The Effects of Early and Comprehensive Intervention on the Use of Psychiatric Rehabilitation Services, Patients\' Function and Caregiver Burden

According to the literature, the major reasons of under-utilization were \"never heard about\" and \"insufficient knowledge\". It revealed that current intervention mode in hospitals could not successfully and adequately give information related to psychiatric rehabilitation services to patients and caregiver. Nevertheless, to date, no study has focused on this issue.

Thus, the author conducted a two-year experimental study in Tsao-Tun Psychiatric Ward using a \"Early and Comprehensive Intervention\" model. Patients in the experimental group (n=45) received intervention from social workers who act as a case manager; the intervention involves two parts: (1) During patients\' stay in the hospital, including comprehensive assessment, information giving, explanation, and education, as well as making discharge plan and referring patients\' to appropriate psychiatric rehabilitation services; (2) After discharge, including follow-up on patients\' use of psychiatric rehabilitation, patients\' function and caregiver burden.

Whereas, patients in the control group (n=31) received regular intervention. The study examined if the experimental group used more of the psychiatric rehabilitation services than the control group. Also, by using T-Test procedure, the study tested if experimental and control group were significantly different in patients\' function and caregiver burden three months and nine months after the patients were discharged from the hospital.

The results indicated that very few patients were referred to any community rehabilitation agency, and only four of them used such service three month after discharged from the hospital. In general, there was no significant difference in rate of referral and service use between the two groups. Neither there were significant differences on patients\' rate of re-hospitalization and social function as well as on caregiver burden between the experimental group and control group.

However, such results do not necessarily imply that the research hypotheses in this study were not supported because there were problems with program implementation process and the structural issues, including insufficiency of psychiatric rehabilitation facilities and the power structure and role allocation among the different professions, deterred the psychiatric service referral and use. The final barrier but not the least important one is the lack of motivation and knowledge concerning psychiatric rehabilitation service among patients and caregivers.

These problems limited social work to act the roles designed in this study. This study discussed these limitation and made the following suggestions: 1. To increase the capacity of community rehabilitation services; 2.

To change the payment system in the our National Insurance system to encourage the use of psychiatric rehabilitation services; 3. To re-structure the job description and role allocations among the professions; 4. To allow flexible work time and methods for social workers; 5.

To strengthen the education toward patients and caregivers about psychiatric rehabilitation service.