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Manual for Community-Based Rehabilitation Workers

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Manual for Community-Based Rehabilitation Workers Manual for community-based rehabilitation workers Version 2.0 Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE): A manual for community-based rehabilitation workers August 2017 Authors: Laura Asher, Charlotte Hanlon, Julian Eaton, Mary De Silva, Sudipto Chatterjee, Rahel Birhane, Atalay Alem, Vikram Patel, Abebaw Fekadu The RISE manual was created following an extensive intervention development process in collaboration between the Department of Psychiatry, College of Health Sciences, Addis Ababa University, Ethiopia and the Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK. For further information please see: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0143572. The RISE intervention was evaluated in a cluster randomised trial (Clinical Trials.gov NCT02160249) Contact: [email protected] AcknowledGements: The authors would like to gratefully acknowledge several source materials that were used to develop the RISE manual, including ‘The COPSI Manual: Manual for Working with People with Schizophrenia and their Families’ (Sangath, Goa, India http://www.sangath.in/copsi/); the ‘Mental Health Pocket Guide for Health Extension Workers’ (Federal Democratic Republic of Ethiopia Ministry of Health); ‘Community Based Rehabilitation Guidelines’ (World Health Organisation); ‘Facilitator’s Guide for Psychosocial Rehabilitation Support Groups’ (Carrie Brooke-Sumner, PRIME South Africa), ‘Mental Health and Human Rights Resource Pack’ (Amaudo UK, 2007), and ‘Where there is no psychiatrist: A mental health care manual’ (Vikram Patel). FundinG: The RISE project was funded by the Wellcome Trust. The RISE project was part of the PRogramme for Improving Mental health carE (PRIME), which is funded by the UK Department for International Development. This manual belonGs to: Telephone number: 2 Contents INTRODUCTION TO THE CBR MANUAL ..................................................................................... 6 SECTION A: UNDERSTAND WHAT SCHIZOPHRENIA IS AND THE PROBLEMS IT CAUSES ............. 7 1 WHAT IS MENTAL ILLNESS? .............................................................................................. 8 2 WHAT IS SCHIZOPHRENIA? ............................................................................................. 13 3 MEDICATION FOR SCHIZOPHRENIA ................................................................................ 18 4 DISABILITIES RELATED TO SCHIZOPHRENIA ..................................................................... 21 5 IMPACT OF SCHIZOPHRENIA ON THE FAMILY ................................................................. 23 6 STIGMA AND DISCRIMINATION ...................................................................................... 26 7 HUMAN RIGHTS ............................................................................................................. 29 8 THE IMPORTANCE OF THE COMMUNITY ......................................................................... 31 SECTION B: LEARN HOW TO HELP PEOPLE WITH SCHIZOPHRENIA AND THEIR FAMILIES THROUGH CBR ....................................................................................................................... 34 9 OVERVIEW OF CBR DELIVERY ......................................................................................... 35 10 COMMUNICATION SKILLS AND PROBLEM SOLVING ........................................................ 50 11 CREATING A TRUSTING RELATIONSHIP ........................................................................... 55 12 NEEDS ASSESSMENT ....................................................................................................... 58 13 GOAL SETTING ................................................................................................................ 62 14 RISK ASSESSMENT .......................................................................................................... 68 3 15 BEING AWARE OF THE CAREGIVER’S NEEDS ................................................................... 73 16 MODULE: UNDERSTANDING SCHIZOPHRENIA AND ITS TREATMENT ............................... 75 17 MODULE: IMPROVING ACCESS TO HEALTH SERVICES ..................................................... 81 18 MODULE: PREPARING FOR A CRISIS ............................................................................... 85 19 MODULE: DEALING WITH HUMAN RIGHTS PROBLEMS ................................................... 89 20 MODULE: SUPPORTING INDIVIDUALS TO TAKE THEIR MEDICATION ............................... 96 21 MODULE: IMPROVING PHYSICAL HEALTH ..................................................................... 106 22 MODULE: DEALING WITH DISTRESSING SYMPTOMS ..................................................... 112 23 MODULE: MANAGING STRESS AND ANGER .................................................................. 116 24 MODULE: IMPROVING DAY TO DAY FUNCTIONING ...................................................... 122 25 MODULE: IMPROVING THE FAMILY ENVIRONMENT ..................................................... 128 26 MODULE: TAKING PART IN COMMUNITY LIFE .............................................................. 134 27 MODULE: GETTING BACK TO WORK ............................................................................. 140 28 MODULE: DEALING WITH STIGMA AND DISCRIMINATION ............................................ 146 29 MODULE: IMPROVING LITERACY .................................................................................. 150 30 MODULE: TAKING CONTROL OF YOUR HEALTH ............................................................ 152 31 COMMUNITY ENGAGEMENT ........................................................................................ 158 32 FAMILY SUPPORT GROUPS ........................................................................................... 167 4 SECTION C: KNOW HOW YOU WILL BE SUPPORTED TO DELIVER CBR ................................... 172 33 CBR WORKER WELLBEING ............................................................................................ 173 34 SUPERVISION ............................................................................................................... 177 35 DEALING WITH DIFFICULT SITUATIONS ......................................................................... 182 36 LINKS TO HEALTH SERVICES .......................................................................................... 195 37 GOOD DOCUMENTATION ............................................................................................. 198 38 HOW TO DEAL WITH OTHER PEOPLE WITH PROBLEMS ................................................. 200 39 SUPPORTING PEOPLE WITH INTELLECTUAL DISABILITY AND SCHIZOPHRENIA ............... 204 5 Introduction to the CBR manual What is community-based rehabilitation (CBR) for schizophrenia? Schizophrenia is a long-term illness, which can lead to severe disability in the individual, especially if the community does not accept them. The illness can also place a heavy burden on the family. People with schizophrenia usually need a period of rehabilitation and family support. Rehabilitation is where people are helped to regain skills and to return to their usual life activities. Community-based rehabilitation is a way to help people with disabilities to be included in the life of their communities. It addresses all areas of a person’s life including health, inclusion in social life and activities of the community, livelihood and work, education and empowerment. Empowerment means that the individual has the ability to make decisions about their own life. The focus is always on the needs and wishes of the individual. As a CBR worker you will work with individuals with schizophrenia, their families and their communities to help the individual to get back to their usual activities and be accepted fully into society. Who is this manual for? This manual is for community-based rehabilitation workers, who will be working with people with schizophrenia. How to use this manual This manual is designed to help you: Understand what schizophrenia is and the problems it causes à this is covered in Section A Learn how to help people schizophrenia and their families through CBR à this is covered in Section B Know how you will be supported to deliver CBR à this is covered in Section C Throughout the manual you will follow the experiences of Yosef and Sara, people with schizophrenia, and their families. Yosef and Sara are not real people, but their stories include situations and events that real people with schizophrenia have experienced. 6 RISE SECTION A: Understand what schizophrenia is and the problems it causes 7 1 What is mental illness? 1.1 What does the mind do? The mind does the following tasks: • Perceiving: this means sight, hearing, smell, taste and touch • Thinking: this means memory, judgement and decision-making • Feeling: this means emotions such as sadness and happiness • Behaviour: this means how we act 1.2 What is mental health? Mental health means the mind is working well and we are productive, we have good relationships with others and we are able to cope well when problems happen. 1.3 What is mental illness? Mental illness is any illness experienced by a person that affects their emotions, thoughts or behaviour, and has a negative effect on their life or the lives of their family. 1.4 What is disability? Disability is where people have difficulty doing their normal activities and being part of their community. Many people with mental
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