Place First, Then Train: An Alternative to the Medical Model of Psychiatric Rehabilitation

Abstract

The medical model has promoted a train-place model for psychiatric rehabilitation. This model carefully trains people with psychiatric disabilities on a range of skills so they can handle real-world demands before placing them in work and independent living situations. More consistent with a social work perspective are place-train programs, which rapidly place people with psychiatric disorders in real-world settings so they can experience the benefits, as well as the challenges of these situations, and then provide the necessary training and support to successfully maintain these placements. This article compares the two models and shows that place-train approaches can help people with serious mental illness attain many of their work and housing goals without increasing the frequency of relapse.

Reclaiming the worker role: Perceptions of people with mental illness participating in IPS

“…These findings can perhaps be explained by the IPS-participants training and gradually developing their social skills at work, a so called place-then-train approach (10,39), instead of participating in traditional prevocational rehabilitation in sheltered settings. However, limitations in work performance caused by cognitive limitations is assumed to remain stable over time (40), which may help to explain why cognitive limitations were perceived as enduring or gradually increasing among the study participants.…”

“Watch your steps” – Community mental health professionals’ perspectives on the vocational rehabilitation of people with severe mental illness

“…The mental health field appears to be in the grips of conflicting and competing paradigms (Corrigan & McCracken, 2005;Rinaldi et al, 2008). There has long been a biomedical-oriented perspective that uses a "train then place" model, with the expected trajectory being: "The illness is decisive for first care, then treatment, and later on rehabilitation, and possibly vocational rehabilitation" (Bejerholm, Larsson, & Hofgren, 2011, p. 60).…”

Is Premenstrual Dysphoric Disorder Really a Disorder?

“…While the medical model seeks to train those diagnosed with mental illness to manage their condition before giving them work and accommodation (the "train-place" model), the "place-train" model instead quickly places them in work and accommodation, then gives them training and support (Corrigan and McCracken 2005). Most studies of the "place-train" model have so far shown greater success in helping those diagnosed with mental illness to live independently (e.g., with greater housing stability and quality of life), as well as greater reduction in rehospitalisation rates (Corrigan and McCracken 2005). Thus, even if the issue here is a mental illness, these findings challenge the medical model's emphasis on medication as the first and most important aspect of recovery.…”