Severe Mental Illness:

Crisis Stabilization

And

Rehabilitation

Chronic Mental Illness

• Long-term

• Persistent impairment of functioning

• Severe mental illness

• De-institutionalization

• Older us. Younger populations

Severe Mental Illness

• Schizophrenia

• Schizo-affective disorder

• Bipolar disorder

• Major depression

• Social, vocational and functional impairment

• Common with long term physical illness

Rehabilitation

• Early

• Community based

• Barriers– Lack of insurance– Transportation– Availability – Illness

Barriers to Maintaining Health

• Housing• Noncompliance to treatment• Transportation• Community and family support• Qualified care providers• Resources in the community• Comorbidity

– Dual diagnosis

Resources

• Adult outpatient services• Day care• Case managers• Alcoholic and drug rehabilitative services• Community Outreach programs• Temporary shelters• Churches• Multiservice centers

Rehabilitation

• Maintain positive coping in time of stress

• Maintain optimum level of functioning

• Remain in own community

• Reduce numbers of exacerbations

Crisis Stabilization

• Poor crisis management– Vulnerable to stress– Poor cognitive functioning– Lack of problem solving skills– Inadequate communication skills– Low self-esteem– Poor work and interpersonal relations

Potential Crisis Situations

• Changes in treatment• Work• Interpersonal• Lack of transportation, money, housing,

etc.• Problems meeting ADL’s• Sexual concerns• Adapting the crisis model

Client and Family Education

• Written

• Follow up

• Home visits

• Multiple support– Support groups– Physical, emotional and financial resources– Stress management– Lieberman’s five basic aims

Five Basic Aims

• Develop a genuine working relationship

• Develop a structure and stable teaching plan

• Support family members efforts

• Develop day by day communication and problem solving skills

• Help family develop a supportive network

Social Skills Training

• Living skills– ADL’s– Recreational– IPR’s

• Learning skills– Money management

• Working skills– dressing

Other Rehabilitation Models

• Vocational Rehabilitation Programs

• Supportive Group Therapy

• Cognitive-Behavioral Therapy