Chapter 4

Treatment Settings and

Therapeutic Programs

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Treatment Settings
Inpatient hospital treatment
Rapid assessment, stabilization of symptoms,
discharge planning
Client-centered multidisciplinary approach to brief
stay
Short inpatient stays

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Treatment Settings (cont.)

Inpatient hospital treatment
Long-stay clients (severe, persistent mental illness
requiring acute care services)
Case management
Discharge planning
Partial hospitalization programs
Day treatment programs
Eight broad categories of goals (see Box 4.1)
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Treatment Settings (cont.)

Residential settings
Vary in structure, level of supervision, services
provided
Group homes
Supervised apartments
Board, care homes
Adult foster care
Crisis resolution/respite care
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Treatment Settings (cont.)

Residential settings (cont.)
Evolving consumer household
Group-living situation
Residents make transition from group home to
residence where they fulfill own responsibilities and
function without onsite supervision.
Transitional care
Peer support
Bridging staff
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Psychiatric Rehabilitation Programs

Services to promote recovery process (see Box 4.3)
Emphasis on recovery, going beyond symptom
control and medication management; includes
personal growth
Reintegration into community
Empowerment, increased independence
Improved quality of life
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Psychiatric Rehabilitation Programs

(cont.)
Clubhouse model
Four guaranteed rights of members
A place to come to
Meaningful work
Meaningful relationships
A place to return to (lifetime membership)
Physicianclient relationship as key
Focus on health, not illness
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Psychiatric Rehabilitation Programs

(cont.)
Assertive community treatment (ACT)
One of most effective approaches (see Box 4.4)
Problem-solving orientation
No problem is too small
Direct provision of service rather than referral
Services intense; no time constraints
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Special Populations: Homeless Mentally Ill

In comparison to homeless not mentally ill:
Spend more time in jail
Are homeless longer
Spend more time in shelters
Have less family contact
Face greater barriers to employment
PATH program
ACCESS demonstration project
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interdisciplinary Team

Pharmacist (see Box 4.5)

Psychiatrist
Psychologist
Psychiatric nurse
Psychiatric social worker
Occupational therapist
Recreation therapist
Vocational rehabilitation specialist

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Interdisciplinary Team (cont.)

Core skills
Interpersonal skills (tolerance, patience)
Humanity (warmth, acceptance, empathy)
Knowledge base
Communication skills
Personal qualities (consistency, assertiveness,
problem solving)
Teamwork skills
Risk assessment, risk management
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Psychosocial Nursing in Public Health and

Home Care
Primary prevention: stress management education
Secondary prevention: early identification of mental
health problems
Tertiary prevention: monitoring, coordinating psychiatric
rehabilitation services
Clinical practice issues such as substance abuse, domestic
violence, child abuse, grief, depression, and many others
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins