage families in the rehabilitation process[8],[11].
  • Peer support/ self-help/consumer operated services: clients offering mutual social emotional and/or instrumental assistance to other clients. Studies in this area reveals that peer support improves social network and quality of life and reduces relapse rates[1],[8],[11].
  • Assertive community treatment: It uses a multidisciplinary team approach to case management with shared caseloads and frequent staff meetings, intensive community-based services, focuses on assistance with daily living skills. Experimental and quasi experimental studies shows that it has been particularly effective in reducing hospitalizations and homelessness. Helps consumers maximize level of functioning in the community[11].
  • Social skills training: Social skills are interpersonal behaviours that are socially acceptable or sanctioned in a particular community or society. Cross sectional and intervention studies identified that social skills training is effective in improving social skills of patients with schizophrenia. Also it is effective in alogia, apathy and anhedonia, but not other domains of negative symptoms[1],[8],[11].
  • Cognitive Behaviour Therapy (CBT): A variety of therapeutic strategies aimed at improving the psychotic symptoms and social functioning of patients is collectively referred to as cognitive behaviour therapy. Review of literatures shows that it reduces the severity of psychotic symptoms and may contribute to reduction frequency of relapses. It also appears that positive therapeutic relationships higher levels of functioning, interact verbal learning and memory and at least modicum of insight into the illness contribute to good outcomes in CBT[11].
  • Vocational rehabilitation :The best validated and most rapidly developing vocational innovation is supported employment[11].
  • Substance abuse management module: evidences have reported that development and usage of Substance abuse management module has reduced the replaces and improves harm reduction statergies[11].

  Conclusion Top

The Evidence that people with mental illnesses can learn new skills is quiet strong. Social skills training is one of the most commonly used skills training method. The most well-known family support interventions are psycho-education group interventions. It is a systematic approach to educate families and patients about mental illness and recovery. Inclusion of family members as part of the treatment team enhances the effectiveness of other EBPs, reduces caregiver’s burden and enhances the satisfaction level of the family members. Supported employment helps consumers find meaningful jobs that fit their preferences, promoting the integration of consumers in the competitive job market.

  References Top

Pathak A, Chaturvedi SK. Review article A Systematic Review of Interventions in Psychiatric Rehabilitation. Int J Med Invest; 4: 272-281, http://www.intjmi.com (2015).  Back to cited text no. 1
Farkas M. Identifying psychiatric rehabilitation interventions? : an evidence and value based practice. World Psychiatry 2006; 5: 161-162.  Back to cited text no. 2
Jaclene A. Zauszniewski, M. Jane Suresky AKB& LK. Moving from Tradition to Evidence: A Review of Psychiatric Nursing Intervention Studies. Online J Issues Nurs; 12, 10.3912/OJIN.Vol12No02HirshPsy01 (2007).  Back to cited text no. 3
Sharan E Stratus, W Scott Richardson PG& RBH. Sackett, D.-. London: Churchill Livingstone., http://www.ncbi.nlm.nih.gov/pubmed/21878863 (2000).  Back to cited text no. 4
Sarah Cole Hirsh Institute for Best Nursing Practices Based on Evidence .Certificate in Implementing Best Nursing Practices Based on Evidence. Cleveland, 2005.  Back to cited text no. 5
Fineout-Overholt E, Melnyk BM, Schultz A. Transforming health care from the inside out: Advancing evidence-based practice in the 21st century. J Prof Nurs 2005; 21: 335– 344.  Back to cited text no. 6
Bernadette Mazurek Melnyk, Ellen Fineout-Overholt, Nancy Fischbeck Feinstein, Hong Li, Leigh Small, Larry Wilcox RK. Nurses’ perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: Implications for accelerating the paradigm shift. Worldviews Evidence-Based Nurs; 1: 185– 193, https://uttyler.influuent.utsystem.edu/en/publications/nurses-perceived-knowledge-beliefs-skills-and-needs-regarding-evi (2004).  Back to cited text no. 7
Corrigan PW. Recovery from schizophrenia and the role of evidence-based psychosocial interventions. Expert Rev Neurother 2006; 6: 993– 1004.  Back to cited text no. 8
Harry, Lovelock RM and KM. Evidence-based Psychological Interventions in the Treatment of Mental Disorders: A Literature Review. Australia, http://dx.doi.org/10.1016/S0002- 7 1 3 8 ( 0 9 ) 6 0 6 5 8 - 0\nhttp://linkinghub.elsevier.com/retrieve/pii/S00027138096065 80 (2010).  Back to cited text no. 9
Wolfson P, Holloway F, Killaspy H. Enabling recovery for people with complex mental health needs. A template for rehabilitation services, Enabling recovery for people with complex mental h.pdf (2009).  Back to cited text no. 10
Alex Kopelowicz CJW& RPL. Treatment of Psychiatric disorders. 4th editio. United states of America: American Psychiatric Publishing, 2007.  Back to cited text no. 11


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