Psychosocial Rehabilitation and Community Psychiatry
This domain tests recovery-oriented practice, functional assessment, community mental health systems, and social interventions. The focus is helping people live in the community rather than simply reducing symptoms.
Core rules
- Recovery emphasizes personal goals, strengths, autonomy, and community inclusion; symptom remission is not the same as functional recovery.
- Evidence-based rehabilitation includes supported employment (IPS), supported housing, family psychoeducation, social-skills training, and assertive community treatment for high-need patients.
- Assess housing, income, work, education, relationships, stigma, and access to care alongside symptoms.
- Care coordination, relapse plans, and advance statements reduce crises; least restrictive options should be tried first.
- Community treatment orders require legal criteria, clear objectives, review, and attention to rights.
Worked example
A patient with recurrent psychosis wants paid work but has repeated admissions. Reasoning: start with a functional assessment and a relapse plan, involve family in psychoeducation, review medication adherence and side effects, and refer to IPS rather than assuming the patient is unemployable. Support is built around the patient's goal, with crisis contingencies documented.
Traps
Do not equate rehabilitation with custodial day care. Do not set goals for the patient without collaboration. Do not overlook stigma, poverty, or housing as drivers of admission.