Presidential
Address
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THE FUTURE OF PSYCHOSOCIAL REHABILITATION IN THE ERA OF GLOBALIZATION
Madianos Michael
President W.A.P.R.
Talking about the
future of psychosocial rehabilitation we must first look at the present. Has
the current body of knowledge and the scientific development of the field of
psychosocial rehabilitation grown enough to provide sufficient evidence for its
effectiveness?
Despite that the area of scientific
psychosocial rehabilitation has a history of 20-25 years it is commonly
accepted that a substantial progress has been achieved in various sections of
rehabilitation, such as:
1. The methodology of assertive
community treatment and social skills training of chronically mentally ill
persons living in the community or already being deinstitutionalized,
2. The involvement of families and
relatives in the rehabilitation process through psychoeducation.
3. The increasing development of evaluation
and psychometrics research, providing reliable and valid results for the
assessment of various interventions
4. The beginning of active
participation of several institutional and structural components of community
in the reintegration of chronically mentally ill persons and their vocational
rehabilitation
5. Stigma for the first time has been
an open common target for many professionals, families, consumers and
international societies and organizations.
6. Finally, consumers or users are getting
together and are organized to fight social exclusion and to struggle for human
rights.
All the above
developments are complemented by the wide use of novel antipsychotics,
providing safe treatment without disabling side effects and securing community
based continuity of care.
Apparently the volume of knowledge
of psychosocial rehabilitation during the last twenty years has all the
ingredients for a fruitful evaluation.
Additionally,
psychosocial rehabilitation incorporates the political notion of strategy.
“Ten years ago the
joint W.H.O./W.A.P.R. consensus statement defined also psychosocial
Rehabilitation as a strategy that facilitates the opportunity for individuals,
impaired or disabled by mental disorder, to reach their optimal level of
functioning in the community, by both improving individuals competencies and
introducing environmental changes.”
The psychiatric rehabilitation process
focuses primarily on the patients existing capabilities based on the “well part
of ego”, but the idea of restoration of the impairments of these capabilities
seems to be mechanical and linear.
The maintenance of
civil rights of patients, and their aspirations are always taken into account,
but their needs in adequate education, work, housing and community acceptance
are often confronted by legal, social, cultural and economic constraints.
Psychosocial rehabilitation recipients are engaged in mental health care policy
decision-making processes and the interconnections of social welfare state and
the socioeconomic phenomena of globalization.
Psychosocial
rehabilitation novel interventions and techniques, such as Case Management,
Social Skill Training, Assertive Community Treatment and others, have been
proven to be effective but their therapeutic and rehabilitative strengths are
weakening or even neutralized, when the social, cultural end economic
environments are negative or even hostile to the recipients of the psychiatric
rehabilitation programs.
Talking about the
present and future of Psychosocial Rehabilitation, we are experiencing for the
first time a world sociopolitical climate called “Globalization”.
More in particular, after the
collapse of the
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There
is one super power, the
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The
outstanding development of technologies of communication and the complete
control of mass media by several only organizations.
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Uneven
distribution of world population and increasing waves of immigration.
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Augmentation
of metropolitan areas with ghettos and slum areas consisting of disadvantaged
minorities.
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Enormous
environmental pollution i.e. the green house effect, as well as several
mutations in microbes. Additionally, there is water shortage all over the
planet.
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Increasing
gap between consumption levels and production of energy resources and
centralized control of production and distribution of natural resources.
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Tremendous
differences in the per capita income between first, second and third world and
internationalization of capitalism by the development of gigantic multinational
companies. Similarly, there is an enormous increase of the debt of the third
world countries.
Work is a basic
rehabilitation goal and obtaining a job (full time or part time) is always a
desirable ambition. The question is how to get a job when unemployment rates
are high, for the same age groups with those of patients?
In most Western states, economic
recession is a chronic phenomenon. This could cause difficulties even to
supported employment programs. Economic recession is always linked with
psychosocial programs budget-cuts leading to a less social welfare state.
In the turn of the
century these phenomena are aggravated and globalization of economy has become
synonymous to serious economic changes (market economy), resulting increasing unemployment
rates (investments are moving to cheap labor countries), privatization of
social instructions, high social mobility (immigration), family structure
transformation and marginalization of social disadvantaged groups e.g. lower
socioeconomic class unskilled workers, minority groups and disabled persons.
The growing economic
insecurity causes a considerable burden especially to families with a member
suffering from serious mental illness. These families are often facing profound
economic hardship. Poverty has intense negative impact for psychosocial well
being, self esteem, health (physical and mental), and the quality of life in
general. Especially low levels of quality of life in its various domains
(social relations, leisure activities, nutrition, and housing) are experienced
by individuals suffering from serious mental illness and family members.
Additionally, the fast growing
processes of deinstitutionalization of long stay inpatients in public mental
hospitals, are involving the family and the community.
When the family and
the local community are unprepared or unable to accept the deinstitutionalized
patients, then those patients are likely to become homeless, or are
transinstitutionalized. At this case psychiatric rehabilitation, sounds ironic.
Apparently the era of globalization
has rather negative implications for the provision of effective psychiatric
rehabilitation programs.
The question is to
what extend there is room for optimism that the impact of the globalization
could be eliminated or even “neutralized” for the benefit of the patient and
the family? The answer is definitely positive. There are solutions like the
empowerment of the international movement of families and users of psychiatric
services with parallel efforts for self-actualization, self-determination of
any suffering person. Political coalitions with other activist groups and
associations are strengthening the ties and the struggle for equal rights of
disadvantaged persons. At the community level, the atmosphere could be changed
by the systematic implementation of various mental health interventions
directed at the modification of the local community’s beliefs and attitudes
towards the integration of the mentally ill. The encouragement of volunteerism
in the field of mental health and the exploitation any available community
resource for food, housing and work could somehow replace the absence of social
welfare state.
Psychiatric
rehabilitation is a multidimensional and dynamic process, involving three
parties: the patient/family, the State and the community. The process is taking
place in specific socioeconomic environment, not in a vacuum. Every
professional in this field has to be optimistic as well as skeptical or
critical to the role of the environment as a major factor in the implementation
of effective psychosocial rehabilitation.
We strongly believe in
the future achievements of psychosocial rehabilitation in the forthcoming
years, against all political, social and economic constraints appearing in the
new Millennium.
Our World Association for
Psychosocial Rehabilitation now has come of age, carrying twenty years of
experience and fruitful work all over the world.
We will continue our
fruitful collaboration with the World Health Organization and the U.N.
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The
number of advanced institutes in low-income countries increased, given the
appropriate support by W.H.O., the local professionals and governments.
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The
ties with international associations of the same interest, such as the World
Federation for Mental Health, the World Psychiatric Association, must be
strengthening.
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Alliances
with international associations of families and users will go stronger by
exchanging ideas and putting common goals into practice.
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Immediate
interventions at local international for every case of endangering the
protection of human rights and dignity of persons suffering from severe mental
illness.
The future lies ahead
of us, strengthen the alliances between users, families and professionals.
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