Psychiatric Nursing

Outline

v  Introduction

v  Sheltered workshop

v  Correctional homes

v  Day care centres

v  Half way homes

v  Partial hospitalisation

v  Institutions India

v  Conclusion

v  References

INTRODUCTION

Community psychiatric nurses play an essential part in community care by:

v  Supporting patients and their families

v  Evaluating the patient’s clinical state

v  Supervising drug therapy, and

v  Encouraging social interaction.¹

So, knowledge of available rehabilitation facilities is essential for the nurses

WHAT IS PSYCHIATRIC REHABILITATION?

v  A person is considered to have disabilities when he/she persistently cannot perform up to the standards expected by the society.

v  Psychiatric patients have three kinds of disabilities:

·         impairment of function directly due to psychiatric symptoms, e.g. persistent hallucinations, social withdrawal, slowness in behaviour;

·         social disadvantages, e.g. unemployment, homelessness, stigma attached to being A psychiatric patient;

·         adverse psychological reactions, e.g. low self-esteem, helplessness, hopelessness.

v  Psychiatric rehabilitation includes two processes:

·         identifying, preventing, or minimizing the above three disabilities;

·         helping the person to develop and use his/her assets.

v  Rehabilitation also involves community nurses, social workers, occupational therapists, and even voluntary workers.

FACILITIES

Psychiatric rehabilitation facilities can be divided into non-residential and residential

v  Non-residential facilities include psychiatric day hospitals, psychiatric day training centres, sheltered workshops, and social clubs.

v  Residential facilities include halfway houses, compassionate rehousing, and long stay care homes.

In-patient care

v  With provision for occupational and social services

v  Sheltered work and recreational facilities in the walking distance.

Day Hospital

v  Patients attend for assessment, supervision of treatment and social activities

Out-patient Clinics

v  in the Community to avoid missing of appointments

v  Follow up by a community nurse

Psychiatric Day Hospital

v  As implied by its name 'hospital', the primary aim of this facility is treatment of psychiatric illnesses rather than rehabilitation of patients' disabilities.

v  Hence the key professionals involved are doctors and nurses.

v  The advantages of day treatment over in-patient treatment include more contact with the community, less risk of dependency, less social stigma, and less family disruption.

Psychiatric Day Training Centre

v  Aim of day training centres is rehabilitation of patients' disabilities, rather than the treatment of psychiatric illnesses.

v  Hence, there are no doctors and nurses.

v  The key professionals involved are social workers and occupational therapists.

v  Patients are usually expected to stay in the centre for rehabilitative training for about nine months.

v  While receiving training in the centre, patients have to return to psychiatric out-patient clinics for follow-up from time to time.

Sheltered Workshop

v  aim of this facility is for patients to work, rather than to receive rehabilitation.

v  This is reflected by the fact that patients can earn salaries, though meagre, for their production in the workshop, whereas in all other rehabilitation facilities, patients have to pay fees instead.

v  Patients work in sheltered workshops instead of finding open employment because they cannot perform up to the standards of normal people.

v  Compared with psychiatric day training centre, sheltered workshop has a much lower staff-to-patient ratio and no occupational therapist .

v  Patients‘ works are supervised mainly by non-trained staff.

v  Many psychiatric patients receive rehabilitative training in psychiatric day hospital or day training centre first.

v  After they have acquired sufficient occupational skills, they are then referred to sheltered workshop to practise these skills.

Social Clubs

v  Social club does not aim to rehabilitate patients actively.

v  It mainly provides recreational activities for patients to socialise among themselves, to prevent patients from idling alone.

v  The club may also organise educational gruops for club members selectively.

Halfway House

v  halfway house is a residential  rehabilitation facility.

v  It is indicated when patients have adverse home environment or no home at all, or when patients need rehabilitation in their social and domestic skills.

v  Halfway houses have no occupational therapist  and do not aim to train patients' occupational skills.

v  Residents usually go out to work in the day time.

Compassionate Rehousing

v  This facility is indicated for rehabilitated patients who cannot return to their families but who do not need to be placed in institutions.

v  Used by Govt. of Honkong

Long Stay Care Home

v  It is indicated for socially disabled mental patients who cannot live independently and who need care.

v  It is expected that only a small proportion of its residents can eventually be discharged back to the community.

v  Long stay care homes differ from psychiatric hospitals.

v  Here, a few hours of may be made available per week.

Correctional homes

v  For young child who has been found guilty of an offence that would be categorised as a crime if committed by an adult.

v  Many are boys between the age of 15-17 years

v  Eg: Correctional Home at Madiwala, Bangalore…

Psychosocial Rehabilitation Institutions in India

v  Centre for Rehabilitation- CIP : Rehabilitation services in the form of Occupational Therapy Unit from 1922.

v  NIMHANS- Comprehensive care and rehabilitation for psychiatric and neuro patients, NIMHANS created a separate department in 1985.

v  The Richmond Fellowship Society (India)

v  Vishwas Day Care Centre with Vocational Training

v  VIMHANS (Vidyasagar Institute of Mental Health and Neuro-Sciences)-New Delhi

Institutions in Kerala

v  IMHANS is an autonomous institution established by the State Government of Kerala in 1983.

v  Mental Health Centre, Kozhikode

v  Mental health Centre, Thrissur & Thiruvanathapuram

v  Shraddha Rehabilitation Foundation- Mumbai

v  Institute of Psychiatry, Kilpauk, Chennai

v  Kusumagiri Mental Health Centre ( KMHC)

CONCLUSION

Psychiatric patients have various disabilities that require rehabilitation. There are insufficient rehabilitation facilities in India. Researches on the needs and effectiveness of various facilities are urgently required. Nurses should assess patients' disabilities and then they should refer disabled patients to the appropriate facilities for rehabilitation.

REFERENCES

1.       Chiu LPW. Psychiatric Rehabilitation in Hong Kong. Honkong University Journal,10:9, 9:1988.

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