An Evidence-Based Psychiatric Rehabilitation Implementation: Illness Management and Recovery

Abstract

Illness Management and Recovery (IMR) is a curriculum based psychiatric rehabilitation intervention which is designed as a program on the basis of a recovery-oriented approach. In recent years, the definitions suggested on the term, recovery, has been seen to be discussed in two ways; clinical recovery and personal recovery. The committee constituted with the aim of developing the mental health service provision in the USA in 2002, issued a call for the necessity for the mental health system’s comprehensive transformation. As a part of this transformation, the committee suggested a move towards mental health specialists’ making decisions related to patient’s mental health treatment in a collaboration with the mental health professionals rather than making conventional, hierarchical decisions. The significance of providing access to evidence-based applications for the treatment of mental illnesses was also stressed. Illness Management and Recovery (IMR) was developed and standardized as a treatment program which comprises empirically supported methods in order to train individuals how to manage their psychiatric disorders. IMR was developed on the basis of an extensive investigation of the researches upon teaching illness management to individuals with chronical mental illnesses. Having reviewed 40 controlled studies, in order to develop illness management, five empirically supported methods/strategies were determined. These are psychoeducation on psychiatric disorders and their treatments, cognitive behavioral approaches on drug compliance, training of preventing relapses, coping skills, and social skills training for developing social support. In this review, the birth of illness management and recovery-oriented program, the process of the program, and research related to illness management and recovery will be depicted. It is expected that the review will instructively contribute to practice and execution of Illness Management and Recovery Program within the scope of mental health services in Turkey.

Keywords

• Evidence-based
• Psychiatric rehabilitation
• Illness Management and Recovery

Kanıta Dayalı Bir Psikiyatrik Rehabilitasyon Uygulaması: Hastalık Yönetimi ve İyileşme

Öz

Hastalık Yönetimi ve İyileşme (HYİ) iyileşme odaklı yaklaşımı temel alan bir program olarak tasarlanmış müfredat tabanlı bir psikiyatrik rehabilitasyon uygulamasıdır. Son yıllarda iyileşme kavramına ilişkin yapılan tanımlamaların klinik iyileşme ve kişisel iyileşme olmak üzere iki şekilde ele alındığı görülmektedir. 2002 yılında ABD’de ruh sağlığı hizmet sunumunun geliştirilmesi için kurulan komisyon ruhsal sağlık sisteminin kapsamlı bir dönüşüm yapması gerektiği yönünde bir çağrıda bulunmuştur. Bu dönüşümün bir parçası olarak komisyon; ruh sağlığı uzmanlarının tedavi konusunda geleneksel, hiyerarşik karar vermektense hasta ve ruh sağlığı profesyonelleri ile hastanın ruh sağlığı tedavisi ile ilgili işbirliğine dayalı karar vermesine doğru bir geçiş önermiştir. Ayrıca, ruhsal hastalığın tedavisi için kanıta dayalı uygulamalara erişimin geliştirilmesinin önemine vurgu yapmıştır. Hastalık Yönetimi ve İyileşme Programı (HYİP), bireylere psikiyatrik bozukluklarını nasıl yöneteceklerini öğretmek için ampirik olarak desteklenen yöntemleri içeren bir müdahale programı olarak geliştirilmiş ve standartlaştırılmıştır. HYİP kronik ruhsal hastalığı olan bireylere hastalık yönetiminin öğretilmesi üzerine yapılan araştırmaların kapsamlı bir incelemesinden yola çıkarak geliştirilmiştir. Kontrollü 40 çalışmanın gözden geçirilmesiyle hastalık yönetiminin geliştirilmesi için ampirik olarak desteklenen beş yöntem/strateji tanımlanmıştır. Bunlar: psikiyatrik bozukluklar ve tedavisi hakkında psikoeğitim, ilaç uyumunu artırmada bilişsel-davranışçı yaklaşımlar, nüksleri önleme eğitimi, baş etme becerileri eğitimi ve sosyal desteği geliştirmek için sosyal beceri eğitimidir. Bu makalede hastalık yönetimi ve iyileşme odaklı programın ortaya çıkışı, programın işleyişi ve hastalık yönetimi ve iyileşme ile ilgili araştırma örneklerinden söz edilecektir. Derlemenin ülkemizde Hastalık Yönetimi ve İyileşme Programının ruh sağlığı hizmetleri kapsamında uygulanması ve yürütülmesine yol gösterici katkı sağlaması düşünülmektedir.

Anahtar Kelimeler

• Kanıta dayalı
• Psikiyatrik Rehabilitasyon
• Hastalık Yönetimi ve İyileşme

Kaynakça

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