Recovery Concepts And Psychosocial Rehabilitation Of A Psychiatric Patient BY Dr Mohammed Abuzaid


valera murder him
sera Maluku our presentation actually today we will talk about a recent and a
new activity that will take place in a few days in our hospital or in our
centre and we’ve been waiting for that since a long time there is a lot of
trials that has been done in the past but was not very successful or was not
well didn’t come to life or didn’t come to light and I will start by mentioning
or by describing the address of our presentation which is recovery concepts
and psychosocial rehabilitation of Psychiatry patients family art community
and why recovery because this is the main aim of our rehabilitation program
which will have inside of it a daycare center a community service and the
hotline this triad will all unite in the service of our patients
just after moments or maybe hours of their discharge from our units or from
our Hospital we all know that the mental health team is the team responsible for
rehabilitation of psychiatry patients but what do they aim to what is their
focus they focus on two main things number one to maximize the abilities of
our patient our patient didn’t lose all his abilities my focaccia she called my
aunt elecman Marisa how calm I am telling me Malik at Murphy he didn’t
lose it all we want to maximize the abilities and to reduce the disabilities
this is our aim and during this aim we found that psychosocial rehabilitation
term has been abused a lot a lot of management and treatment
has been named psychosocial rehabilitation even in
psychopharmacology so to correct some of the use of the psychosocial
rehabilitation at the start we will say that psychosocial rehabilitation is not
a mode of treatment or it is not a psychiatric treatment on the contrary it
focused not the psychiatry treatment focused on symptom alleviation and
stress alleviation symptom reduction and stress reduction and this has nothing to
do with the return of our patient to the community and the return of our patient
to his usual life Miroslava been a lion hail Galba new anthem imal were active
romantic TANF in mock Tama and reduce symptoms with our good men I am and
consonant with the discovery of chlorpromazine ok
Bessie L symptoms will stress with AHA sometimes the family is the one needed
that were needing this treatment but the patient needs is to return to life
active functional having a job having good social support or good social
surroundings and a good social activity okay how did we go through community
mental health community mental health passed through a lot of errors through
reform movement reform movements which means slow movements and slow change
from one ERA to another not a revolution of movement it didn’t come suddenly and
they said we need to make hospitals not suddenly they said we need to make
community service it started by moral treatment in the 17th century and the
18th century where they had the mental patients were not looked at as be
widgets or as magicians or as any of the possessed by bad spirits or any any kind
of this they started to look at them as patients or as people suffering or as
victims of mental illness but they were not having any place to be treated in at
that time they were only looked at this way and it change it later on to putting
them into asylums and to putting them into a places where they are only put
away from the community so that they are not the interest to the community and
the community is not dangerous to them then it came the Mental Hygiene era
which is after 1910 or or during the 1910 til the world war 1 where this is
the era where they were very caring about spreading the mental health
hygiene through cinemas through movies through newspapers through books a lot
of books were written at that time about stories of mental patients and how they
did get the disease and how they were suffering from it and how they were
alleviated and treated this is the error then the communion the community mental
health which is the era where that the in
Stosh analyzation happened at the start of this error they started taking
patients out of the Institute and this came after a lot of shiet and no inside
the mental hospitals there is abuse sexual and non-sexual they are treated
badly they are put inside these hospitals in overcrowding they sleep on
the floor they are naked they are not looked after so people said why not
treating these patients outside but what happened at this time that they helped
them out of the Institute and they were not put in any other programs there was
no community psychiatric community service centers making fewer data
centers so they were in the streets they started to be abused again in the
streets and in the end they started thinking about the community services
inside the hospitals that can take and reach the patients outside and can see
the patient’s not as an inpatient or as a sleepover patients but to be part of
the day at the home where they live with the families and the other part which is
during the morning in the hospital to pass through programs and to pass
through rehabilitation programs that is needed for them so if we what do we need
from our daycare center we thought about the problem of stagnation in the wards
of Psychiatry acute or non acute and how can we deal with this first of all we
thought about making doctor of the most and thought about making a committee for
the revision and for the review of the capacity of the patient and the review
of the patient’s ability to take a decision and if really he is needed to
be inside the hospital or not what if we said he is not to be inside the hospital
but also not to be outside where can we put this patient
where will we put this patient so it’s the day care
the only place that can handle this conflict the day care can take the
patient who are not eligible for hospitalization doesn’t need to be a
hospital but at the same time he cannot be taking care of outside he needs still
a medical attention or let’s say a professional attention because later on
I will discuss the problem of the take care that it is not a must or a
mandatory to have the psychiatric doctor working in this field he has to
supervise but not to be the active and the only active one of course we found a
problem in discharging patients or the studies found the problem in discharging
patients out of the long institutionalization because they became
during their stay in the hospital they became highly institutionalized they
don’t feel safe except inside the safety walls of the hospitals and they start to
be begging to return back to the community they were in inside the
hospital the second thing that families doesn’t want the patient in their
residence they don’t want to take care of the patient and they cannot take care
of the patient this is the two things that we found as a problem therefore we
had some provision of doing this program of the
Community Program which will constitute as I mentioned before of a data center
of a community outreach service and of hotline in the day care center the day
care center is mean or is caring first of all for the bio psycho social
spiritual rehabilitation of the patient and in this we are trying to tailor for
each patient a program which will help him to function and to return back to
the community easily each patient has certain disorder with a certain
different completely social background with a certain different abilities and
we have to tailor our management for this patient solitary or uniquely and
among the therapeutic approaches that we will do inside the daycare will be the
counseling sessions will be the psychosocial skill training also we will
have to do the motivational enhancement modeling or roleplay and all this serves
in letting the patient taking responsibility back of himself and of
others of course we started this modeling and the role play in our
rehabilitation unit in a very narrow scale and was aiming to make the patient
to be put inside a situation which is the role of his role is the one
responsible to deal for example with a bank account
how can he open a bank account how can he take money from the bank how can he
use any of the services around and he take this and we are helping him in
directing his movements and in directing his behavior until he grasped this and
starts to be part of him relapse prevention and reserve skills the
personal inside this daycare will control be a psychiatrist who is
responsible as a catalyst and the physic who will be responsible for emergencies
of the that can happen to the patient or to any change in his behavior that
cannot be controlled by the team there a nursing staff which will be as we did
sit the head of the department and myself with the nursing staff and the
promise of giving us about 3:00 in the morning and maybe 3:00 in the afternoon
to be taking care of the patient during his stay in the day care a psychologist
and more than one psychologist because they are the backbone of our structure
and they will be the one performing all the therapists all the different
individual and group therapies inside this facility okay a social worker who
will be responsible mainly the one we are asking for would be responsible for
ot and occupational therapy and also for the leisure and for the art therapy and
for the music therapy he will be handling these things and the head of
the unit the head of the rehabilitation unit will be the one responsible for the
daycare center they will have a record that is very specific to this daycare
that it doesn’t have to do anything with the KCM at files this files will be kept
inside the daycare they will be registered inside the daycare and they
will take care mainly of the number of admissions the first presentation of our
patient and the medical comorbidities and previous admissions of course and
his last medication first of all the physician in charge or the psychiatrist
in charge in the day the request came for the day care from the inpatient or
from the outpatient he will see the request and will start applying the
exclusion and the inclusion criteria that will be discussed later and will
start seeing if this patient is eligible for joining the program or not not all
the patient discharged from the units will be eligible for the
daycare program and we will see why the inclusion criteria will be relatively
age-related from a till to 65 and it has to be a stable patient
I cannot take an acute or agitated or aggressive or any form of patients that
can be disruptive to the program and of course the patient requires a long-term
rehabilitation also I need the willingness and the motivation of the
patient and of his family which will give us a support and a push forward for
initiating this program and going on with it as it is part helping them very
much sooner or later their patient had to be
discharged and to be back home so when they have to understand what we are
doing I think the willingness and the motivation of these patients would be of
the patient’s family there will be exclusion criteria as as shown now of
course again age and if the patient has any tendency to be aggressive towards
himself or towards as others any acute psychiatric symptoms depressive suicide
acute depression suicide hallucination delusions in psychosis or acute manic
episode any acute stage we cannot accept of course handicapped patients primary
diagnosis of substance abuse primary diagnosis of mental retardation
handicapped physical handicapped I mean because we will not be able at least in
the start of our service to deal with this disability as we are very well
meant with psychosocial disability we cannot deal with the physical disability
and patient with active cleaning criminal charges the schedule of
attendance will be flexible we have a schedule of everyday attendance or every
other day attendance which can be three days a week and once a week at the start
of the program we will have to deal with the patient daily sure we will have to
fair hand to the other schedules of every other day or once weekly but this
will take some time but at the start mainly we will have to deal daily with
our patients and the activities will start in the morning as we have settled
in our meetings at 9 o’clock in the morning and it will stay till 7 p.m. in
the afternoon which is quite a period that can cover the medication all the
medication given to the patient and can cover his meals even Yannick mana Asahi
no Hamish hire got bit doing anything more than sitting with the family and
maybe sleeping at this time how can we do this
doctor the Mosin have agreed of making this patient as an impatience we can
deal with them as an inpatient facility so we will take the drugs if from the
pharmacy a meal will be given to them and they will stay as an inpatient still
7 o clock when they leave at 7 it’s as if they are having a leave I usually
leave like we do with other patients who stays for long stay ok after that there
would be some activities as I did mention before in the form of individual
psychotherapy group psychotherapy social skill training any other counseling
family education until the lunch time and then the lunch time will be surveyed
and afterwards they will reget be a lunch time will take about two hours or
one and a half hour maybe that will be during the prayer time if there will be
praying in the day care or they will go to the mosque and after that they will
go back again to the program in the afternoon and we did agree with the head
of the psychological department that people working in the afternoon or
having the clinic in the afternoon that can be serving us for two hours or more
as as doing their psychological therapies
and for the patient in the afternoon here is another example of our group
activities psychotherapeutic sessions educational sessions social skill
training and also there will be a leisure activities or recreational
activities indoor there will be fun days wellness program recreational programs
or outdoors picnics to the cinemas to the club’s or to any other facility that
we can prepare and organize with there will be a social activity and regular
family meetings of course the program will deal a mildly with medical problems
of the patient so the treatment we will give the treatment and we will follow up
the treatment in order to alleviate symptoms and distress also there will be
a crisis intervention if any problem that happens to the patient acutely we
can deal with it we will and then there will be a case management there will be
someone responsible for each case that will cause the management that will draw
the plan and that will put in the patient’s file what will have to be done
for the next six months this plan can be revised every six months it will be put
according to the patient’s condition at the end
also the rehabilitation will be dealing with the patient’s skills developing the
patient skills as I mentioned before and this was through the role functioning
also through the modeling there will be an enrichment of the patient’s abilities
engaging the patient in fulfilling and satisfying activities which will cause
self-development and self-assurance also we will teach the patient about his
rights in the family and outside the family and about the law some of the law
that he has to go with and not to break and that we will tell him about his
rights advocating to uphold one’s right and about equal opportunities that he
has to go through not because he is a patient he will be treated less than any
other also about basic support self-help and
wellness this the day center clinic is proposed also that can be done as a mid
Way between sending the patient out of the day care center after he’s fulfilled
the discharge criteria and going back to the general clinic if we are not sure
that he can be going back to the general clinic directly we can have this clinic
that follow-up him once or twice every two months and then when we are sure of
him sending him back to the general clinic we will send him at this time so
it will be serving as a weaning period amoled fo Tom Tom Lee L murid where who
what the kurkureu Bardo is a winning period here with the discharge criteria
I think we mentioned that the patient being compliant and we have reached with
the patient the point that we can send him back to the community he is
independent and he starts to be aware of his rights and he starts to be socially
active and we can see all this in him we will send him to the community any
discharge will happen if the patient needs a serious admission to psychiatric
hospital acute admission to the psychiatric hospital
we will discharge him any non-attendance or any delinquency in his attitude to
the program or inside the program the patient can be attending the program but
he’s not into the program he’s not working in the program he’s not
compliant with the program he’s not this all will let us discharge because there
is a place for other patients that has to be filled as a disciplinary action
this will be taken the hotline service will be put into consideration inside
the hospital as a part of the telephone of the patient in the day care if he had
any problem coming or coming have any problem with medications
inside the hospital a side effect we can help him and direct
him not as a way that we can go and outreach him
it’s only a consultation by for a hotline I have this problem okay
you will be coming tomorrow we will deal with it or take this or do this and this
will will become will contain the nursing staff and that can reach a
doctor if needed but mainly it will be through the nursing staff working in the
facility the community case management or the outreach management this is in
the plan of the head of the department we did not go deep through it but this
is in our plan we did reach some agreement with outside resources that
can help us in najran and offer say Arad was on a lot about Al Hayat Amelia
Ella I’m a convert at al Mar de basura guardo Plano had taken an ax
not a fan culture the trouble is they our idea because I think before can fee
trials the hazard walk an OB you Kabul who be rough
the debate will be roughly L when our medication inside the house ow in
roughly in shots the guy cut Abib lemuria cliff a
battalion of have been in has a ship would fire Hollander through this
cultural studies in London chauffeur will shoot their plans 11 Peterson in
Halabja salafi trip like so the outreach teams mean
Hamill Hackett Elfi and Nova focusing on very severe mental illness were focusing
on one patient or botanial patient doctor I will serve this doctor I will
serve as patient relationship ratio la la yaani inside the hospital is taking
being taken care of for example 25 patients taking care of by one nurse but
here inside his house they will outreach him and they will deal with him only
himself so there is a focus on the page allô patient staff ratios and also the
frequency of contact may be very frequent that can be daily or can be
weekly or at least we here did put the plan of a twice per week also the team
can be planned for later on to be intended to deal with crisis if there is
a crisis outside and the patient has to be transferred to a hospital maybe we
can deal with this problem inside the house inside his house this is not sure
yeah the the team will consist of a psychologic as a social worker a
psychologist a psychiatrist and a nurse and at least two has to be available to
go to the – to be in the outreach to either psychiatrist and psychologist
psychologist and the nurse a nurse and a social worker but at least two has to be
there the service they will give there will be supportive psychotherapy Family
Therapy counseling educational and long-acting depo injections also there
will be a case manager for this case when we receive this request which will
be either from the outpatient clinic or from the day care or from the hotline we
have to study the case and then to deal with the case manager the head of the
department and the head of the unit manager to see what we can do to this
case first of all is it legible for community care or not if it is legible
what will be the plan the primary plan and then the the case manager will take
a phone of the patient and will call them and we’ll prepare what is the best
time where is the best situation where the best setting that we can meet the
patient and we’ll take also in consideration the difficulty of the
transfer yani we will not go to very far places but at
least in the start it will be inside for example the city of
and later on maybe we will go outside of this the case manager will take the data
and we will and he will prepare for the team the easiest way to go to this place
and in the best circumstances and will take from the team a feedback about the
case from the first and the second session seen by to redraw the plan of
this patient because when we have a request it doesn’t have everything in it
but when the team visits we will have a bigger and broader picture of the
patient’s condition and they will make another plan for the patient afterwards
the patient will be seen in a basis at least of twice weekly and for a period
of not less than six months till we reach a point where we find that even
our presence is not needed by the patient and we can only form the patient
to make sure he is doing the program ok and everything for about 2 months and
then we are able to discharge the patient to return back to just usual
follow up in the clinic maybe for the medication if needed or for anything if
not I don’t want to make it long lecture thank you very much for attending and I
think the head of the psychology department has a lot to say because they
are the backbone as I said she will be with us you

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