SCARF has established itself as a centre of repute in the areas of rehabilitation and research. Rehabilitation is one of the key fundamental goals of SCARF. All through the past more than 3 decades, psychosocial interventions have played a major role in the care and treatment programs at SCARF, dealing both with patients and their families. About 2 years ago, the need for a structure in the psychosocial interventions led to an experimental study to evaluate the feasibility of doing a structured intervention for persons with Schizophrenia. The study established that the case managers at SCARF could carry out individualised and group psychosocial interventions with focus on daily living activities, social and communication skills,vocational rehabilitation and family interventions which included psychoeducation. This led to the formation of a Department of Psychosocial Rehabilitation in October 2015 to offer comprehensive psychosocial interventions based on optimal treatment guidelines.

VISION

To implement structured psychosocial rehabilitation services to individuals with mental health problems attending Outpatient facility, In patient facility and day care centre.

MISSION

  • Toprovide evidence based comprehensive structured psychosocial intervention for the individual with disability based on a complete evaluation of the patient and the family on felt needs, clinical and psychological status, functioning and the family situation.
  • To develop partnership with caregivers, employers, government and non- government organizations working for mental health and vocational and life skills training in order to support and maximize the range of available choices for our client
  • To enable patient’s access to welfare benefits provided by the State governments, Central governments through the process of Disability certification
  • To conduct workshops/training on psychosocial rehabilitation primarily to facilitate capacity building for rehabilitation providers, imparting knowledge about psychosocial rehabilitation for various students and staff working in the mental health field.

PROCEDURE

The department accepts referrals from the clinical staff in SCARF. For persons outside SCARF who want to attend the psychosocial interventions must register with the SCARF Clinical services. The flow chart of the referral process is described below:-

psr-department

Following a detailed assessment for interventions, an INDIVIDUALISED REHABILITATION PLAN is developed as a collaborative strategy between patient and family, case manager and consultant. The team then offers a comprehensive treatment through a variety of interventions tailored to meet the individual needs of our patients and their families. The interventions focus on medication adherence, psycho education, supportive counselling, and psychotherapy, dimensions of self-care, independent living tasks, daily routine management socialization, vocational training,and job planning.

WHAT WORKED?

Jainey Joseph

Advaita (Name Changed) a young married woman, was diagnosed with schizophrenia 11 years ago.  She was first referred to me for psychosocial interventions in July 2016, to overcome her difficulties in not doing anything and bring in activities for a healthy active life.

A detailed interview with client helped to understand her capabilities and weaknesses. She was noted not to participate in any activities of daily living. There was no felt need for independent living – all her living needs were taken care of by her family –  largely her mother.  She was living in her mother’s house along with her spouse Hence, she did not have to worry about household chores like cooking and cleaning as her mother managed the house. Though her mother had made attempts to involve her in chores at home Advaita resisted. When mother sent Advaita to work outside, at a supermarket, she immediately relapsed – she manifested referential delusions that people were watching her and making fun. Her family then decided that going to work was not an option. Her mother was seen to be very stressed – after 11 years of illness, her mother had developed a “no hope attitude”. Her mother described her to be a “log” and had little faith that she would change.   Although the family ensured medications, they were not hopeful of any efforts to improve Advaita’s functioning.

During the initial conversations, Advaita  talked a lot about her experiences with Psychosis , the family’s responses, the names she was called.  Her mother too ventilated and expressed worry about her daughter’s future. The family as a whole did not know how to manage Advaita’s illness. Advaita was reported to have poor interest in doing any work at home, never wanted to take responsibility. She would lie down on bed most of the time, watching television. Fighting against Schizophrenia was not easy task for Advaita and her family.

The felt need by the client and her mother was to improve ADL. Initial session focused on bringing awareness to both client and mother about “REHABILITATION” as a treatment strategy. In further sessions client was persuaded to identify her short term goals based on mastery and pleasure principle. Interventions were planned targeting these goals based on a hierarchy starting with easily achievable goals. The first step was to get her to do tasks that interested her. Her interests & creative talents were identified and she was encouraged to undertake these activities at home.

In the next visit, Advaitha came up with a beautiful sketch with SCARF logo embossed with glitters, the effort was highly lauded.  Gradually, with regular conversations we created a list of tasks that included both creative ventures and household tasks. The tasks soon became complex over a period of three weeks of contact. One example was we agreed that she would write down a recipe from a TV show and prepare the item for the evening meal – this she did enthusiastically. The spouse was very happy and was encouraged to praise her. This motivated Advaitha to be more involved and take responsibility for housework.  At the same time, mother was psycho educated regarding what is ADL & its Importance, not to assume that person with schizophrenia can’t get better or live a meaningful life.

In subsequent sessions Advaita was guided to make a checklist incorporating more tasks involving all her daily living tasks including self-care and exercise. Her involvement was affirmed and reinforced – this motivated her to continue diligently everyday. Examples of patients who had made progress without disclosing personal details were used to motivate her.

Now she is pregnant but is still engaged with all her chores. She and her family report immense satisfaction. Although discharged from active interventions, I remain in contact with her.  In the last session she had a number of questions related to pregnancy and child birth which I answered.  Every session with her focusses on motivating her to persevere. More recently, due to her pregnant status, she has been receiving support and guidance through phone, while her mother comes in person to speak to me.

What worked? The opportunity to talk, a planned approach to augment her activities, the initial focus on her interests and creative talents, improved understanding by her mother, the subsequent praise and encouragement rendered by the family as a whole, played a significant role. They call me her lucky charm…..!

Advaitha also provided feedback saying that rapport with therapist, frequent and structured guidance as well as attention to her life and activities, which she was receiving for the first time, helped her in the road to functional recovery.

CAREGIVER PSYCHO-EDUCATION PROGRAMME

This is a very important part of the services. SCARF –PSR Department offers group psycho educational programme on Schizophrenia for the caregivers once every month on a 4th Saturday. Here, the caregivers receive important information on how to best provide support and care to their loved ones. It is also a vital opportunity to interact and share with other family members going through similar experiences. Families can attend any number of sessions as they please. Often, we invite a family member to address the gathering. Feedback and suggestions from the family are also welcomed.

TRAINING IN PSYCHOSOCIAL REHABILITATION METHODS

Education and knowledge transfer is one of the departmental priorities. The department offers training to various students and professionals in psychosocial rehabilitation.

Work Placement services at SCARF

An oft cited need of clients and families is to be placed in a suitable job.  SCARF – Day Care runs an active Vocational Rehabilitation program. Pre-vocational training focuses on attributes necessary for successful work life-the emphasis is on regularity, punctuality, sustainability and social communication as important goals. To facilitate a job search – a central pooling of client biodata is created. Similarly, a list of potential employers is being generated. Attempts to match client strengths with job requirements is made and placements initiated. We also follow up at the work spot to address any difficulties that arise for either the client or the employer.

We have established a liaison with Dr Reddy’s Foundation (http://drreddysfoundation.org/youth/) for providing soft skills training and placement of  our clients as an additional venture.

It is earnestly hoped that Vocational Rehabilitation of persons with serious mental illnesses will gain substantial ground for promoting income generation.

If you know of a potential employer or have a client who needs a job,

please post this information to employability.scarf@gmail.com

JOURNAL CLUB

To enable the staff to keep abreast of latest research in psychosocial rehabilitation, various topics are discussed at the Journal Club The journal reading focuses on emerging research, treatments and applications in psychosocial rehabilitations. The aim is to learn from current research and apply to practice. The Journals Club runs twice in a month.