Current approaches to assessment and treatment of persons with serious mental illness.

Abstract

Psychologists increasingly have the opportunity to work with persons with serious and chronic mental illnesses. Managed care encourages services that rely less on hospital treatment and more on a combination of brief and intensive outpatient therapy and long-term, low-cost maintenance and support. Diagnostic practices needed to be effective in such an environment include categorical and functional assessment. Psychological treatments that have been demonstrated effective include cognitive-behavioral social skills training, pragmatic supportive therapy, personal therapy, the multimodal functional model, therapeutic contracting, case management, and multiple family therapy. These innovative assessment and treatment techniques are described along with some experimental treatments of cognitive dysfunction.In the past, many psychologists believed that they had little to offer individuals suffering from serious mental disorders, such as schizophrenia and chronic major depression, and considered those cases to be more suitable for psychiatric treatment that was based on pharmacology and hospital care. Psychology training generally includes little exposure to course work and practical training with seriously mentally ill individuals (Millet & Schwebel, 1994), and there are relatively few role models in the profession to encourage students to pursue this area of spe-JEFFREY R. BEDELL received his PhD in clinical psychology from the University of South Florida in 1975. He is currently an associate professor of psychiatry (psychology) at Mount Sinai School of Medicine and is the director of Community Options, .a clinical research program at Elmhurst Hospital Center developing and evaluating clinical and costeffective community treatments for persons with serious mental illness. RICHARD H. HUNTER received his PhD from Southern Illinois University at Carbondale in 1982. He is chief psychologist for the Bureau of Clinical Services, Illinois Department of Mental Health and Developmental Disabilities, and is clinical associate professor in the Department of Psychiatry at Southern Illinois University's School of Medicine. He is working on programs and intervention strategies for treatment-resistant patients and interventions for people with a dual diagnosis of mental retardation and mental illness. PATRICK W, CORRIGAN, PsyD, is an associate professor of psychiatry at the University of Chicago, where he directs the Center for Psychiatric Rehabilitation, a clinical, research, and training program for persons with serious mental illness and their families. He is also the principal investigator and director of the Illinois Staff Training Institute for Psychiatric Rehabilitation, related to the implementation and maintenance of effective rehabilitation programs in real world settings.

A Taxonomy for Homework Used by Mental Health Case Managers When Working with Individuals Diagnosed with Severe Mental Illness

“…schizophrenia, bi-polar and schizoaffective disorder). The grouping of these disorders are consistent with previous conceptualizations of disorder duration and severity (Bedell et al, 1997).…”

“…Nurses, psychologists, social workers, occupational therapists and welfare workers all commonly work within community mental health teams and bring discipline specific skills to the case management approach. For example, nurses play a major role in supporting medication adherence (Coombs, Deane, Lambert, & Griffiths, 2003), psychologists are utilised to conduct specific counselling interventions (Bedell, Hunter, & Corrigan, 1997) and occupational therapists may assist with ensuring that the individuals living situations are adequate (Luboshitzky & Gaber, 2000). There is also a great deal of skill and task overlap, where case managers will be required to provide a variety of generic case management activities.…”

Assessment of the Long-Term Benefits of Life Skills Programming on Psychosocial Adjustment

“…In accordance with the literature on skills training for psychiatric patients, Life Skills is perceived as most beneficial in the interpersonal realm, increasing individuals' social functioning in a variety of situations (Bedell et al, 1997;Benton & Schroeder, 1990;Dilk & Bond, 1996;May et al, 1985;Pratt & Mueser, 2002). Not surprisingly, many participants indicated that the poor attendance of other students, the videotaping of exercises, and discomfort with role-playing exercises were problematic aspects of their Life Skills experiences.…”

“…Social skills training has been described as the ''single most important innovation for the psychological treatment of persons with serious mental illness'' (Bedell, Hunter, & Corrigan, 1997, p. 220). Empirical studies have consistently shown that social=life skills training programs are effective in improving targeted skills, enhancing social functioning, increasing patients' level of assertiveness, reducing the severity of psychiatric symptoms and the length of stay at a psychiatric hospital (Bedell et al, 1997;Benton & Schroeder, 1990;Dilk & Bond, 1996;May et al, 1985;Reddon et al, 1996Reddon et al, , 2008. In a rigorous meta-analysis of 68 studies regarding skill training effectiveness for individuals with severe mental illness, Dilk and Bond (1996) concluded that behavioral skills training is effective for teaching interpersonal and assertiveness skills, either within a hospital setting or in the community.…”

Problem solving training for schizophrenia: Rationale and review

“…This method is almost identical to that employed in cognitive-behavioural family therapy and has much in common with that used in the evidence-based cognitive-behavioural treatment of depression, the prevention of self-harm, social skills training and cognitive behavioural marital therapy (Bedell et al, 1997). However, the main differences are in the training methods.…”