Thursday, April 5, 2012

Why PSR is Still Needed

I just spent the weekend working with others from PSR/RPS (Psychosocial Rehabilitation/Readaptation Psychosociale) Canada on core competencies and developing a registry. I know, it sounds like pretty dry stuff but I want to expain why it is important.

I had a chance to speak to a couple other OTs who have worked in inpatient psychiatric facilities. I was quite disappointed to hear that their experiences in these environments were similar to what mine had been. I had hoped that other facilities would be different, and that improvements were being made.

Let me explain some of my concerns with the inpatient facility that I worked at. It claimed to be using a psychosocial rehabilitation approach. It looked great on paper. However, much of what I saw was custodial, medical model care.

"Patients" were often treated with a lack of respect. I observed one staff member call a patient a pig to his face. Others were called terms such as "monster" behind their backs.

There was one shift of workers where there was an alarmingly high use of the seclusion room whenever they worked. In fact, one patient was injured while being dragged by the leg into the room. Yet management never switched around that shift.

After I performed an assessment and determined that a specific client had excellent skills for living independently, his psychiatrist told me, "Some people aren't meant to live in the community".

To me, this is not acceptable. People deserve to be treated like people, whether they have a mental illness or not.
I heard similar stories from the other OTs that I talked to from other regions of the country. They too had seen patients treated as if they were not people. They had seen them threatened. They had seen staff talk about patients as if their mental illness was a character flaw, and they just need to pull up their socks.

Real changes are being made at these places, but they are slow and painful, and there is a long way to go. However, if there is no way of holding people accountable, and if there is no force to continue pushing for a change, change will stop, and we will likely see a reversal.

It seems that most places are now saying that they are using a PSR and Recovery approach. However, they are usually hiring people with no training or certification in PSR. PSR Canada does not yet have a way of accrediting facilities that say they are using PSR, so there is no way of determining whether they really are or not.

This weekend, we starting drafting up core competencies for a PSR practitioner. This is the first step toward a process of ensuring that people who say they are doing PSR, really are doing PSR. PSR Canada is also planning on creating its own registry of PSR practitioners, and is in the process of sorting this out.

This process is essential for ensuring the future of PSR Canada. Without PSR Canada, there will be no one to continue to promote the use of PSR and Recovery, no one to offer supportive resources, and no one to ensure that people really are using this approach when they say they are.

This is why it is so important we support PSR Canada (by actually paying for memberships - only $80 if you do not want the journal). It is also why it is important that when PSR Canada releases its draft competencies, everyone gives a lot of feedback on them.

I have seen so much change, and so many good things happen. There are some great workers out there. We need to keep supporting and acknowledging them. I think there is also still a lot of room for improvement.

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