Psychiatric Rehabilitation

Persons with severe and persistent mental illness require effective community-based services as well as medication to achieve recovery. Recognition of this fact has led to a demand for staff with the knowledge, attitudes, and skills to provide these services.

Until now appropriate textbooks for preservice and inservice training of such staff have been limited to edited collections such as those of Liberman (1) and Spaniol and associates (2). While these handbooks offer contributions from leaders in the field, they lack the narrative continuity that can be provided by a well-written textbook. Psychiatric Rehabilitation, which focuses on community interventions, was written to serve as a text for undergraduate and graduate students, as a training tool for staff, and as a reference for researchers.

The book is divided into three parts. The first addresses the nature of severe and persistent mental illness, the second covers principles and methodology of psychiatric rehabilitation, and the third focuses on applications of psychiatric rehabilitation principles and methodology.

Part 1 attempts to provide the reader with a sense of the experience of severe and persistent mental illness and an overview of the common symptoms, etiology, course, outcome, and treatments of severe mental illness. The authors use a variant of the stress-diathesis model as their primary explanatory model and emphasize that there is a wide range of potential outcomes for persons with severe and persistent mental illness.

Part 2 addresses the goals, principles, values, ethics, and basic strategies of psychiatric rehabilitation, such as skills training, role modeling, behavioral strategies, and the client-centered approach. This part draws heavily on the work of William Anthony and colleagues at Boston University and on the principles articulated by the International Association of Psychosocial Rehabilitation Services.

Part 3 provides an overview of some psychiatric rehabilitation applications, such as vocational and educational rehabilitation, case management, consumers as advocates and providers, and work with families. The authors illustrate their points with a nice mix of case studies and brief vignettes and demonstrate how various legislative decisions have influenced service delivery. Other features of the book include highlighted sections that discuss controversial issues and key topics; brief biographical sketches; and class exercises at the end of each chapter.

Psychiatric Rehabilitation is an excellent text for undergraduate survey courses in psychiatric rehabilitation. Teachers using it in graduate courses will want to provide supplementary readings from journals or from the handbooks mentioned earlier. The reference section at the end of each chapter is a good place to initiate a search for supplementary secondary and primary sources. Those using the text for staff training will need to augment it with material to teach specific skills, such as how to conduct assessments or skills training.

Because of the book's brevity and wide range, the authors had to be concise. Thus a few points are oversimplified or confusing. For example, after the authors explain that in behavioral theory "positive" refers to something added and "negative" to something removed, they state, "A positive punishment means that something negative is added." A more frequent problem is the lack of careful proofreading. For example, students will have difficulty locating the work of T. Lindz (Lidz) or R. Caan (Cnaan). Taken as a whole, however, the advantages of Psychiatric Rehabilitation are many, and the deficits are relatively few and easily corrected. Teachers of psychiatric rehabilitation will find this an excellent text and resource for both preservice and inservice training.

Dr. McCracken is director of training and associate professor of clinical psychiatry at the University of Chicago Center for Psychiatric Rehabilitation in Tinley Park, Illinois.