Psychosocial Rehabilitation of Individuals with Chronic Mental Health Difficulties:
Research Developments and New Perspectives

The present paper reviews the knowledge that has been accumulated by the research conducted over the last two decades regarding basic levels of psychiatric rehabilitation such as clinical, functional, psychological, interpersonal, vocational. It aims to: a) present the variables that have been found to predict best the clinical, housing and vocational rehabilitation outcome, b) relate levels of functioning with specific elements of interventions, c) discuss the role that a supportive social network could play on prognosis, recovery and rehabilitation outcome and, d) underline the importance of subjective experience in schizophrenia and the negative psychological consequences that are often associated with chronicity.
Concerning the predictors of psychiatric rehospitalization (an aspect of a clinical level intervention), the research shows that previous hospitalization, demographic (gender, age and race) and clinical characteristics (psychiatric diagnosis and severity of psychopathology), levels of utilization of community services, community tenure and subjective perceptions of quality of life have a quite strong predictive power of future rehospitalization. However, studies in this area should examine the possible predictive role of other variables such as levels of functioning and availability of external social resources. Furthermore, research concerning effective ways of dealing with psychiatric symptomatology, preventing relapses and complying better with medication should be expanded. Traditionally, the variables that have been found to predict vocational rehabilitation outcome include employment history, levels of skills and ability to work with others. It will be useful to examine the predictive role of other variables such as vocational interests, vocational goals, internal psychological states, availability of external social resources and levels of functioning. Moreover, it is of prime interest to develop well standardised and comprehensive assessment techniques of vocational outcome among homogeneous samples. In relation to housing rehabilitation outcome, the literature shows that environmental variables had better predictive power than the sociodemographic characteristics of the residents. In specific, the environmental variables that have been found to have a positive impact on the prognosis of mental illness include: supportiveness, moderate levels of expectations, involvement in decisionmaking processes, non-restrictivenes, low levels of Expressed Emotion by the staff, individualised approach and resident"s subjective perceptions of satisfaction. A new approach in the area of housing rehabilitation that places an emphasis on normal housing with support is presented. In rehabilitation that places an emphasis on normal housing with support is presented. In relation to levels of functioning have been found to determine community placements, the quality of interactions with family and staff members, care processes and therapeutic characteristics of the settings. However, a number of questions remained unanswered such as what is the pattern of improvement of functioning levels following resettlement process, what is the relationship between levels of functioning and other outcome indicators (psychopathology, quality of life, social support)? The present paper discusses in depth the critical role that a supportive network could play in preventing relapses and in improving the quality of life of the sufferers. Most individuals with a clinical diagnosis of chronic or paranoid schizophrenia and with high levels of positive symptomatology tend to be socially isolated. Research on social support has been traditionally focused on support provided by family and staff members. Our knowledge on what the sufferers themselves prefer as social support network is very limited; their interpersonal needs and preferences may concern other than traditional sources of support such as friends from the past, lovers, volunteers. In relation to how the individuals with clinical diagnosis of schizophrenia perceive and manage their illness and how the rehabilitation interventions effect their internal psychological states, the research is remarkably limited. There is only a small body of research that shows that interventions aiming at enhancing feelings of self-efficacy and perceived control have positive impact on quality of life and self-concept.
Psychosocial rehabilitation should re-define its objectives. These new objectives should place an emphasis on:
a) normal supported housing and normal vocational conditions with limited gradual preparation;
b) development of innovative and flexible community services, such as outreach community teams and 24hours services on call;
c) the critical role that social support networks (other than the traditional ones) could play in the prognosis of chronic mental illness
d) the recognition that people with health difficulties could play a major role in designing and implementing psychosocial rehabilitation interventions.

Key words: psychosocial rehabilitation, individuals with chronic and persistent mental health problems.