As we stated above, the goals of PsyR represent the objectives of PsyR services. These are what all PsyR services strive to achieve for their clients. In that sense, goals are guidelines for service and go hand in hand with PsyR values. The combination of goals and values helps determine the guiding principles. Our review of several efforts to identify these ideas (Anthony et al., 2002; Anthony & Nemec, 1983; Cnaan, Blankertz, Messinger, & Gardner, 1988, 1989, 1990; International Association of Psychosocial Rehabilitation Services [IAPSRS], 1996) suggests that there is near universal agreement on three goals of PsyR, as discussed next.
1. PsyR Services Are Designed to Help Persons with Severe Mental Illness Achieve Recovery
The goal of recovery illustrates both the hope and the difficulty of the PsyR enterprise. Recovery, which we discussed earlier, is the defining goal of PsyR. Because recovery is unique for each person, guidelines for achieving this goal may vary. You will see that some of the values and guiding principles we outline are designed to promote the idea that each individual must follow his or her own path to recovery. Because recovery is really an abstract idea defined by each individual, it is something that each person must achieve for himself or herself rather than something that we can do for or to someone. Achieving this goal presents the PsyR worker with an important challenge. The worker
The Goals, Values, and Guiding Principles of PsyR
2. Community integration
3. Quality of life
2. Dignity and worth of every individual
4. Capacity of every individual to learn and grow
5. Cultural sensitivity
Guiding Principles (13)
1. Individualization of all services
2. Maximum client involvement, preference, and choice
3. Partnership between service provider and service recipient
4. Normalized and community-based services
5. Strengths focus
6. Situational assessments
7. Treatment/rehabilitation integration, holistic approach
8. Ongoing, accessible, coordinated services
9. Vocational focus
10. Skills training
11. Environmental modifications and supports
13. Evaluative, assessment, outcome oriented focus has to help and encourage the individual to do something that the individual has to accomplish on his or her own.
2. PsyR Services Are Designed to Help Persons with Severe Mental Illness Achieve Maximum Community Integration
This goal, for the individual to be able to live with a degree of independence in the community of his or her choice, is the most consistently stated goal of PsyR services both nationally and worldwide (e.g., Cnaan et al., 1988, 1989; IAPSRS, 1996). In a very real sense, this was the starting point on which all the other goals and values emerged. Residing in the community, instead of in an institution, offers the opportunity for self-direction, rehabilitation, and recovery.
How this goal can be best achieved is still a matter of some contention. A good deal of criticism has been directed at some PsyR services accused of keeping consumers segregated by creating small institutions in the community rather than working toward community integration. Some housing advocates feel strongly that housing facilities should be integrated (a percentage of residences open to the public at large) rather than designated specifically for persons with severe mental illness (e.g., Carling, 1995). Ultimately, many advocates believe that there should be no housing designated for people with psychiatric disabilities at all. Instead, people with disabilities should live in regular community residences (e.g., homes, apartments) of their own choosing.
Some PsyR models, such as the Fairweather Lodges (Fairweather, 1980), continue to embrace sheltered support for some individuals as an appropriate strategy given the level of stigma that still exists in the community. Regardless of these differences, the maximum degree of community integration feasible continues to be a goal of the PsyR enterprise.
3. PsyR Services Are Designed to Help Persons with Severe Mental Illness Achieve the Highest Possible Quality of Life
The PsyR practitioner believes in the importance of achieving the highest quality of life possible for every individual regardless of the stage of his or her illness or the severity of his or her symptoms. The concept of quality of life refers to both the individual's subjective sense of life, for example, how the individual feels about his or her living arrangement, and to the objective, for example, yearly income. Much of this research is based on the Lehman (1983, 1988) quality-of-life interview, which takes aspects such as symptom level into account. This goal goes hand in hand with optimism about recovery and community integration, despite the presence of a handicapping condition. The presence of symptoms should not detract from the importance of those things that help ensure a reasonable quality of life such as social support, companionship, employment, recreation, food, shelter, clothing, and an active sex life. For the PsyR worker, quality of life is an important goal regardless of what stage of the illness the person is experiencing. For the individual, symptom reduction can be a quality of life issue as much as a treatment issue.
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