Psychiatric Rehabilitation: A Key to Prevention

Preventive interventions designed to preempt or stop the progression of severe mental illnesses are a focus of the current National Institute of Mental Health (NIMH) Strategic Plan. Preventive interventions are increasingly becoming an emphasis in mental health research, practice, and policy. The service recipients of this field of practice and study are people labeled with descriptors such as "first episode," "early psychosis," "psychotic prodrome," "first break," "early onset," and "at-risk mental state."

I am often asked, "Does the psychiatric rehabilitation field have a contribution to make in the prevention of severe mental illnesses?" My answer is "Absolutely." Unfortunately, the knowledge and technological base of psychiatric rehabilitation is often not emphasized in the early phases of many mental health initiatives (for example, in deinstitutionalization, managed care, or Medicaid financing). Recent attempts to prevent or preempt the progression of serious mental illnesses seem to evidence a similar omission. Yet there is every reason to believe that the empirically based principles of psychiatric rehabilitation, which have helped people with severe mental illnesses to recover, will also help to preempt illness progression among people at risk of severe mental illnesses. Although the mental health field seems to begin most new initiatives, including the recent focus on the field of prevention, by routinely testing various medications and therapies, sooner or later the value of adding psychiatric rehabilitation knowledge and technology to the therapeutic mix is recognized.

Without the inclusion of psychiatric rehabilitation interventions, people who are at risk of developing long-term, severe mental illnesses will not receive the critical help they need to remain in, resume, or improve their living, learning, working, and social roles. We should not have to learn over again in the field of prevention what has taken us so long to learn in the treatment field—that medications and therapies designed to ameliorate symptoms do not routinely or singularly help people achieve their residential, educational, vocational, or social goals.

We must work together to ensure the integration of the contributions of psychiatric rehabilitation into current research and practice in the area of prevention of severe mental illnesses. We must do this sooner rather than later. NIMH is taking a positive first step in this regard in its proposed initiative called Recovery After an Initial Schizophrenic Episode (RAISE). The RAISE initiative intends to test an intervention model that combines pharmacological, psychological, and rehabilitation interventions.