Rehabilitation services

Mental health rehabilitation services specialise in working with people whose long term and complex needs cannot be met by general adult mental health services. Over 80% supported by rehabilitation services have a diagnosis of schizophrenia but only 1% of people with this diagnosis, supported by secondary mental health services, require inpatient rehabilitation at any given time77 78.

  • Most of this group experience severe “negative” symptoms that impair their motivation, organisational skills and ability to manage everyday activities (self-care, shopping, budgeting, cooking, etc) and place them at risk of serious self-neglect 77 78
  • Most have symptoms that have not responded to first-line medications and require treatment with complex medication regimes77
  • Around 20% have co-morbidities such as other mental disorders, physical health problems and substance misuse problems that complicate their recovery further78
  • Most require an extended admission to inpatient rehabilitation services and ongoing support from specialist community rehabilitation services over many years.

Although these people represent a small proportion of all individuals accessing secondary mental health services, their complex needs mean that they require a high proportion of resources.

Despite their problems, with appropriate rehabilitation and support, there is good evidence that:

  • 2/3rds of people with complex and long-term mental health needs who are supported by rehabilitation services can progress to successful community living within five years and around 10% will achieve independent living within this period79
  • Those who receive support from rehabilitation services are eight times more likely to achieve and/or sustain successful community living than people with similar problems who were receiving support from generic community mental health services80.

Disinvestment in mental health rehabilitation services has led to many people with severe and complex problems being moved to so called ‘out of area placements’; hospital, residential and nursing care homes that can be many miles from the person’s home. These facilities are socially dislocating and concerns have been raised about the quality of care in some and the lack of rehabilitative ethos81.

People placed in out-of-area facilities have similar profiles in most respects to those placed locally82. http://www.rcpsych.ac.uk/pdf/insightandinmind.pdf

Almost all NHS Trusts in Englandhave at least one type of inpatient rehabilitation unit accepting referrals from acute admission wards and secure mental health services. Most (60%) of these units are sited in the community, 11% are wards within a mental health unit and 29% are separate units within the mental health unit’s ground. Around one third of Trusts also have a low secure rehabilitation unit83.

The quality of inpatient rehabilitation services is positively associated with service users’ experiences of care and autonomy83