Mental health rehabilitation services

To reskill (from the Roman Latin word habilitas), to restore to a former capacity, to reinstate, to restore former rights. It can also mean to prepare someone to resume normal life after an illness, or to restore to their former status.

It is a service to help people recover from the difficulties of longer-term mental health problems. It will help and support people who still find it difficult to cope with everyday life or get on with other people. It will aim to help you deal with problems, to get your confidence back, and to help you to live as independently as possible.

The difficulties with living with a longer-term mental health problem can mean that you can't be discharged home, but you may have to spend some time in a specialist rehabilitation service.

Many NHS regions in the UK have mental health rehabilitation units. Just over half are based in the community and the rest are based in hospital sites. Around half of NHS Trusts in England also have community rehabilitation teams who work with people after they have left hospital and moved to supported accommodation.

The service will try to help you recover, while accepting that you may still have serious difficulties which need continuing help and support.

The rehabilitation team includes psychiatrists, nurses, occupational therapists, psychologists and social workers.

Usually if you have a diagnosis of schizophrenia, schizoaffective disorder or bipolar disorder. However, only around one in every 100 people with a diagnosis of schizophrenia require rehabilitation. Typical difficulties include:

• problems with organising and planning your daily life – finding it hard to plan and actually carry out what you mean to do
• symptoms of mental illness, such as hearing voices that are distressing or make it difficult to communicate with other people
• being exploited or abused by others
• behaving in ways that other people find difficult or threatening - this can lead to contact with the police or courts
• harmful use of alcohol and non-prescribed ("street") drugs.

You may have difficulties because:

• medication just doesn't work well enough for you. The illness affects your concentration, motivation and ability to organise yourself
• you also suffer from depression and anxiety
• you may struggle to manage everyday activities – like self-care, budgeting, shopping, cooking, managing your money.

The stigma of mental illness can be an added burden. It may be particularly difficult to find work, have a reasonable income, or to be included by other people. You may have to cope not only with a difficult mental illness, but also with the attitudes of other people.

• Usually after a few years of mental health problems - and a number of hospital admissions. However, it can sometimes be helpful if you are trying to get over a first episode of illness.
• If you can't be discharged from an acute ward, but are unlikely to get any better there.
• If you are moving to a placement with less support and supervision. This can happen if you are leaving a forensic or secure service, or if you are moving from residential care to a more independent home in the community.
• If you might benefit from the structured environment and intensive therapeutic programmes that are available on a rehabilitation unit.

• To learn or re-learn life skills.
• To get your confidence back.
• To cope better without so much help.
• To achieve the things you want to, like living in your own flat, getting a job or building family relationships.
• To feel independent and comfortable with your life.

Professionals working in rehabilitation services support people with their particular problems, but, as they get better, adjust this support as needed.

Rehabilitation services will usually work for you for months or years. They will support you as you feel more confident and improve your skills. It can be hard to keep hopeful over these long periods - and the staff will do their best to help you do this.

• Medication.
• Talking therapies (e.g. cognitive behaviour therapy and specific work with families and carers).
• Guidance on healthy living (e.g. diet, exercise and stopping smoking).
• Help to reduce or stop alcohol and street drug use.
• Support to manage everyday activities such as personal hygiene, laundry and more complex living skills such as budgeting, shopping and cooking.
• As you get better, you will spend more time in the community. You might do some sport, go to the cinema, do a course, learn some skills for work, or start to get a job.
• Help with accommodation and social security benefits.
• Sometimes legal advice.

Your rehabilitation service should be helping you to regain your skills for community living, with the same opportunities as anyone else. You need to be able to have useful and interesting activities.

Rehabilitation units should provide a safe and homely space where you can feel comfortable, safe and are able to have safe relationships with other people.

They will have specialist expertise in the long-term treatment and care of people with severe mental illness and complex needs. They look at the long-term possibilities for the patient, not just symptoms of the illness, and work closely within a team of other professionals. They will provide:

• thorough assessment and treatment
• advice to colleagues on the diagnosis and management of severe and complex mental health problems for people who are not helped quickly by standard treatments
• advice on residential and community support services
• advice to commissioners about what services should be developed, and how to run high-cost placements
• joint working with voluntary sector agencies that provide supported housing and work opportunities for rehabilitation patients as they recover.

When you are first admitted to a rehabilitation service, you should have a detailed assessment which includes your views and preferences.

The staff will discuss a care plan with you. This should be developed as far as possible with you – and sometimes with a carer or your family.

As time goes on, you will spend more and more time doing things in the community and less time in the unit.

A rehabilitation unit should help you to feel better about yourself, more confident, more easy with your feelings and more hopeful for the future. Your length of stay will depend on how you get on – according to what you need.

Some regions in the UK, and around half the NHS Trusts in England, have a community rehabilitation team. These services support people who have made the move from a rehabilitation unit to some form of supported accommodation, but who require ongoing support with their day-to-day lives, both social and personal.

The community rehabilitation team can give more specialised support than the more general community mental health teams.

The team will continue the work of the rehabilitation unit. They will work with you to update your care plan and make sure that it progresses. They will support you with managing your medication, looking after your home, and doing any activities you may want to get involved with,

The team will involve your carer(s) or family (if appropriate) to help them give you the understanding and support you need.

In other parts of the United Kingdom, approaches to rehabilitation and recovery may be different.

Enabling recovery for people with complex mental health needs – a template for rehabilitation services. Published by the Royal College of Psychiatrists' Faculty of Rehabilitation and Social Psychiatry, edited by Drs Paul Wolfson, Frank Holloway and Helen Killaspy.

Joint Commissioning Panel for Mental Health. Guidance for commissioners of rehabilitation services for people with complex mental health needs. This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery. 

Mental Health Ireland: a national voluntary organisation which includes mental health professionals and lay people who provide care, support and friendship.

Mind: provides advice and support to anyone experiencing a mental health problem and campaigns to improve services, raise awareness and promote understanding. Infoline: 0300 123 3393.

Rethink Mental Illness: a national mental health charity which provides information, services and a voice for everyone affected by mental illness. Helpline: 0300 5000 927.

Scottish Association for Mental Health: Scotland's leading mental health charity which provides information and services for people experiencing mental health problems, addictions, homelessness and other forms of social exclusion.

Support in Mind Scotland: works to improve the wellbeing and quality of life of people affected by serious mental illness. This includes those who are family members, carers and supporters.