An evaluation of the implementation and the effectiveness of two treatment and organizational strategies in the rehabilitation of long-term psychiatric outpatients.

Mental illness usually needs long-term treatment and rehabilitation. Since de-institutionalisation of psychiatric patients in the 1970s, most of this treatment and rehabilitation has needed to be done in the community through psychiatric clinics. It therefore is important to establish which rehabilitation strategies can be implemented in the South African services, and how effective they are. This study reports on two strategies which were implemented in the service to Black patients in psycho-education groups, and skills teaching. The implementation of the strategies was evaluated by looking at feasibility and effort, and their effectiveness was assessed by measuring functional status, symptom improvement and duration and frequency of hospitalisation. It was found that both strategies could be implemented although there were specific problems. These related to the physical facilities in the clinics, the lack of adequate training of nurses in these techniques, and the inadequacy of community resources. The psycho-educational groups were found to have no influence on either functional status or symptoms, but this might be related to difficulties in the research design. None of the patients were hospitalised from the time the study started so hospitalisation could not be used as a pre-and-post-test. Skills teaching was found to influence functional status positively. Although a positive influence on symptoms was also shown, this may have been due to rater un-reliability. The results of this study show that psychiatric community clinics should be reorganised to include psycho-social rehabilitation strategies. These strategies generally are effective and can be implemented if there is a rehabilitation philosophy in the service.