Psychosocial Assessment for Community Based Psychiatric Rehabilitation:
A Practice Oriented Approach
K.J. Mathew. MSW, MPhil 1,
Faculty member for Social Work in Mental Health,
Dr. Guislain Svastha Education Trust (G-SET),
1st floor, Claret Institute of Employment Training,
Purulia road, Ranchi, Jharkhand
Sakshi Rai. MA, MPhil, 2
Department of Clinical Psychology,
Central Institute of Psychiatry,
Kanke, Ranchi, Jharkhand
Matthew KJ & Rai S, (2015) Psychosocial Assessment for Community Based Psychiatric Rehabilitation:
A Practice Oriented Approach. International Journal of Psychosocial Rehabilitation. Vol 19(2) 83-95
Based Rehabilitation has been recognized worldwide as a best method of
rehabilitation for individuals with various Psychiatric problems. It
aims to restore the wellbeing and quality of life of the individuals
with Psychiatric disorders at its maximum possible level with the
active participation of his/her living community. A comprehensive
assessment of all psychosocial factors is very crucial to plan an
effective management plan for any of such interventions. This article
aims to give basic technical and practical information to the fresh
professionals and volunteers in the field of Community Based
Psychiatric Rehabilitation. The article attempts to combine the
theoretical knowledge and author’s practical experiences from the
KEYWORDS: Community Based Rehabilitation, community
volunteers, Psychiatric problems, psychosocial assessment, psychosocial
rehabilitation is a systematic and strategic approach to restore the
psychosocial functioning of an individual with mental illness through
continuous strategic services targeted on symptom management,
prevention of relapses, and maximizing the level of functioning and
wellbeing. Although not restricted to particular mental disorders by
definition, traditionally such interventions are focused on chronic
psychotic illnesses like Schizophrenia, mood disorders and at times
Obsessive Compulsive Disorders. Community based psychiatric
rehabilitation aims to provide psychiatric rehabilitation services with
the assistance of individuals and resources available in patient’s
living environment. Placing or treating the patient in his/her
community itself with the support of community volunteers, has received
lot of appreciation in recent time. A detailed psychosocial assessment
which is often carried out by a social worker or any mental health
professional is very essential for initiating and for ensuring success
of rehabilitation. A careful psychosocial assessment gives
detailed idea about the individuals living conditions, past and present
experiences, risks and protective factors, culture and beliefs,
available and lacking resources etc., and such information helps to
develop clearer view about illness, an appropriate treatment plan based
on individual circumstances, diagnosis, define immediate and future
goals and planning to achieve them systematically and realistically.
Although there are many structured and semi structured instruments for
psychosocial assessments, they do carry number of limitations when
practiced in community such as it is not possible to go with scales or
interview schedules every time as such way of measurement does not
ensures the sensitivity to the patient’s situations as well as a single
measurement is unable to cover all the areas of psychosocial
functioning. Each family and community differs in terms of culture,
beliefs, attitude and approaches.
The quantitative data
received through the structured measurement may not have a direct
applicability in practical context. Whereas a qualitative approach
provides situational related descriptive idea based upon patients
circumstances which can be used effectively for the management. In such
situation it is often not clear for many of the mental health
professionals about how to go ahead and what all areas should be
covered under the psychosocial assessment for the community based
rehabilitation of an individual with mental illness. Present article
attempts to combine the theoretical knowledge with practical
experiences for assessment in community based rehabilitation focusing
on family dynamics. Undermentioned components are significant in
evaluations of psychosocial rehabilitation.
sex, marital status, details of family members, socio-economic status,
place and type of residence, religion, geographic features etc., has
its own significance in community based rehabilitation under the cover
of socio demographics. It helps to have a clearer and individualized
understanding based on their circumstances, which is a part and parcel
of an emic view. Researches also state that socio- economic
status is related with mental illnesses in different ways (Bradley
& Corwyn, 2002; Goldberg& Morrison, 1963). All such
information’s need to be incorporated carefully under various phases of
psychosocial rehabilitation. For example, the implications of
socio-demographic factors for the rehabilitation plan for an aged
person living in a hill area and costal area has to be different.
BRIEF DEVELOPMENTAL AND SCHOOL HISTORY
brief developmental history about the patient’s childhood and family
backgrounds, social situations, friends, various likes and dislikes,
life events etc., are also important. The negative life experiences,
especially associated with parents and key caregivers are found to
increase the vulnerability of the individual to develop various
psychiatric disorders (Bifulco et al, 1994; Bowlby, 1973). It caters
following advantages. Firstly it supports to have more empathetic
understanding towards the patient by being realistic towards their
situations. Secondly it helps in tailoring specific individualized
interventions. For example identifying some specific interest areas
like playing chess or badminton can be effectively utilized for
managing negative symptoms of a person with chronic schizophrenia.
SEXUAL AND MARITAL HISTORY
orientation, attitude towards own and opposite sex, knowledge about sex
and sexuality, sources of information, masturbation history, menstrual
history, deviant behaviors etc. are the key elements. If the individual
is married, the information about the type of marriage (i.e., arranged,
forced, love marriage), duration, history of divorces, quality of
current relation, number of children etc., should be collected.
Considering spouse as primary care taker for most of the married
individuals it is essential to understand the marital relationship for
incorporating those details in the management plan.
the person was employed earlier the details of the job, job adjustment,
ability to take care of responsibilities, changes in job or job
pattern, satisfaction with job, history of promotion or increments
etc., should be collected in detail. Such information will be
effectively useful for planning the vocational rehabilitation for the
premorbid factors are important for planning and implementing an
effective strategy for the individual’s psychosocial rehabilitation.
Premorbid personality refers to the individual’s overall functioning at
various levels prior to the onset of illness. Premorbid personality
found to be associated with development of different mental illnesses
and also associated with differences in psychopathology and prognosis
(e.g., Hirschfeld et al, 1989; Erlenmeyer-Kimling et al, 1995; Peralta
et al, 1991). It is also important to frame realistic treatment
goals as the primary objective of psychosocial rehabilitations would be
to restore the premorbid functioning of the individuals. Addressing
personality issues may become additional or secondary goals in the
rehabilitation process as it progress. Possibility for dilemma may
exist in distinguishing personality traits with presentation of current
psychopathology such as schizoid traits can be interpreted as negative
symptoms of schizophrenia, or as anhedonia in depressive disorders etc.
The assessment in this domain can be done by collecting the information
about, their predominant mood before the onset of illness, interests in
social and interpersonal relationships, hobbies and interests,
vocational adjustments, religious and moral practices, problem solving
and coping skills, recreational activities etc.
CURRENT MENTAL STATUS
will not be reasonable and realistic to plan a psychosocial
rehabilitation without assessing the current mental status. One must
thoroughly assess the individual for ongoing psychopathology, their
abilities and limitations because of psychopathology, progress
(improving, stable, and worsening) etc., to make set of achievable
goals. The interventions should be designed in such a way which helps
to deal with the ongoing psychopathology, if present.
families have been classified into nuclear, extended and joint
families. Nuclear families consist with members from two generations
such as father, mother and children. In extended family there may be
three or more generations present such as grandparents or one more unit
of family may live together such as two brothers and their family
living together. Joint family consists of multiple family units living
together under same shelter with defined power structure. Understanding
family type is important to define the systems and subsystems and
related dynamics in the family.
is conceptualized as a small social system consists of individuals who
are related to each other by sharing reciprocal affections and
loyalties (Terkelsen, 1980). It has been viewed as a system of
interacting parts having many subsystems (Minuchin, 1974). The common
subsystems in a family are parent subsystem, child subsystem, and
grandparent subsystem and so on. Boundaries can be any of such factors
which separate or limit the interaction between two systems or
subsystems. In family factors like age, sex, generation, religion,
geography, education, socio-economic status etc. are major determinants
of boundaries. As because of such boundaries the communication process
between different systems are restricted and regulated. For example,
communication between parents will be different from their
communication to the children as some content of communication may vary
depending upon the factors cited above. Likewise all the information
shared between siblings may not be shared with parents. Boundaries have
been classified into three such as open, closed and semi-open or
partially open (Holman, 1983). An open boundary is where anyone
from the outside system or subsystem can enter in the system without
any interference and a closed boundary where no outsider is
permitted to enter in the system or subsystem are considered as
dysfunctional (Holman, 1983). Sharing ‘all’ or ‘not at all’ between any
system results unfavorable outcomes. Maintaining equilibrium between
‘what ought to share’ and ‘what not to’ results in semi-open boundaries
where a healthy exchange of information takes place. Boundary
dysfunctions are found to be associated with the onset of
psychopathology and problems in different functional domains of life
(Carlson et al, 1995; Fullinwider-Bush & Jacobvitz, 1993; Sroufe et
al, 1993; Tienari et al, 2004). One can easily assess the
existence and functions of boundaries by gaining the relevant
information in the areas like; what are the subsystems in the family?
Are there proper communications between subsystems? Are they sensitive
about what to share and not to share with others? Is there someone left
out from other peoples? Is the family open or closed for outside
members? Do they accept suggestions and advices from others? Are there
any kinds of restrictions or how easy for an outsider to come and
interfere with family matters? An open boundary increases the
chance of different kind of abuses and external influences, which
hinders the management and may interfere negatively. Whereas the closed
boundary reduces receptiveness to the new persons and information.
Management issues need speculation to cater such elements, for example
if a family maintains very rigid boundaries in terms of religion a
volunteer from the same religion may be easily accepted and may be in
future they can work on changing such attitude of the families.
refers to the kind of distribution of power among the family members
and leadership patterns. It can be democratic, laissez fair,
authoritarian or autocratic. A defined power structure such as who is
first and who is next is important for a family to maintain healthy
functioning. Family structure denotes the relationship pattern within
and between the family by its members, way of participation and
influence on other members (Levy, 2006), and the family power structure
defines the actual influence of each member on day to day functioning
and decision making process of the family (Gladding, 2007). It
defines the hierarchy distribution of power in the family which serves
as base for family’s decision making in day to day functioning, and
change is based upon the generational changes such as death, acquiring
maturity through age and by taking up new responsibilities such as
marriage and procreation. It will be helpful in problem solving and
resolving different kind of conflicts when it flows with a set of norms
in family. The leadership styles like autocratic and laissez fair may
not be healthy for a family. A democratic style and an authoritarian
style with the readiness of the leader to consider others opinions
before taking decisions may be healthier. Problems in power structure
occur when a family fails to define their power structure or fail to
maintain it or to execute the authority on children by its senior
members. Dysfunction in the family power structure is associated with a
number of problems in children and adolescents including delinquent
behaviors (Moitra, 2012; Zimmermann, 2006). It is important to
understand these factors for a successful strategic intervention in
community based rehabilitation. It gives clear idea for the
professionals to approach the right person or to work on such deficits.
One can understand the power structure by clarifying factors like; how
the family takes decisions usually? How they resolve conflicts when
there are differences of opinions? Is there any person whose decision
is ultimate in the family? Is there any person who is considered as the
head of the family? Are the family members obeying the decisions of the
family head? Is there someone who get over importance or less
importance in family?
PROBLEM SOLVING AND DECISION MAKING
refers to the activities of the family for resolving conflicts and
taking appropriate decisions. A democratic approach where a collective
brainstorming takes place along with most suited and acceptable
decision is taken is considered as appropriate. Most often families are
unknown about such strategies and the decision making ends up with
everyone taking their own decisions when it is concerned about them, or
the head of the family takes decision in autocratic manner. The
dysfunction in family problem solving and decision making is found to
be associate with the onset and maintenance of different psychiatric
disorders and delinquencies (e.g.,Heru, & Ryan, 2004; Mathew et al,
2009; Trangkasombat, 2006; Unal et al, 2004). In presence of unhealthy
problem solving strategies, teaching family about the alternative
becomes important in order to include the one who is left out or may
underperforming the role that is the one with mental health issues. A
healthy inclusion promotes feeling of accepted and boost the
self-esteem. Following information may be required to address the issue
of problem solving like; what do they do in face of problem? Do they
share it with other members? If it is a concern to whole family, who
takes the decisions? In such circumstances whether family members’
opinion considered? Do all members express happiness with the process
or how do they react? Do such decisions result in resolving the
conflicts or accelerate to another problem?
is an important area containing various concerns within. It can be
explained as an exchange of information between two or more
individuals, families, systems or community. Communication with and
between other members may affect the individuals. Studies suggest that
the faulty communication between family members may affect the mental
health of children and a proper management of such problem gives
desirable outcomes (Dwyer et al, 2003). Problems in communication and
communication deviances have been observed in a greater level among the
families of individuals with various psychiatric disorders including
schizophrenia and bipolar disorders (e.g., Miklowitz et al, 1991;
Goldstein, 1987; Heru, & Ryan, 2004; Mathew et al, 2009;
Trangkasombat, 2006). To have an understanding in this area,
communicational engagement between all the systems in family needs to
be explored, and in case of dysfunction reasons need further
exploration. Factors known for the communication dysfunction are rigid
boundaries where one or other members of the family keep restrictions
from another member due to certain reasons like age, sex, generation
gaps, technology, level of education, lack of interest, psychopathology
and personality. Possibility of separation and feeling cornered by
family members because of ongoing psychopathology needs attention.
Sensing out someone at the initial part of assessment who can be a
resource person in healing such dysfunction in relationship is
advisable. Need based communication in present era is known; however
patients with mental illness face it in even harsher and at times in
punitive manner. Families may limit their communication with mentally
ill persons because of different reasons like ongoing psychopathology,
feeling of incompetency, prejudices towards them, family burden and so
on. These peripheral issues need to be addressed. The quality of
communication lies in clear meaning in message, conveyed through
appropriate emotional tone and audibility along with positive attitude
and congruence between verbal and non-verbal expressions. Double bind
communication, confusion, argument, strained emotional attachments,
lack of volume and audibility, half completed messages, lack or excess
of nonverbal expression are all ingredients of poor quality of
communication. A careful observation during home visits and clinical
interviews helps the practitioner to understand these factors. Locating
sources and severity of such unhealthy communication helps to work on
underlying issues in the management.
can be understood as the socially expected and appropriate performances
of behavior and action from each individual in the family or society
(Biddle & Thomas, 1966 cited in Holman, 1983). Each of the identity
expects a specific set of responsible behavior functioning from the
individual and appropriate performances of such responsibilities which
is important to maintain a healthy functioning of families, communities
and nations. Not performing or deviations from such duties may result
different kinds of dysfunctions in family. A gross dysfunction in role
functioning have been reported by different studies in different
psychiatric conditions (e.g., Heru, & Ryan, 2004; Mathew et al,
2009; Trangkasombat, 2006). Mental illnesses are known to cause
dysfunction in role functioning which requires productive compensation
from family, in terms of financial, social and emotional aspects.
Families failing to compensate need speculation by focusing upon
individual strength and weakness of each family member. Undue
compensation result in many role dysfunctions within families such as
role confusion, role diffusion, role conflict and so on. People with
mental illness face difficulties to resume their roles after recovering
from illnesses and at times their roles are taken over by the other
members. Often such circumstances raise question to their competency to
perform any duties or responsibilities which further pushes them back
to perform as a passive member in the family without any specific
roles. Bringing the person from passive to active role in family
requires careful assessment about his current level of functioning
which covers his current status of psychopathology and related
cognitive and physical abilities which helps the team to develop an
appropriate plan of management. It could be started at basic level of
scheduling activities with very simple tasks such as pouring water in
the garden, taking care of poultry, simple purchases from shops etc.,
depending upon individual’s capacity and backgrounds.
control in family refers to the kind of strategies adopted by the
family to maintain and control the behaviors of each individual member.
Disorders such as schizophrenia, depression and anxiety disorders are
found to be associated with low levels of parental care and high levels
of parental control (Parker, 1983; Silove et al, 1991). Dysfunctional
parenting strategies are found to be associated with various risks in
the children’s life under various stages including increased
vulnerability to develop different psychiatric illnesses and affecting
prognosis and recovery (e.g., Arrindell et al, 1983; Bryce et al, 2007;
Johnson et al, 2006; Mathew et al, 2015). It is important for the
family to have a clear understanding about acceptable and
non-acceptable behaviors and their consequences. The rules should be
common to all and in case of restriction to a particular group, it
should have a rationale. For example “you are a child so you should not
smoke cigarette” is not a rational explanation in a family’s context,
but “you are a minor so you should not drive a car” is having a
rationale. There should be consequences for all the behaviors based on
good or bad. Most of the families are not aware about
reinforcement strategies and even if they know they fail to follow it
consistently, contingently and with clarity and hence yield unhealthy
outcomes. Approach of the families may become ignorant or over
protective and at times even hostile depending upon their attribution
towards patient’s behavior. Before formulating a management plan it is
important to recognize the following points. Does the family have any
kind of common understanding about the acceptable and non-acceptable or
good or bad behaviors? If yes, do such rules are common to all? Do they
share clarity about the consequences of their good or bad behaviors?
Does the family have someone who looks after and monitor the behaviors
of other family members and if yes whether it happen every time
properly? Is family aware about the positive and negative
Cohesion is one of the
necessary characteristic for family, which comprises the healthy
attachments and bonding between members of the family. At the same time
it permits space for developing individuality and independence. Ideal
position requires a healthy attachment and healthy separation between
all the family members. All the members should be mutually supportive
with an emotional bond. Lack of emotional bonding and insecure
attachment may lead to different kind of mental health problem mostly
in developing years (Ginsburg et al, 2004; Rosenstein & Horowitz,
1996). An excessive involvement in terms of control or overprotection
is known to yield unhealthy outcome and may create vulnerability for
problems like anxiety disorders (Bowlby, 1973; Frey & Oppenheimer,
1990). A detached and strained relationship and conflict between
individuals in family causes negative impact on other members, mostly
on children (Cummings & Davies, 2002; Fincham et al, 1994;
Fergusson & Horwood, 1998). Dyadic and triadic bonding are known to
be most dysfunctional in the families (Gjerde, 1986). Having a person
with mental illness in family may lead to gradual strained relation,
emotional distancing and at times even over protection.
Clarifying such factors need inquisitiveness under following domains
like, do they feel loved and supported by the family members? Are they
satisfied with the emotional and physical support from their family
members? Do they feel separated or isolated from other family members
because of the illness or any other reason? Do they think that some of
the family members love someone more or dislike someone? Do they think
that there is some kind of subgroups in the family such as someone
preferred to be with someone than others? Do they think that there are
sub-groups who hate one another? Do they think family respect their
rights to take decisions and being independent?
is an important concern for the improvement, remission and recovery of
a person with chronic mental illnesses (Brown et al, 1972; Butzlaff
& Hooley, 1998). It is found to be associated with recovery,
relapse and functional outcome of various disorders like schizophrenia,
bipolar disorders, and depressive disorders (e.g., Butzlaff &
Hooley, 1998; Hooley & Teasdale, 1989; Miklowitz et al, 1988).
Expressed emotions refer to the attitude of the family members towards
an individual reflected through their comments and behaviors. George
Brown (1985) identified five types of expressed emotions under two
different categories of positive or favorable and negative or
unfavorable. The negative expressed emotions includes critical
comments, hostility and emotional over involvement. Critical comments
are the attitude expressed by the family members towards a person with
mental illness through verbal comments, mostly projecting them as a
continuous burden, disturbance or problem for the family, attributing
it to their unproductiveness or laziness etc. Hostility is the attitude
of relatives expressed through their emotional expressions and
behaviors, such as reflecting frequent anger outburst, irritability
towards patient, physical and verbal abuse etc. Emotional over
involvement is a kind of undue involvement with the patient by not
letting the patient to do any work, being over protective, accepting
all the behaviors including problem behaviors as part of the illness
etc. The positive expressed emotions are warmth and positive
regards. Warmth refers to a comfortable level of expression of positive
emotions such as love, affection, kindness and being empathetic to a
person with mental illness. Positive regard refers to giving meaningful
feedbacks and appreciations to the individual in a way to reinforce
their desirable behaviors, confidence and self-esteem. During
interaction and assessment understanding factors behind expressed
emotions, such as burden, stigma due to mental illness, inability to
attribute behavioral change to psychopathology etc., should be
evaluated carefully (Scazufca & Kuipers, 1996; Schoonover, 2014).
Careful observation during interview reveals expressed emotions in the
family from different sources under the content of the speech, verbal
and emotional tone, emotional expressions and behavior etc. It is also
important to understand the subjective feeling and emotional status of
the patient with respect to such events. The intensity and frequency of
expressed emotion from different family members needs to be speculated.
Sensing the upper hand of negative expressed emotions with respect to
positive expressed emotions, requires solution in the subsequent
visits. For example addressing the probable reasons for critical
comment in form of raising awareness of illness, dealing with obstacles
secondary to psychopathology and problem behavior can be of help. Based
upon the locus approach of intervention can be changed from
psychoeducation to behavior modification and so on.
is a broad term which refers to the extent and quality of interpersonal
relationships of an individual. It is defined as “verbal and or
nonverbal information or advice, tangible aid or action that is
proffered by social intimates or inferred by their presence and has
beneficial emotional or behavioral effects on the recipient” (Gottlieb,
1978). Social Support is found to have significant influence on the
onset, recovery, number of episodes and relapses of various mental
disorders (e.g., O’Connell et al, 1985; Mueser and Tarrier 1998;
Johnson et al, 2003; Davidson et al. 2004). Studies demonstrate
positive effects of social support by helping individual to develop
immunity from developing various disorders and also for more desirable
outcome for those who are affected (Cobb, 1976; Cohen and Hoberman
1983; Cohen et al. 1985; Brugha, 1990; DiMatteo 2004). The social
network includes family, friends, neighbors, social institutions etc.,
as the major source for social support, which could be positive or
negative, supportive or stressful, depending upon the manner of
relatedness which is also an important concern during assessment. Over
protection or autocratic power structure in family, lack of intimacy in
family relationships, antisocial traits in the family, antisocial
gangs, substance abuse and communal violence can be seen as the
examples of negative social networks (Tracy & Whittaker, 1990). The
primary social support which a person receives from his/her immediate
relatives is most important. Reid (1989, cited in Costello, Pickens
& Fenton, 2001) identifies four kinds of social support as given
Instrumental support: It is a direct support to an individual by
fuelling material in the forms of money, food, shelter, healthcare etc.
• Informational support: It
includes providing information according to the need of the individual.
It is more important during growing ages.
• Affiliative support: It means the physical presence of other individuals who have mutual interests.
Emotional support: It includes developing and maintaining a good
emotional bond between individuals, by expressing concerns, providing
space for sharing the feelings, etc.
functions are interconnected with other areas of family functions as
well. For example providing only instrumental support is also an
indicator of a failure in the areas of role functioning, communication
and cohesion and vice versa. The knowledge about availability and type
of support of family members, availability of support from one’s
community and neighborhood as well as from service sector is also
essential to plan an effective psychosocial rehabilitation plan.
For example, a youth club with a willingness to help a patient can be
utilized effectively for managing the deficits of a patient with
chronic schizophrenia in social functioning.
SOCIO-CULTURAL AND RELIGIOUS FACTORS
community differs in various aspects related to psychiatry and mental
health, based on the cultural, religious and educational background of
their belonging. There can be favorable or unfavorable attitudes,
beliefs and practices in the community related to mental illnesses
directly or indirectly. Understanding, interpreting and adopting
socio-cultural and religious factors are vital for community based
rehabilitation. A direct confrontation or lack of knowledge about such
factors may hinder intervention process. At the same time many of such
factors can be utilized in a positive manner. For example advising a
morning walk to a women hailing from a remote village of India may not
be a good example rather motivating her to visit temple at a distance
every day in morning can be fruitfully utilized as it is culturally
sanctioned and may even fetch social support. People often try to
define or explain the causes, symptomatology, treatment and prognosis
of mental illnesses based on their self-experiences or their
observations of mental illnesses by using their own understanding
mostly developed from the belief systems in which culture, religion and
tradition are the basic ingredients and such definitions are called as
explanatory models (Kleinman, 1980). It is necessary to understand the
explanatory models in context of each culture and patient as the help
seekers rely more on these explanations. People from developing
countries like India often follow a set of culturally sanctioned models
of explanations for the symptoms of mental illness and follow a variety
of traditional healing practices including faith healing and approach
to the mental health professional mostly at the end. Again the
explanatory models colored by culture and superstitious beliefs are
more common among individuals belonging to socially backward groups and
poorly educated (Schoonover, 2014; Nambi et al, 2002). Community
workers during the process of community psychiatric rehabilitation need
to remain conscious to the use of such strategies while addressing
IMPACT OF ILLNESS
illness is the consequences happened to one’s life and their family
because of the mental illness. A significant level of stress and burden
because of the mental illness in a family member has been observed in
several studies and such stress and burden may also be responsible for
generating negative attitude and behavior towards persons with mental
illness by their family members (Abramowitz & Coursey, 1989; Dore
& Romans, 2001; Perlick et al, 1999; Scazufca & Kuipers, 1996).
An assessment can be focused and pin pointed on the following areas;
Personal & cognitive areas: it includes ability to maintain
personal care, activities for daily living, motivation, ability to
learn, think and reasoning, decision making, memory etc. A careful observation
in the areas mentioned above provides idea about the changes in the
different family system because of illness. Professionals need planning
for different strategic interventions for tackling each of these issues
with a motive to bring maximum healthy atmosphere in the family by
minimizing the negative effects.
Family: role functioning in the family, managing relationships, ability
to express and maintain emotional attachments, ability to take
responsibility, participation in day to day family functions etc.
Social: level of social relationships, ability to establish and sustain
social surroundings, social relationships, social behaviors,
adaptability with situations etc.
Physical: capacity to function appropriately and in healthy way,
to meet day to day physical needs, appropriate energy level, stamina,
biological functions etc.
Occupational: ability to concentrate and do simple or complex tasks,
goal directedness, sustainability, tolerance with others and situations
whether in person or in social setting etc.
Recreation: motivation to engage and participation in pleasurable
activities such as hobbies, gardening, chatting, meeting friends, etc.
On family (it is about the changes and difficulties for individual family members of the person with mental illness).
Personal & cognitive areas: includes negative effect on one’s
life because of another person’s illness as of insufficient time for
maintaining self-care and activities of daily living, perception of
stress, changes and problems in studies and jobs, difficulties in
getting married secondary to stigma etc.
Family: changes and inadequacies to perform role functioning in the
family appropriately, change in relationships as the families may
prefer to remain away from other relatives or separated by other
relatives because of mental illness, labelling, family burden,
financial resources etc.
changes and limitations in social relationships, attitude toward other
members in the society, and perceived feeling of acceptance in the
society and perceived social stigma, changes in friends and
capacity to function and meet day to day physical demands of self and
for the patient by any of the family member, physical illnesses and
difficulties, changes in biological rhythm etc.
Occupational: changes and challenges in occupation because of illness
such as meeting financial needs and compensating for resources or
patient’s income, or difficulties in managing job responsibilities and
patient care, problems at work place secondary to patient care at home
• Recreation: changes in the
availability and preference for activities which give pleasure, changes
in habits, etc.
health issues need multidimensional approaches to bring fruitful
outcomes. Finding out areas need attention and strategies to restore
the wellbeing of an individual requires knowledge and skill based
comprehensive assessment. Community based assessment requires more
humanistic approach which provides individual information about socio-
demographic details, possible etiological factors, current status of
mental illness, psychosocial issues, issues related with
psychopathology, protective and risk factors, strength and weaknesses
of the individual with mental illness, available and lacking resources
etc., in such a way that can guide an attitude of an examiner in
tailoring a comprehensive yet approachable plan for psychosocial
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