Psychiatric Disabilities: Challenges and Training Issues for Rehabilitation Professionals

More than 40 million people in the United States have psychiatric disabilities, and of this number, 4 to 5 million adults have been diagnosed with severe psychiatric disabilities (National Institute on Disability and Rehabilitation Services, 1993). Despite the desire to work, functional competencies and appropriate educational qualifications, many individuals with psychiatric disabilities do not have long-term success in the labor market (Garske, 1999). Clients who have poor social skills, limited peer relationships, and who have difficulty adjusting to community living need more than vocational counseling Many clients require comprehensive services dealing with a variety of psychosocial and emotional issues before they can focus effectively on vocational issues (Garske, 1999). Psychiatric rehabilitation and case management services are very demanding and complex requiring advanced training (Chan, et al., 1998) as part of rehabilitation counselor education programs. Nemec, Spaniol, and Dell Orto (2001) have noted: "The gap is wide between current knowledge of best practices in psychiatric rehabilitation and current instruction on psychiatric rehabilitation in rehabilitation education programs" (p. 118). For rehabilitation professionals, working with individuals who have a psychiatric disability can seem daunting, especially if adequate training has not been provided (Garske, 1992). Although there appears to be a consensus among rehabilitation professionals that employment is an important part of life for persons with mental illness (VandenBoom & Lustig, 1997), estimates of the unemployment rate for the working-age members of this population are around 85% (National Institute of Disability and Rehabilitation Services, 1993). Even when persons with serious psychiatric disabilities seek vocational services, they have success rates of only about half of those with physical disabilities (Marshak, Bostick, & Turton, 1990) For individuals with psychiatric disabilities, employment remains all important, but often elusive, goal. Work is extremely important in a person's life, providing direct economic and social benefits and contributing to self-esteem and quality of life (Fabian & Coppola, 2001). Some researchers attribute low employment rates to the nature of the disability, lack of effective vocational support methods, and continuing negative attitudes and stigma that impede workplace entry and retention. Less frequently addressed however are the competencies and attitudes of rehabilitation professionals who work with this population (Fabian & Coppola, 2001). To this end, this article will address the following issues as they apply to working with individuals with psychiatric disabilities: (a) invisibility of people with psychiatric disabilities, (b) psychosocial barriers, (c) recovery philosophy, (d) intervention models, and (e) psychiatric rehabilitation training needs. Invisibility of People with Psychiatric Disabilities The nature of therapeutic disbelief toward an individual with chronic illness has been discussed at length in the literature (Bowman, 1991; Lovgren, Engstorm & Norberg, 1996; Thorne, 1993). Clients who are put in the position of needing to convince a disbelieving professional of the seriousness of symptoms creates a context in which clients are often viewed, and many times labeled, as complaining, over-anxious, or obsessed with their condition (Benner, Janson-Bjerklie, Ferketich, & Becket, 1994; Johansson, Hamberg, Lindgren, & Westman, 1996; Malterud, 1992, 1993). Negative altitudinal patterns of professionals toward individuals with psychiatric disabilities serve to undermine the therapeutic relationship (Thorne, Nyhlin, & Paterson, 2000) and such tendencies on the part of professionals' serves to further diminish the rehabilitation and recovery of the person with a psychiatric disability (Singer, 2001). Many consumers with psychiatric disabilities report a sense of feeling invisible, or not important when interacting with service providers (Carling, 1995). …