Guidance

Context

Context

Over 80% of people who are referred for mental health rehabilitation have a primary diagnosis of schizophrenia, schizoaffective disorder or other psychosis, around 8% have bipolar affective disorder, and the remaining 11% have other diagnoses. Around two‑thirds are men. Although people who need mental health rehabilitation have varied primary diagnoses, a common feature is the complex problems they experience. These have a severe, negative impact on the person's day-to-day functioning, including managing everyday activities and social, interpersonal and occupational functioning. These problems often make it impossible for people to be discharged from acute mental health inpatient care back to the community. Some people with these difficulties struggle to manage in the community and may benefit from mental health rehabilitation services.

The problems people may experience include 1 or more of the following:

  • treatment-resistant symptoms (for people with a primary diagnosis of psychosis, this may include 'positive' symptoms such as delusions and hallucinations and/or severe 'negative' symptoms that lead to problems with motivation)

  • specific cognitive impairments associated with severe psychosis that have a negative impact on organisational and social skills

  • coexisting mental health problems, such as severe anxiety, depressive or obsessive-compulsive symptoms, or substance misuse

  • physical health problems, such as diabetes, cardiovascular disease or pulmonary conditions

  • pre-existing neurodevelopmental disorders, for example autism spectrum disorder or attention deficit hyperactivity disorder.

Rehabilitation is essential to address these complex problems. For the vast majority of people, mental health rehabilitation leads to successful and sustained discharge from hospital and a meaningful, rewarding community life.

Although the mental health rehabilitation care pathway includes both inpatient and community services, there is significant national variation in how they are provided. In areas where there is a lack of local NHS rehabilitation services, people may receive treatment through the NHS or independent sector in the form of out-of-area placements. Since 2012, there have been many closures of NHS inpatient rehabilitation units across England and only half of trusts have a community rehabilitation team. Given that the users of these services have complex psychosis as described above, this suggests that many people do not have access to the specialist rehabilitation services they need, either locally or elsewhere.