Rehabilitation and recovery now

Rehabilitation and recovery services are a rewarding area of psychiatric practice; these services are in a continuing process of development, in response to the changing needs of the target population and to the changing political climate of mental health care delivery. The developmental journey for rehabilitation and recovery services is at a particularly interesting stage and offers many opportunities for psychiatrists to develop new skills over the course of their careers.

There are new developments in the way in which services are provided in partnership with service users, their families and other agencies. Rehabilitation and recovery services now provide unique opportunities for the development of longer-term therapeutic relationships with patients and their partners in care, and also offer the rewarding challenge of practical service development.

Most rehabilitation services have a developmental history that bridges deinstitutionalisation, reprovision in its many forms, community care and now social inclusion, working to reduce the impact of stigma and to promote recovery. Embracing the concept of recovery, and promoting the recovery ethos throughout rehabilitation service provision, probably represents a clear new direction.

This report describes the philosophy underpinning a modern approach to rehabilitation and recovery. It defines the service user population and gives a description of the range of service provision, together with the guiding principles that inform service development. These principles are based upon:

1. • enhancing the strengths and resilience of long-term service users and their families

2. • maintaining optimism for individual growth and recovery

3. • treating disability with respect and acceptance

4. • improving the holistic quality of life for those with the most severe disabilities

5. • reducing stigma and promoting social inclusion

6. • therapeutic risk-taking to promote personal responsibility.

New ways of working with service users and their carers lie at the heart of the specialty. The journey towards individual recovery while respecting individual disabilities must inform rehabilitation service development. The perspective of service users and their families, together with their many partners in care, can provide a powerful force for development and should be the starting-point for new work.

This report describes how services can be developed, monitored and evaluated, and gaps in services identified through collaborative partnership working. Assessment, treatments and interventions are described and the need to improve the evidence base for rehabilitation is outlined. Suggestions for an audit focus in local rehabilitation services are made, together with the latest recommendations for workforce planning.

Collaborative work with service users, peer group and inter-agency networking, research, service development and evaluation, and the training of other staff, all offer significant rewards to psychiatrists keen to respond to the challenge of providing a modern rehabilitation and recovery service. These services should lie at the heart of comprehensive community care, responding to the needs of those most at risk of living with severe disability, and aiming to promote their recovery.