Rehabilitation aims at avoiding unfavourable consequences of a disorder and its care and at training and improving impaired and compensatory skills. The needs of the main diagnostic groups with resulting cognitive or social impairments, namely mental retardation, infantile autism, chronic depression, severe psychoneurosis, substance abuse, schizophrenia, and dementia in old age, have specific aspects. An increased need for rehabilitation was prompted by the worldwide movement of deinstitutionalisation, which hit above all the socially most vulnerable schizophrenics. The instruments and methods of rehabilitation for the socially disabled mentally ill go far beyond the sphere of psychiatry. Individualised rehabilitation must be in mutual interaction with the social and occupational environment. The socially disabled individual is, for example, dependent upon awareness and acceptance in the community, upon financial and social support or upon the availability of a job. In the case of persisting deficits, supportive measures at different levels are needed to compensate or to minimize severe consequences of impairments. Their approach is by the social environment with the objective to grant the optimum quality of life combined with a minimum loss of independence. The great variety of measures often required at the same time must be based on a network of services and their purposeful coordination. Psychiatric rehabilitation requires a functioning social system and, in times of scarce resources, political priorities.

This paper summarizes several issues related to the mental health aspects of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) and its use in the field of rehabilitation. Rehabilitation is characterized by multiple interventions, demanding extensive communication and coordination among different care providers. The ICIDH will be useful in the field of rehabilitation by providing a sound framework for consequences of diseases or disorders if clear descriptions and assessment guidelines of the categories are given. The development of dedicated assessment instruments linked to the ICIDH will be useful to many health workers to assess the needs of the patients, to evaluate services and to measure the outcomes of rehabilitation interventions, thus creating a common language for disablements.

This paper describes some of the World Health Organization's (WHO.) activities related to psychosocial rehabilitation highlighting its Initiative of Support to People Disabled by Mental Illness. Critical issues related to consumer empowerment and the role consumers can play in psychosocial rehabilitation are discussed. Consensus and disagreements between medical and lay views about concepts relating to mental disorders and rehabilitation are also discussed. WHO future work in this area is indicated.

The present paper deals with computer based training approaches in psychiatric rehabilitation. First an overview of programs is presented, which are currently available on the software market in Germany and appear suitable for the training of patients with information processing (including sensorimotor) deficits. Then a description follows dealing with a clinical setting which may serve to illustrate how computer based cognitive training can be organized in a group format. Finally a couple of clinical studies which have aimed to determine the efficacy of PC based training programs in schizophrenic patients are briefly reviewed.

The authors examine the situation of rehabilitation of schizophrenic patients in France. After describing the methodology of their survey, the results are given. The housing facilities include halfway houses, “therapeutic” flats. The rehabilitation facilities include outpatient clinics with vocational units and rehabilitation centres such as vocational centres and sheltered workshops. In addition, a few centres provide placement and follow-up in the workplace. This type of centre is a recent innovation which helps stabilized schizophrenic patients find a regular job. The Fondation Santé des Étudiants de France (the health foundation of French students) deserves particular mention because it provides rehabilitation to high school and university students. In the discussion, the authors emphasize the insufficient number of such facilities, due to French psychiatrists only quite recently becoming aware of the importance of rehabilitation, which in turn, leads to insufficient funding of public mental health. As a result, most of the rehabilitation facilities were created and are now managed by private associations such as Les Croix Marines, UNAFAM, MGEN, Fondation Santé des Étudiants, Route Nouvelle Alsace, CAPPA Clermont-Ferrand, etc. In addition, their administrative tutelage is so complex that very few new facilities are developed. In view of their experience, the authors suggest that a large number of vocational centres should be built since they provide an essential service. Thus schizophrenic patients could enjoy a decent life in our society and not become one of the already many homeless. The European Union and the Council of Europe ought to consider the increase of such centres as a significiant aspect of their mental health policy.

Nowadays, the rehabilitation of schizophrenic patients is a major issue for psychiatry. Regarding the role of conventional neuroleptics, the following points will be considered in this paper: the role of neuroleptics in the number, length and frequency of hospitalisations; the role of neuroleptics in the number, degree and length of relapses; the clinical effects of neuroleptics focusing particularly on their disinhibitory action, the most controversial and least studied of the clinical effects of these drugs; and the side effects, which have been intensively studied and particularly criticised during these last years, leading to the development of new drugs discussed in the next article. All the published data relating to the psychosocial profile of schizophrenic patients clearly demonstrate the need for further research in order to improve the familial, social and professional rehabilitation of these patients

The aim of this article is to describe the cognitive-behavioral methods for social rehabilitation and psychotherapy of chronic psychotic patients which are nowadays available in French-speaking countries, then to propose a theoretical framework to help integrate these various methods for use in our duly pratice and, finally, to expose our research in this field, especially concerning the topic of quality of life and social skills training programs. We present a study we designed in order to assess the impact of a comprehensive social skills training program upon quality of life of chronic schizophrenic patients. Starting from the point of view that a good psychosocial rehabilitation program is one that improves social skills and social functioning without negative effects on quality of life, we tried to show such qualities in a quite comprehensive rehabilitation program using social skills training methods corresponding to the social readaptative “modules” from Liberman and Wallace's Social and Independant Living Skills Program — “medication management module” — followed by “basic conversational skills module”, and finally, a brief adapted version of “interpersonal problem solving skills module”. We were able to observe the evolution of social skills and functioning of eight schizophrenic patients having benefited from this program, over a one year period, and we compared results regarding quality of life with two control groups made of schizophrenic patients, one of them having benefited from a supportive group therapy in order to study the impact of non-specific factors. The results indicate a clear dissociation between direct benefits of social skills training (knowledge, social skills, social functioning and symptomatology) which all showed a significant improvement in the experimental group, and subjective benefits (self-esteem, sense of self-efficacy, quality of life) which showed no change, as well when consider no intra-group as well as between group comparisons.

Therapeutic effects of neuroleptics (NLP) in schizophrenia are well established in numerous international studies. Varying modalities of evolution under NLP treatment are described and require a clinical analysis. Neuroleptics are a necessary but insufficient condition for the therapy of schizophrenia. Via NLP treatment, other therapeutic approaches, such as psychotherapy, or sociotherapy become more effective. Consecutively, we present the effects of two compounds with dopaminergic selective activity (amisulpride, remoxipride) and of two other compounds with non-selective activity (risperidone, clozapine) regarding rehabilitation in schizophrenic patients. Data were collected from international studies with a medico-economic perspective and from French experience of clozapine in refractory schizophrenic patients. All these data stress the importance of several areas of study: clinical features, everyday life consequences and therapeutical effects observed with the atypical neuroleptics.

Psychiatric rehabilitation at present has a focus on the prevention of chronic disability and on active rehabilitation of socalled new long-stay patients. This is a major public health problem, concerning about one-third of all disabled persons in need of rehabilitation. Close co-operation between the various agencies concerned, with funding organizations, patients organizations etc, is of high priority in assuring effective rehabilitation. Various structures and models have been realized in order to facilitate such cooperation. The main axes of rehabilitation are lodging, occupation, financial independence/support, need for out-patient psychiatric care and quality of life. Rehabilitation results are measured along those axes, based on an assessment of patients' needs and satisfaction. Specific programmes have been implemented for various diagnostic groups, especially schizophrenic psychosis, mental retardation, substance dependence and organic brain damage. Specifications of these diversified programmes are described. Evaluation of rehabilitation efforts uses different designs, methods and instruments; a harmonization on the level of instruments is intended. A few examples regarding evaluation results (concerning schizophrenic and drug dependent patients) are presented. Finally, external factors limiting the efficacy of rehabilitation efforts are described.

The future and present day state of psychosocial and sociobiological rehabilitation depends on scientific research, the differing rates of development within the autonomous communities, and the “administrative reform”. In the rehabilitation of the chronic mentally ill, these three factors complement existing psycho and sociobiological therapy and cognitive methodology training.

Since the beginning of the 1980s the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden have gone through a process of decentralization. This process has taken place at a different pace and according to slightly varying decentralization models, but in all five of the countries the reduction in capacity of psychiatric hospitals has leveled out, whereas the establishing of decentralized treatment functions are not yet sufficiently developed. Furthermore, all five countries focus on rehabilitation of the most severe mentally ill. Examples of different models from the Nordic countries are mentioned.

The foundation of a rehabilitation center for schizophrenics annexed to the Psychiatric University Clinic of Vienna in 1963 initiated a systematic readaptation strategy for these patients all over Austria. The main task of these rehabilitation units is to evaluate the working and social capacities after acute illness episodes, to motivate the patient to accept professional activities and living conditions adapted to their health state through reinforcement of special competences, to replace inadequate attribution and coping styles by appropriate behavior patterns and to enhance compliance for necessary drug treatment. During the rehabilitation period the families are systematically prepared to live with the patients. In accordance with the obtained level of rehabilitation the patients are then either reintegrated into their family and/or normal professional conditions or placed in special settings (homes, sheltered workshops). A long-term followup is assured.