Technology provided a template for the modernization of mental health services based on the needs of the population.  The inclusion of rehabilitation and recovery community mental health care for people with severe and enduring mental illness endorsed the importance of rehabilitation within an effective mental health center.  

The main function of mental health rehabilitation center is to provide specialist treatment and support to help people with complex mental health needs to gain or regain skills and confidence to achieve the same kinds of goals in life as other citizens: to live as independently as possible; to engage in rewarding activity; to have good relationships with family and friends; to have adequate income to support these goals; and to participate in society. 

In order to further develop specialist rehabilitation and recovery mental health services, it is important to define the needs of individuals with severe and enduring mental health problems who are most disabled by their illness. Without an understanding of the needs of this group, comprehensive assessments cannot be carried out, targeted interventions cannot be implemented coherently and service planners cannot develop appropriate services.   Despite their complexity, lengthy admissions and cost to the health service, until now there has been no description of the characteristics of the users of mental health rehabilitation services in Ireland and no evidence about the costs or effectiveness of these services.  

This thesis describes the current provision of mental health rehabilitation services for the first time in a Nigeria context.  It describes the characteristics of users of these services and compares clinical outcomes and costs of care for those receiving rehabilitation with those receiving care from standard sector services and awaiting rehabilitation services center.




What is Mental Health Rehabilitation?


Rehabilitation can be defined as: “A whole system approach to recovery from mental ill health which maximises an individual`s quality of life and social inclusion by encouraging their skills, promoting independence and autonomy in order to give them hope for the future and which leads to successful community living through appropriate support”.

Rehabilitation services aim to support people with complex mental health problems to gain or regain cognitive, emotional, social, intellectual, and physical skills needed to live, learn, work and function as independently as possible in the community with the least interference by symptoms,

Wykes & Holloway defined the rehabilitation client group as “people with severe and long-term mental illness who have both active symptomatology and impaired social functioning as a consequence of their mental illness”.

Despite the increased emphasis on community based mental health care, admissions to mental health units are clearly still necessary for some people in acute mental health crisis, some of whom require an extended period of inpatient rehabilitation prior to discharge to appropriately supported community

accommodation.  Such individuals are, by definition, “treatment resistant” in some way and require a longer period of inpatient care than is usually available in an acute admission ward.  They mostly have diagnoses of severe and enduring mental health problems such as schizophrenia, recovery from which is complicated by the negative cognitive and conative sequelae of the illness and/or by co-occurring problems such as substance misuse or challenging behaviors.  

Although certain factors have been found to influence the degree and speed of recovery for patients with a diagnosis of schizophrenia, such as specific forms of cognitive impairment these factors are not specific to rehabilitation service users. 

Indeed, cognitive dysfunction has been found in up to 15% of people with schizophrenia living independently.  There is encouraging evidence that even those patients whose difficulties are considered most challenging are ultimately able to progress to supported community living.....