Psychosocial rehabilitation services in community support systems: a review of outcomes and policy recommendations.

OBJECTIVE: This review examines the place of psychosocial rehabilitation services within community support systems in light of the need for mental health service systems to develop policies to direct the use of limited resources.
METHODS: Literature reporting experimental or quasi-experimental outcome studies of psychosocial rehabilitation interventions for persons with severe and persistent mental illnesses was reviewed, with a focus on skills training, family psychoeducation, and supported employment. A meta-analysis of the findings from recent outcomes studies was done. An integrative cost-outcome analysis examined allocation of resources among various levels of service intensity.
RESULTS: The clinical characteristics and service needs of persons with serious and persistent mental illness vary significantly throughout the life cycle and course of the illness. Outcomes research strongly supports use of psychosocial rehabilitation but is insufficiently developed to determine the effects of service components used at varying levels of intensity and the interaction of those components with client characteristics, medication levels, or phase of the illness. Cost-effectiveness studies of psychosocial rehabilitation show an average reduction of more than 50 percent in cost of care due to reduced hospitalizations.
CONCLUSIONS: Continued research is required to further specify the effects of psychosocial interventions and to determine the most effective amount and intensity of those interventions. Current evidence supports a policy of funding the psychosocial rehabilitation components of community support systems and balancing allocations for these systems among various levels of service intensity.