The Effectiveness of a Community Psychiatric Rehabilitation Program Led by Laypeople in China: A Randomized Controlled Pilot Study

Background: Community psychiatric rehabilitation has proven effective in supporting individuals and their families in recovering from mental illness. The delivery of evidence-based community rehabilitation services, however, requires health care workers to possess a set of specially trained knowledge and skills. Most developing countries, including China, do not have specially trained mental health personnel. The purpose of this study was to test the feasibility and efficacy of a community psychiatric rehabilitation program delivered by laypeople.Method: We conducted a randomized controlled study. Patients at two sites in Chengdu, China, were randomly assigned to either the laypeople-delivered (LPD) community psychiatric rehabilitation group (N = 49) or the drop-in center control group (N = 45). The outcomes were changes in symptoms, social functioning, and family functioning over 6 months, as measured by the Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance Scale (PSP), the Family Burden Scale of Disease (FBS), and the Family APGAR index.Results: The number of sessions received over the 12-week period of treatment ranged from 20 to 100%, with a mean completion rate of 77.32% for all 12 sessions. Statistically significant interactions between group and time were found for the total PANSS [F(2, 94) = 12.51, p < 0.001] and both the Negative PANSS [F(2, 94) = 5.89, p < 0.01] and Positive PANSS [F(2, 94) = 6.65, p < 0.01] as well as the PSP [F(2, 94) = 3.34, p < 0.05], FBS [F(2, 94) = 5.10, p < 0.01], and Family APGAR index [F(2, 94) = 4.58, p < 0.01]. The results showed that the experimental group outperformed their counterparts in symptom management, personal social functioning, family care burden, and coherence.Conclusion: These results support the feasibility and efficacy of having laypeople deliver psychiatric rehabilitation services. A discussion and limitations of the study have been included.

The benefit of an ambulant psychiatric rehabilitation program in Vienna, Austria: an uncontrolled repeated measures study

We investigated the benefit of a 6-week ambulant psychiatric rehabilitation program in an ambulant psychiatric rehabilitation clinic in Vienna, Austria, from January 2014 to December 2016 by an uncontrolled repeated measures study. The potential of this intervention program was assessed by effectiveness and cost measures using suitable statistical analyses. We compared the effectiveness and cost measures of this ambulant psychiatric rehabilitation program on patients for the period of up to 12 months after discharge to the period of 12 months before admission to the intervention program based on self-reported catamnesis questionnaires. For the program’s effectiveness measures, we accounted for both psychological indices for measuring depression severity, symptom burden, and functioning to document the health improvement of patients and economy-related indices such as the number of sick leave days for patients. For the program’s cost measures, both direct tangible treatment and medication costs and indirect tangible costs based on the productivity loss measured in non-working days of the patients were considered. The results significantly demonstrated that all psychological effectiveness measures for the patients highly improved by the 6-weeks rehabilitation program and remained rather stable 12 months after discharge. We found that costs for the 6-week ambulant psychiatric rehabilitation program could be easily covered within 12 months after discharge once a total societal cost perspective was considered. Even additional total cost savings of up to over 5000 Euro could be achieved which were highest for employed patients, followed by unemployed patients receiving rehabilitation allowance due to both their high direct medication and treatment costs as well as high indirect costs for productivity loss. The most important finding was that this treatment program was especially beneficial for rehabilitation patients in earlier stages of psychiatric diseases who were still employed, indicating the need for early intervention in mental disorder.

Building Research Capacity in a Mobile Psychiatric Rehabilitation Program: Service Learning in a University-Agency Collaboration

Social service agencies face increasing demands for accountability, emphasizing the necessity of preparing professionals to effectively evaluate practice. University-agency collaborations incorporating service learning can build community research capacity while providing opportunities for application of student research skills. We describe a partnership model between a Master of Social Work program evaluation course and a mobile psychiatric rehabilitation program to design a formative evaluation. Course structure and tasks central to the management of the partnership are described. Agency staff benefited from access to peer-reviewed literature, introduction to standardized assessment instruments, and stimulation of staff discussion and critical thinking around service provision. Students valued the applied research experience including exposure to the agency context and a real-world impact of their work. Lessons learned and implications for university-agency collaborations are discussed.

Changes in Chinese Discharged Chronic Mental Patients Attending a Psychiatric Rehabilitation Program with Holistic Care Elements: A Quasi-Experimental Study

This study attempted to examine the changes and related factors in discharged chronic mental patients attending a psychiatric rehabilitation program in Hong Kong adopting a self-help group (SHG) approach with holistic care emphases on the physical, psychological, social, and spiritual functioning of the program participants. A quasi-experimental design involving an experimental group (109 participants attending the program) and a control group (154 patients from a psychiatric outpatient clinic who had never attended any SHG before) was adopted with the participants responding to measures assessing their functioning in the physical, psychological, social, and spiritual domains. Results showed that those who joined the SHG with holistic care elements had more friends and more social satisfaction than the control subjects. Duration of attendance, religious involvement, and group involvement were three key factors related to the outcomes of the program participants. This pioneering study provides support for the effective use of the SHG approach with holistic care elements to help discharged chronic mental patients in the Chinese culture.

PERCEIVED PERSONAL CHANGES IN CHINESE EX-MENTAL PATIENTS ATTENDING A HOLISTIC PSYCHIATRIC REHABILITATION PROGRAM

This study was an investigation into perceived personal changes in ex-mental patients attending a psychiatric rehabilitation program in Hong Kong. The program used a self-help group approach with holistic care elements emphasizing the physical, psychological, social and spiritual functioning of the participants. Nineteen participants were invited to complete a repertory grid based on the personal construct theory to measure self-identity changes after joining the program. Results showed that participants perceived positive changes in physical, psychological, social and spiritual dimensions after joining the program, which indicates the value of adopting a holistic psychiatric rehabilitation approach and provides initial support for the use of the repertory grid method in measuring changes in ex-mental patients in the Chinese context.