PSYCHOSOCIAL MODEL

Psychosocial Model

Psychosocial Model

Introduction

Until about 40 years ago, the accepted approach to treating individuals with psychiatric disorders was to isolate them from society by committing them to psychiatric hospitals, where patients receive treatment for their entire lives by nurses or care givers. The accepted treatment in such facilities was medication based, and its objectives were to provide low-cost compassionate care, maintain social order, and protect the community. These objectives, however, were not achieved. The overcrowding of the hospitals and the long-term institutionalization increased costs while keeping patients from receiving adequate treatment. Psychiatric hospitals' central position in treating persons with psychiatric disorders began to decline as a result of strong criticism of their denial of patient rights, and the deinstitutionalization and civil rights movements, along with the hospitals' harsh conditions. Psychiatric hospitals gradually stopped being the only treatment option and were joined by other, more community-based means, such as foster family or cloistered community frameworks, where patients are treated by professionally trained mental health nurses.

These changes led to the development of psychosocial rehabilitation approaches, whose objectives, according to the World Health Organization (WHO 1996), are to provide individuals with psychiatric disorders the opportunity to reach their optimal level of independence within the community. For this to happen, the WHO recommends that treatment focus on the strengths and abilities of these individuals rather than on their weaknesses; on developing their ability to take relative control of their lives, their fates, and their surroundings; and on promoting their personal and social functioning (Wrycraft 2009, pp. 16-247). These goals were adopted by the professional community and function as guiding principles, manifested in various interventions, models, and approaches psychosocial rehabilitation in mental health. Accordingly such interventions are personal and tailored to the needs of the individual, and include elements of support based on the personal characteristics of the patients and their families. In these models, the cooperation of the patient is essential during all stages of the intervention (Fortinash & Worret 2004, pp. 423-512). They thus require a very different therapist-patient relationship than that found in traditional psychiatric models.

The psychosocial approach to rehabilitation supported deinstitutionalization policies because it saw in psychiatric hospitals a custodial environment that failed to afford patients the opportunity to exercise choice or to discover their strengths and capabilities. Gradually, there began a worldwide downward trend in the number of patients hospitalized in psychiatric institutions.

Psychosocial treatments: Theoretical Framework

Rationale

Psychosocial interventions effectively address psychosocial risk factors for depression, with the rationale that targeting modifiable factors may decrease depression and reduce the risk of depression, particularly if medications are not likely to address these vulnerabilities. The modifiable risk factors for developing depression include stressful life events, low social support, physical illness and disability; more importantly, change in these factors is associated with recovery (Read, Mosher & Bentall 2004, pp. 36-76). Psychotherapy can also help people to cope with psychosocial risk factors that cannot be easily modified, including caregiver strain, bereavement and role transitions.

Psychotherapy is infrequently prescribed by primary care physicians (PCPs), but people not only consider ...