Essentially bio-psycho-social, the psychosocial rehabilitation movement is found in positive psychiatry, in particular with the flagship dimension of recovery developed by users who had found (or found) a place in society and a feeling of good – be satisfactory. These people, although suffering from mental disorders, had access to a satisfactory state of mental health. Recovery reorients the approach to care towards psychosocial rehabilitation interventions, which place objectives on the front line, an optimal subjective state of functioning. The reduction of symptoms, a project prevalent in conventional psychiatry, becomes a means like any other to achieve this recovery objective, namely to regain power over one’s own life and the management of one’s health. Each person has recovery potential, strengths and values ​​to set in motion or restore. Rehabilitation interventions therefore favor techniques that promote positive psychosocial determinants, and follow their evolution:

• therapeutic education to promote understanding of access to mental and somatic care.


• cognitive remediation to improve learning skills, empowerment and social skills training to regain the ability to act and therefore a sense of self-efficacy.


• motivational techniques to support project dynamics.


• stress management and self-esteem interventions …

Innovative actions to improve the reception of people with mental disabilities in terms of citizenship, rights or social inclusion have also been supported by the current of psychosocial rehabilitation: the “Housing first” programs,  for assisted access to housing or “Intensive employment support” postulate that social or professional skills are best expressed in the community or the company with support that takes into account the strengths and values ​​of the environment in their interaction.

The psychosocial rehabilitation movement also militates in support of families, with the dual objective of improving the well-being of loved ones and people affected by the disease. In this sense, it greatly favored the transition from psychiatry to mental health. In terms of prevention, it surely has a lot to learn from positive psychiatry by also taking into account populations not affected by mental illness.
 
 In conclusion:
The current of positive psychiatry is recent and still little known. It brings hope and de-stigmatization because it reconciles in its approach the “sick” and the “non-sick” around the concept of global well-being and mental health, valid for all.
 
In addition to conventional psychiatry, positive psychiatry thus seeks to understand and promote well-being in a holistic approach. It takes into account, in addition to biological determinants, positive psychosocial characteristics in order to contribute to the development and optimal functioning of individuals, through the mobilization of their resources.
 
In addition to “conventional” psychiatry based on the management of disorders, this complementary approach, via tools for developing positive emotions, offers the patient to focus on the search for his well-being, based on his own objectives and of his strength. We will see that the current of positive psychiatry represents, for psychosocial rehabilitation, the opportunity to find a more readable identity for its principles and its interventions within psychiatry.
 

Essentially bio-psycho-social, the psychosocial rehabilitation movement is found in positive psychiatry, in particular with the flagship dimension of recovery developed by users who had found (or found) a place in society and a feeling of good – be satisfactory. These people, although suffering from mental disorders, had access to a satisfactory state of mental health. Recovery reorients the approach to care towards psychosocial rehabilitation interventions, which place objectives on the front line, an optimal subjective state of functioning. The reduction of symptoms, a project prevalent in conventional psychiatry, becomes a means like any other to achieve this recovery objective, namely to regain power over one’s own life and the management of one’s health. Each person has recovery potential, strengths and values ​​to set in motion or restore. Rehabilitation interventions therefore favor techniques that promote positive psychosocial determinants, and follow their evolution:

• therapeutic education to promote understanding of access to mental and somatic care.


• cognitive remediation to improve learning skills, empowerment and social skills training to regain the ability to act and therefore a sense of self-efficacy.


• motivational techniques to support project dynamics.


• stress management and self-esteem interventions …

Innovative actions to improve the reception of people with mental disabilities in terms of citizenship, rights or social inclusion have also been supported by the current of psychosocial rehabilitation: the “Housing first” programs,  for assisted access to housing or “Intensive employment support” postulate that social or professional skills are best expressed in the community or the company with support that takes into account the strengths and values ​​of the environment in their interaction.

The psychosocial rehabilitation movement also militates in support of families, with the dual objective of improving the well-being of loved ones and people affected by the disease. In this sense, it greatly favored the transition from psychiatry to mental health. In terms of prevention, it surely has a lot to learn from positive psychiatry by also taking into account populations not affected by mental illness.

When we talk about the rights of users / patients, we are at the heart of the concept of rehabilitation which aims to regain the power to act and the dignity of the person to repel stigma and social exclusion.

Respect for the rights of people with mental health problems implies that we consider that these people have the same rights and freedoms as all citizens and that we respect these rights and freedoms in our practices. In particular, it means that these people can make decisions for themselves that affect their lives in all respects.

In this perspective, PR aims to strengthen this decision-making power and this right to autonomy by enabling users to better control their lives in all areas and by encouraging them to do so. As far as possible, users determine their personal goals themselves and choose the services and means to achieve them.

The needs of users, like those of any person, vary from one to another; they understand biological, emotional, sexual, psychological, social, cultural and spiritual needs.
 

They are multiple, of variable importance and they vary over time. In this sense, PR aims to provide users with services adapted to their specific needs and changing in the multiple spheres of their lives, whether in the form of support, clinical treatment, accommodation services, leisure, ” occupational or vocational activities and actions with relatives and the community.

The Treatment-Readaptation-Rehabilitation (T-R-R) model is a conceptual model of mental health intervention that explicitly refers to the continuum of care and services necessary to take into account the multiple needs of people struggling with mental health problems.

On the one hand, the Diagnostic-Treatment axis, in which the healthcare team led by the patient’s psychiatrist mainly intervenes, focuses mainly on the quality of early diagnosis, the identification of the disease and its environment, its deficits, its causes and symptoms. In this regard, one of the first interventions is pharmacotherapy, which consists in providing the patient with the necessary psychiatric medication, adapted to reduce his symptoms and stabilize his mental and emotional condition.

Pharmacological advances in recent decades have greatly facilitated the role of psychiatrists in this regard, by making it possible to significantly reduce the positive symptoms of mental illness (hallucinations, delusions, unusual behaviors). However, the effects of psychiatric medication on the negative symptoms of mental illness (social withdrawal, depression, anergy) are much more modest, which points to the need for alternative and complementary approaches to intervention. Among the approaches of the treatment axis, we obviously have psychotherapy, psychoanalysis and cognitive behavioral therapy for which we have demonstrated the significant impact on the reduction of negative symptoms associated.

On the other hand, the Rehabilitation axis focuses on functional disabilities, the strengths of the person and the maximum development of their capacities through environmental learning and support procedures. The interventions aim to support the person in the development of his autonomy and his quality of life, by accompanying him in his daily life and in the pursuit of his personal goals.

Finally, the Rehabilitation axis aims to take the person to take a further step in their development, by supporting them fully in their social integration. In this regard, if rehabilitation provides people with the means to develop their capacities and autonomy, rehabilitation aims rather at updating their skills in concrete situations, through their active participation in their environment.

In some cases, to achieve this ideal, the intervention may consist in supporting the person in their integration or social participation procedures; in others, it may involve changing the environment to reduce stigma, change people’s negative attitudes and beliefs about mental illness, and help people adapt. Employment support programs are a good example of this practice. In this respect, it should be noted that Anglo-Saxon literature does not distinguish these two concepts (readaptation and rehabilitation) and refers without distinction to the concept of psychosocial rehabilitation. The distinction here provides an additional gradient in the person’s evolutionary continuum in their journey from illness to recovery.

The T-R-R model is an integral part of the reference framework of the Portes de l’Eure Clinic.

It provides a very useful conceptual basis for conceptualizing the coordination between the various clinical and social support programs. Thus, the features of the T-R-R model refer to the idea that none of the spheres is detached from the others, that each is necessary and dependent on the others.

The quality of the treatment ensures the possibility of rehabilitation, which itself makes rehabilitation possible. Conversely, the quality of rehabilitation makes it possible to avoid or reduce relapses and readmissions. In fact, the model obliges to conceive the broad path of the person and to adopt a broad and global perspective of the intervention focused on the progressive path of the person. Its purpose, which applies to both psychiatric and rehabilitative intervention, aims to maximize people’s capacities and quality of life, by offering them the best possible supports.

One may think of the founding articles of Bachrach (1996) in which the values ​​and principles of psychosocial rehabilitation are clearly exposed, or even demonstrated to be necessary and essential in a more mature conception of psychiatry, where the caregivers have fully endorsed the values ​​and principles of psychosocial rehabilitation, from a real biopsychosocial perspective. 

Increasingly, the notion of recovery is gaining ground in the field of mental health and bringing about profound changes in the way of thinking about mental illness and mental health intervention. Several leaders in psychiatry and PR, including William Anthony, Marianne Farkas and Phyllis Solomon speak of it as the new vision that now guides the field of mental health:

Recovery is the deep and intimately personal experience of those struggling with mental illness, which find meaning in their life, their suffering and their illness, as well as a way of living a satisfying life, full of hope and goals, even with the limitations caused by the illness.
 

Anthony (2001) defines recovery as “a deeply personal journey of change and working on oneself, on attitudes, values, feelings, goals, skills, roles and life plans”. In many cases, recovery represents a significant reduction in symptoms, or even a complete remission of symptoms. This is documented by numerous longitudinal long-term follow-up studies. For others, these will be profound positive changes in their lives, despite the persistence of symptoms.
 

In short, if treatment and psychosocial rehabilitation are what caregivers do to help people with mental health issues, recovery is what these people themselves do and live to make sense of their lives and live a better life.

The psychosocial rehabilitation assistance relationship is based on mutual trust between the worker and the user. Given the relational and emotional difficulties inherent in mental illness, the establishment of such a relationship of trust requires special qualities, know-how and above all know-how on the part of stakeholders to create and maintain this relationship. confidence and arouse motivation and hope in the user. Stakeholders have a responsibility in this sense and must sometimes overcome the resistance of users to want to be actively involved in their rehabilitation. The practitioner must create a climate and an environment rich in hope and motivation that help the user to persevere despite the difficulties of his mental illness, despite the symptoms and obstacles he encounters. The helping relationship aims to support the user in his difficulties as well as his encouragement in his strengths, his projects and his efforts to improve his control over his life and his quality of life overall. 

This requires qualities of know-how and interpersonal skills, the main ones of which we describe here:

Establishing a relationship of trust:

the creation of a bond of trust with the patient, some would say of a therapeutic alliance, comes from the development in the patient of a feeling of security and confidence in his relationship with his facilitator who allows him to feel comfortable, to express his needs, his difficulties, his concerns and his successes. It has long been recognized that the therapeutic alliance is a central dimension of psychological intervention. Key interventions to establish such a relationship of trust include, among others, active listening, creating a climate expressing acceptance of the other, lack of judgment and positive reflections of the person. In this context, the person can feel understood, listened to and motivated to improve. This allows her to reveal her strengths, to arouse her hope and to motivate her in her recovery process.

Empowerment, or the reappropriation of the power to act, is the process by which people take more responsibility for the direction of their life, exercise greater control over their environment and develop strategies allowing them to play a role. active in achieving their life goals. Several components are linked to the power to act: self-confidence, belief in one’s personal strengths and their use, the perception of control over the environment, the acquisition of skills allowing to be more autonomous and to influence others in the exercise of their choices, decision-making authority and personal efficiency. Obviously, the role of the stakeholder in this process is very important. He must stimulate the user in all possible ways, so that he participates as much as he can in his own life, in the decisions and situations that concern him, in particular by actively involving him in the development of his intervention plan, by encouraging him to make personal choices and to contribute to decisions affecting his home groups (e.g. user committee and self-help group).

Positive attitude: alone, the techniques and knowledge necessary for the support worker are not sufficient. They must be embodied by the speaker so that a welcoming contact with the user can emerge. This is mainly based on a positive attitude that the worker maintains in his relationship with the user. We know that a positive attitude creates a climate that is supportive for the person and that preserves or even restores their self-esteem. This positive attitude is expressed in the gestures, exchanges or contacts that the worker has with customers. It is also manifested by encouragement: by positive reflections on the person, constructive remarks emphasizing his strengths, by sharing personal experiences or even by assistance in solving concrete problems. Encouragement can also be done by helping the person to better foresee the consequences of their actions and decisions, by providing them with information and by guiding them in their choices. Thus, a positive attitude and encouragement constitute elements which, in the daily life of the helping relationship, allow the person to face difficulties and contribute to the maintenance of hope.

Listening: a helping relationship presupposei a good understanding of the person’s needs, expectations and desires. The practitioner must ensure that he or she is going to meet the needs of the person rather than his own aspirations as a practitioner. In fact, the relationship really begins with listening to the person. Good listening requires empathy, a positive outlook on the person who gives him the space and the climate necessary for him to express himself with confidence, which allows him to get to know him better, to learn from her, her strengths and difficulties. The person is in the best position to inform the worker about his or her needs, expectations, plans and dreams. Listening also means knowing how to observe, being attentive to the person, what they are, the changes that occur in their life, the potential signs of decompensation or, on the contrary, the signs of improvement in his condition. Listening is therefore also a benevolent attitude that reassures, without being intrusive. It allows the worker to create a trusting environment with the patient.

The qualities of the psychosocial rehabilitation worker:

Relational qualities are the skills for establishing a positive, helping and warm relationship with the user. It involves knowing how to listen to the user, knowing how to motivate them, using the helping relationship to facilitate change, offering hope, building on the person’s successes and minimize your failures, generate energy and enthusiasm, have the ability to support emotionally, be empathetic, have good negotiation and mediation skills and know how to set limits.

Personal qualities are the more general qualities of the caregiver that promote the effectiveness of his role as a caregiver. They include emotional stability, self-awareness, flexibility, patience, sense of humor, tolerance of ambiguity and the ability to let go when necessary.

Professional qualities are the skills more directly linked to the performance of the role of intervener. They include:

• believe in the person’s recovery and potential,


• respect ethical values,


• avoid personal bias and prejudice,


• know how to work in collaboration and in a team,


• recognize the limits of the stakeholder role,


• know how to use oneself as a role model


• and knowing how to take calculated risks.