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Program Elements

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Programs for individuals with Severe and Persistent Mental Illnesses (SPMI) requiring tertiary care should be informed by principles of psychosocial rehabilitation (PSR) with sophisticated medication management and behavioural interventions. In summary, PSR is a therapeutic approach to the care of mentally ill individuals that encourages each person to develop his or her fullest capacity through learning procedures and environmental supports. PSR approaches have been implemented in various tertiary care settings. One application, developed by Lieberman and others, consists of a series of psychoeducational modulesto teach social and instrumental skills (6). Wallace and others report that in a variety ofsettings, including a state hospital, the modules fulfilled their objectives, with demonstrated improvements in patients' knowledge and performance ofskills targeted by the training (7). Other applications of PSR approaches in tertiary care settings have been shown to be effective by the Boston University Centre for Psychiatric Rehabilitation (8). Links and others describe the role ofthe psychiatrist in PSR programs (9). They recommend thatpsychiatrists work with interprofessional teams in applying PSR approaches and that several key elements be established inrelation to the psychiatrist's role. These include providing expertise in psychiatric assessment and medication management; establishing, developing, and maintainingthe therapeutic alliance with SPMI individuals; and attending to the various interfaces between assessment and medication management, development oftherapeutic alliances, andrehabilitation interventions

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