A Therapist's Guide to Psychiatric Rehabilitation Programs (PRP) For Adults

In 2019, over 13 million adults had serious mental illnesses (SMI) in the United States, and only about 65% of those adults received mental health services. These serious mental illnesses are determined by disorders resulting in severe functional impairment that limits or burdens major life activities.

Some examples of serious mental illnesses can include various types of schizophrenia, bipolar disorder, major depression and other overlapping mental illnesses. Over the years, therapeutic and psychiatric services have evolved to accommodate and provide support and independence for individuals living with mental illnesses. These services and programs are often designed for those that have trouble keeping a job, socially interacting with others or maintaining personal and household activities.

Table of Contents

What Is a Psychiatric Rehabilitation Program?

Adults who struggle with various mental health issues will sometimes be admitted to a PRP. PRP stands for psychiatric rehabilitation program, and it aims to provide a wide range of services, treatment and support for mentally ill adults. These programs focus on improving the patient's quality of life, recovery and outcomes and successfully integrating them with social and community resources. PRPs can include day and residential programs designed to support independent living skills.

These skills can include vocational skills, personal hygiene and daily activities. These programs aim to help individuals build and strengthen their sense of community and self-sufficiency. PRPs also focus on the patient's unique qualities, needs and symptoms to provide appropriate therapy and medication.

Principles of Psychiatric Rehabilitation

The principles of psychiatric rehabilitation help ensure specific goals are met that reflect psychiatry's values. Essentially, any person receiving services can and should request that every service or treatment they receive reflect these principles. The Psychiatric Rehabilitation Association (PRA) Code of Ethics provides these principles, guidelines and values, which serve as a guide of conduct for providers and practitioners.

These principles vary in definition and are not ranked in any specific order but are fundamental to the psychiatric rehabilitation field and profession. Here are the 12 guidelines based on principles set by the PRA:

Principle 1

Psychiatric rehabilitation practitioners display respect, hope and the belief that all individuals can learn and grow, regardless of their background. Practitioners should always believe that there is room for improvement for each person.

Principle 2

Psychiatric rehabilitation practitioners recognize that an individual's culture plays a vital role in their recovery and aim to provide culturally relevant services. This is important because individuals with mental illness come from all different backgrounds and experiences.

Principle 3

Psychiatric rehabilitation practitioners create partnerships with the family, friends or support system of the individual receiving services. Practitioners work to keep them informed and allow them to share in the decision-making process during treatment.

Principle 4

Psychiatric rehabilitation practitioners focus on the individual's unique strengths. This principle allows practitioners to focus on what patients can do and build on those abilities.

Principle 5

Psychiatric rehabilitation practices are designed and implemented to address an individual's specific needs, hopes, aspirations and values. This principle ensures that treatment is person‐centered and aligns with an individual's goals for recovery.

Psychiatric rehabilitation practices

Principle 6

Psychiatric rehabilitation practices support individuals in their recovery to integrate with their community. This principle helps to maintain the individual's rights of citizenship and assists them in accepting responsibilities and discovering new opportunities as valuable members of society.

Principle 7

Psychiatric rehabilitation practices promote and support an individual's empowerment and self-determination. This principle emphasizes that all people have the right to make their own decisions, especially about the services and treatment they receive.

Principle 8

Psychiatric rehabilitation helps develop personal support systems and networks within an individual's community. This social network could consist of peer support, individual therapy, group therapy or other support.

Principle 9

Psychiatric rehabilitation practices aim to help individuals improve their quality of life. These practices strive to enhance all aspects of life, such as social, educational, financial, occupational and other areas that affect an individual's fulfillment.

Principle 10

Psychiatric rehabilitation programs encourage the health and wellness of every individual, ensuring they identify objectives and create unique wellness plans. This principle helps those with mental illness simultaneously receive treatment and achieve recovery while maintaining their comfort and security.

Principle 11

Psychiatric rehabilitation services emphasize utilizing the best evidence-based healthcare practices for every individual. These practices should successfully produce outcomes that align with the individual's recovery goals and intentions. Treatment programs should be evaluated and regularly improved for quality according to the person receiving the services.

Principle 12

Psychiatric rehabilitation services must be available and accessible to any individual in need, regardless of their mental illness or psychiatric circumstances. These programs and services should maintain a sufficient level of coordination and offer the individual a combination of other psychiatric, medical and holistic practices and treatments.

These twelve principles each fall under a category of one of the following in the Psychiatric Rehabilitation Association Code of Ethics:

  • Ethical behavior
  • Integrity
  • Freedom of choice
  • Justice
  • Respect for culture and diversity

These principles and values are fundamental for practitioners to find the appropriate psychiatric rehabilitation program for individuals and support their progress to meeting their goals and outcomes.

Types of Psychiatric Rehabilitation Program Models

There are a few different types of rehabilitation program models depending on the patient's diagnosis, severity of symptoms, willingness to participate and several other factors. The Psychiatric Rehabilitation Model lays out the framework for the different stages of severe mental illness and how they align with the rehabilitation services required for an individual:

  1. Impairment: Mental illness that presents a loss or abnormality of psychological or physiological function or anatomical structure is identified as impairment. This can be displayed in various forms, such as hallucinations, delusions or depression.
  2. Dysfunction: An individual with mental illness at this stage lacks the ability or restrictions to perform typical tasks or activities that are considered normal. This could include a lack of social and work adjustment skills or activities of daily living (ADL) skills.
  3. Disability: Mental illness at this stage can result in restrictions or lack of ability to perform a role considered normal for a human being, displayed in the form of unemployment or homelessness.
  4. Disadvantage: Severe mental illness in this stage presents a lack of opportunity for the individual that limits or prevents them from doing an activity or fulfilling a normal role based on their age, sex and cultural and social factors. These disadvantages can include discrimination and poverty.

These guidelines help mental health providers and therapists determine the type of appropriate treatment and rehabilitation for each patient. Psychiatric rehabilitation values the needs for patients in these stages as well as their involvement, choice, strengths, growth potential and provider outcome accountability during treatment and training. There are a variety of mental health treatment settings and levels of care depending on the rehabilitation model and individuals' circumstances.

Types of Psychiatric Rehabilitation Program Models

The following are different types of general licensed psychiatric rehabilitation program models that an individual might benefit from:

  • Outpatient programs: These programs are defined as treatment involving no overnight stays at a facility or clinic, such as day treatment. These programs can be located in mental health centers, general hospitals or private practices. Individuals in outpatient settings can receive services from various mental health providers, such as individual and group therapy or medication management.
  • Inpatient or hospitalization programs: These programs involve overnight or longer stays for severely ill mental health patients who need around-the-clock care. Usually, the inpatient stays last about 30 days. Then, the individual will be transferred to another psychiatric facility or residential program.
  • Housing or residential programs:These programs are a type of inpatient service that helps patients whose mental illness has drastically impaired their ability to function. Housing programs provide patients with a sense of independence while learning basic daily activities and strengthening their social skills. Residential programs often provide long-term treatment and medical care but are designed to be more comfortable than the typical hospital setting.

More specifically, patients can receive treatment and achieve outcomes from various organizational program structures that fall within the previous three categories, including:

ACT Programs

Assertive Community Treatment, or ACT programs, are a comprehensive and local-based treatment model for individuals with serious mental illness. These programs work on a service-delivery model that provides individualized treatment in a person's home. This way, the individual can benefit from around-the-clock treatment, care and services that they would receive in a psychiatric unit but be more comfortable in their own home.

ACT program team members are trained in various fields, such as vocational rehabilitation, social work, psychiatry and other treatment services to ensure every patient receives ongoing support to help alleviate their symptoms. ACT programs are also a great way for patients to feel a sense of independence while treating their mental illness.

The primary goals of ACT are to reduce or eliminate the debilitating symptoms of mental illness that prevent an individual from meeting basic needs. This program also aids in lessening the burden on an individuals' family to provide care while helping them improve in social and employment roles.

Some of the key features of ACT programs include:

  • Behavioral skill teaching
  • Collaboration with families
  • Group therapy
  • Medication
  • Support for employment, housing, money-managing and education

Clubhouse Programs

The Clubhouse model combines an intentional therapeutic community with the support and promotion of employment, education, housing and health and wellness. This program is often a cheaper alternative to a psychiatric stay in a hospital setting. It allows individuals who have mental illnesses to live in an environment of shared work and purpose. Clubhouses emphasize the sense of community, membership and belonging as means to recovery.

While members are staying in a Clubhouse, they will have access to many different opportunities that enable them to successfully rejoin societal support. In contrast to ACT programs, Clubhouse programs bring individuals together to live in a healthy, restorative environment to rely on others who are also in the process of recovery. For many people whose lives have been severely disrupted due to their mental illness, living and engaging with others who are going through the same thing can make them feel less isolated.

Clubhouse programs may also help individuals feel hope in treating their mental illness and increase their confidence and participation during rehabilitation. Clubhouses are usually voluntary and self-determined, so individuals can stay and receive treatment and healthcare services in their chosen timeline.

IPS Programs

IPS psychiatric rehabilitation PRP programs

Individual Placement and Support Programs, or IPS, are rehabilitation interventions for those with debilitating mental illness. This program focuses on supported employment so those with severe behavioral health conditions can work jobs of their choosing. Using various forms of education and technical training, individuals can learn skills that help advance their career paths.

When individuals with severe mental illness are also unemployed, it may add to their feelings of low self-esteem and alienation. These strong feelings may sometimes lead to increased symptoms of their disorders, making it even more challenging to access and accept help. IPS programs emphasize the benefits of employment for those with mental health illnesses, such as:

  • Improved self-esteem
  • Enhanced quality of life and social skills
  • Reduced substance misuse and hospitalization

IPS programs are also another cost-effective treatment option that offers services to all individuals regardless of their diagnosis, symptoms or prior psychiatric hospitalizations.

The psychiatric rehabilitation process can be implemented in any of these program models in any setting. The importance of these programs is not necessarily the setting of the treatment as much as helping the individual become successful in recovery and feel fulfilled in living, working and thriving in social environments. These programs vary from state to state depending on different codes, rules and regulations for psychiatric rehabilitation services.

How to Track the Psychiatric Rehabilitation Process

The most crucial part of the psychiatric rehabilitation process is note-writing. Without proper documentation of an individual's symptoms, diagnosis, behaviors and progress, it would be very difficult for mental and behavioral health professionals to track their recovery. The major steps of any mental health rehabilitation program or service can be tracked to identify and measure how close a patient is to their intended outcome.

Here are the major steps of the service delivery process, which will vary for each individual:

  • Treatment
  • Crisis intervention
  • Case management
  • Rehabilitation
  • Enrichment
  • Rights protection
  • Basic support
  • Self-help
  • Wellness and prevention

The Diagnostic-Planning-Intervention (DPI) Process of Psychiatric Rehabilitation helps mental health providers keep track of these processes by segmenting them into three main phases:

  • Diagnosing phase: This phase determines an individual's readiness for rehabilitation. The practitioner will help the individual set goals and evaluate their strengths and skills in relation to their goals. This phase will also involve functional and resource assessments, which are important tools in the rehabilitation process.
  • Planning phase: This phase involves planning for resource and skills development to help reduce symptoms. A practitioner will also develop supports and high-priority objectives for the overall rehabilitation goals and set specific interventions for each one.
  • Intervention phase: In this phase, the rehabilitation plan is finally implemented to help achieve the set goals by changing the individual or their environment with the growth of their skills and supports.The intervention phase involves direct skills teaching and utilization as well as resource coordination and modification.

Tracking everything through documentation is essential because it can give the patient or participant a means to know they are moving along in their recovery toward their intended goal. Note writing is also important for the practitioner because it will help identify any changes that need to be made and find the focus for each session or treatment option. With tracking, mental health professionals can determine the level of documentation specificity needed according to the individual's needs.

PRP Note Writing With ICANotes

With proper documentation through ICANotes, you can efficiently record, track and update your patient's progress. ICANotes is the premier EHR for the behavioral health specialty, working with inpatient and outpatient settings to help bring you the most clinically robust and intuitive charting solution.

Our fully templated software allows you to document notes in a fraction of the time, access progress notes, create comprehensive initial assessments and develop treatment plans for a variety of services. With ICANotes, you can also share your patient's behavioral health chart with external medical and mental health professionals for simultaneous treatment. Maintaining thorough documentation is important, and it has never been easier with our software solution that offers plenty of efficient features to fit your patient's unique needs.

Start your free trial today or request a live demo online to see how we can reduce your documentation time.

ICANotes premier EHR for behavioral health

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