The Attitudes toward and Enactment of Psychiatric Rehabilitation Principles among Professionals in Rehabilitation Agencies

Background and Purpose: Recently, recovery has been the goal of the rehabilitation services for the persons with psychiatric disability. Previous literature suggests that attitudes have critical effects on recovery outcomes. Yet, rehabilitation professionals' attitudes toward psychiatric rehabilitation principles (PRP) have not been fully addressed. This study explored how rehabilitation professionals in Taiwan perceived PRP, and whether there were discrepancies between attitudes toward and enactment of PRP. Also, the correlates of attitudes and enactment were examined.

Methods: Survey questionnaires were sent to 53 psychosocial rehabilitation agencies with 444 professionals in Taiwan. The return rate was 32.5% with 136 valid samples. “The attitudes towards PRP scale” was developed based on the principles proposed by Cnaan, Blankertz, Messinger, and Gardner (1988, 1990). Factor analyses revealed a nine-factor structure within the scale, including utilizing recovery strategy, advocating for social changes, recovery-oriented helping relation, normalization/early intervention, emphasis on strengths, utilizing environmental resources, equipping clients with skills, empowerment, commitment from staff. The discrepancies between attitudes and enactment were examined by paired t-test. In accord with the literature, the potential correlates included three groups of variables: demographic, professional background, and professional training experiences. Multiple regression analyses were utilized to examine the significant correlates of attitude and enactment.

Results: The results revealed that the subjects held more positive attitudes and enacted more on micro related principles, yet less on macro related ones (social change, empowerment, and utilizing environmental resources). The discrepancies between attitudes towards and enactment of PRP were mainly on macro related principles. Generally speaking, the extent of enactment was less than that of positive attitudes. Multiple regression analysis showed that none of the variables in the model significantly correlated with the attitudes. Whereas, attitudes, reading related articles/books, and type of professions were the important correlates of enactment. The first two variables had a positive correlation with the extent of enactment. Case manager had a higher extent of enactment than the remaining types of professionals (doctors, nurses, psychologists, and OT). Among the three significant variables, “attitudes” was the most important one.

Conclusions and Implications: The discrepancies between attitudes towards and enactment of PRP on macro related principles worth attention and further exploration. Combing the importance of attitudes and reading related articles/books on the extent of enactment, future training could utilize the form of book/article readings, which could help transform the attitudes and discuss various probable ways of enactment. Internal and external structural barriers for the enactment on macro related PRP should be considered for future related studies.

Keywords: Psychiatric rehabilitation, recovery, attitudes, enactment.