Rehabilitation- A New Path to Recovery

As the clock struck 8am, the kitchen doors open with the aroma of freshly cooked breakfast. Soon thereafter the residents emerge from their rooms, all well-dressed after their morning showers to have their first meal of the day. Some look unresponsive, a few seem drowsy while others appear happy and motivated to start the day. 

This is the everyday routine of residents at The Recovery House, the only psychiatric rehabilitation center located in Karachi, Pakistan. These residents are the heart of the center. They may look contented but internally they are broken and smashed. They need support to re-establish a purposeful life, re-learn lost skills and become a functional member of society and their communities. 

The Recovery House was founded in 2009, to address a significant gap in the field of psychiatry in Pakistan where almost 34% of the population suffers from major to minor mental illnesses1. A limited numbers of psychiatric and social sciences professionals are serving large number of patients, and the majority of individuals who need assistance are unable to receive any kind of professional help. 

The pillars of The Recovery House (TRH) are based on the strong belief that people have the ability to recover from chronic mental illnesses such as Schizophrenia, Major Depressive Disorder or Bipolar Disorder with the help of rehabilitation services & supports. Rehabilitation is a recent phenomenon for psychiatric treatment in Pakistan that acknowledges individuals’ strengths to achieve realistic goals for themselves and become effective members of the society. TRH promotes recovery, full community integration, and improved quality of life for persons with mental illness. 

TRH offers a residential program to the clients who need 24 hours monitoring due to the noncompliance towards the treatment or severity of symptoms. As they progress in their recovery, residents step down to the day program. The day treatment program is a unique, comprehensive service, operating six days a week. It is designed to provide integrated psychiatric treatment, primary care and rehabilitation services under one roof. 
The process of rehabilitation comprises a collaorative, person directed and specialized program built on five-step approach. The first step in this process is psychiatric assessment by consultant psychiatrist to determine the severity of illness, their biological, social and psychological tendencies and the readiness for rehabilitation. The second step involves consultation and therapeutic services of psychiatric rehabilitation practitioners, which consists of rehab goal planning and skills development.

The third major component of the rehab process is day program activities and clients are engaged in 6 hours purposeful activities based on evidence based practices such as WRAP, IMR, Pathways to Recovery, yoga, conflict resolution, sound therapy, interpersonal skills, and more. Individualized care management by care manager is the fourth step where clients are facilitated to develop and achieve their short and long term goals.
The fifth step is family psycho-education which incorporates families. This provides education for healthy relationship and supportive environment. The process assists families in developing understanding towards the mental illnesses and management of the illness in daily life. The involvement of families in the healing process ensures compliance and prevention of relapses. 

Our client, Ms. Anna* was a young, vibrant woman in her twenties.   Her aunt approached TRH with despair and resentment in order to seek assistance and support for her niece.  Anna graduated in marketing from a well-known university abroad, was a professional piano player, and was gainfully employed in her field of interest. Unfortunately, at the peak of her professional career, her life deteriorated due to emotional instability and dysfunctionality. The major disturbance in her life was found in the areas of employment, social relationships, poor treatment compliance and poor insight which were a result of the paranoia and psychotic features of her illness. 

The rehabilitation team managed her symptoms initially and later explored the triggering factors of her illness. She was persuaded to focus on her strengths and potentials that gave her confidence to design effective future goals and achieve recovery by pursuing them.

Her biggest challenge was nurturing the relationship with her elder brother. He lived abroad so the rehab team conducted several Skype sessions to resolve conflicts and develop understanding about psychiatric illness. 
Her rehabilitation process, made her aware of identifying warning signs of relapse, the role of medications and the need for a supportive social environment. She is successfully working in a multinational company at a managerial post and teaching piano to students at home.

The Recovery House impacts many lives like Anna’s. However, due to a lack of awareness about rehabilitation services in Pakistan very few people opt for this option. This calls for investing in spreading awareness about rehabilitation and developing work force to the growing demand. The TRH is receiving training by US experts in the field and those training are modified in Pakistan according to its cultural needs. Caravan of life Psych. Rehab. Academy (CUPRA) is planning to offer trainings leading to Certified Psychiatric Rehabilitation Practitioner (CPRP). The training program is scheduled to start in January 2017 which will in time develop an effective rehabilitation workforce in Pakistan by producing trained certified rehab professionals. 

The Recovery House took a major initiative and drew people’s attention towards this unique approach by organizing a conference in September 4, 2016 in Karachi. It focused on sharing future directions in Psychiatric rehabilitation where experts connected the dots between the two key services that is psychiatry and psychology by introducing a new concept of psychiatric rehabilitation in Pakistan. Professionals from US helped revive hope among families and mental health practitioners in the process of recovery and gaining a fulfilled life. The family system is a cultural asset and a special session was conducted for the effective role of caregivers in the rehabilitation process. It was combined with sessions for individual’s ‘Environment of Choice’ in four major areas; Living, Learning, Working or Socializing to integrate them back into society. 

The rehabilitation service in Pakistan is developing awareness about mental illnesses and its recovery process by doing tremendous efforts in improving the quality of life of individuals diagnosed with mental illness. The purpose of rehabilitation has always been to transform dysfunctional lives by helping them become confident, independent and self-sufficient individuals so they can play the role of a responsible person in community. The success stories of our graduates are giving hope to others believing in recovery. There is no doubt that hope is the first tool of wellness in the pathway to recovery and TRH is the promising institution in Pakistan which is lighting the candles of hope in despaired lives.

Acknowledgement: 
*Names have been changed to protect identity.
We acknowledge our clients for sharing their experiences with us and staff who helped in providing us with their support in data collection.
We also acknowledge Dr. Nazila Bano and Ms. Shaheen Ahmed for their unconditional support and guidance.

References:

http://tribune.com.pk/story/889024/per-capita-income-a-pakistani-now-mak...
  WHO Mental Health Atlas 2014 – Country Profile Pakistan. Available at:  http://www.who.int/mental_health/evidence/atlas/profiles-2014/pak.pdf?ua=1
  WHO-AIMS Report on Mental Health System in Pakistan (2009). Available at: http://www.who.int/mental_health/pakistan_who_aims_report.pdf