Psychiatric Rehabilitation of a Homeless After Depression

Rehabilitation refers to interventions utilized in the clinical practice as part of rehabilitative care aiming to optimize the functional outcomes of patients and promote recovery. Eliminating symptoms and returning to healthy functioning are the primary objectives of this strategy (Martinelli & Ruggeri, 2020). According to Morin and Franck (2017), the effectiveness of rehabilitation interventions can vary, and informed decisions are critical to improving the patient’s outcomes. In particular, the mental health field accepts psychiatric rehabilitation as a legitimate field of practice. Patients with various health conditions, depression, intellectual disabilities, a history of substance abuse, or dissociative disorders can benefit from the positive effects of rehabilitation interventions (Ge et al., 2018). Namely, emerging methods along with evidence-based practices can facilitate recovery, as well as help individuals to get valued roles and overcome insecurities. This paper aims to consider a specific clinical case from mental health-related practice and critically discuss the rehabilitation interventions that can be used to address the issue and improve the patient’s outcomes.

Brief Description

In the given case scenario, Jack, a 30-year-old male, is admitted to the psychiatric ward with depression resulting from homelessness and a 15-year long history of drug abuse. From a clinical viewpoint, the patient’s readmission to the hospital is due to his depression. A number of complicating factors can be considered, including drug abuse history, homelessness, unemployment, and a compromised family structure. Furthermore, a slight intellectual disability and speech articulation disorder prevent the patient from succeeding in life and significantly undermine his self-esteem.

At the same time, Jack reports the willingness to quit using drugs and the hope of being readmitted to a rehabilitation program that he had not completed previously due to impulsive behavior and coercion with others. The patient’s increased interest in participating in ward activities suggests his willingness to work towards finishing the program. Nevertheless, it does not cater to participants with intellectual disabilities, and this fact aggravates Jack’s condition by causing deeper feelings of resentment, unworthiness, and impulsivity. Moreover, his self-awareness of speech articulation difficulty has increased, resulting in low self-confidence and thoughts about being destined for failure. Overall, one aspect that can be explicitly targeted for rehabilitation in the given scenario is the patient’s depression.

Restoring Self-Esteem

Restoring self-esteem would be the primary rehabilitation intervention in the case scenario discussed above. In this regard, it is essential to critically discuss the chosen practice and examine its relevance for the particular situation. As stated by Orth and Robins (2019), self-esteem can is “an individual’s subjective evaluation of his or her worth as a person” (p. 328). Abdulghani et al. (2020) describe this notion as “a degree to which a person esteem himself or herself, the summation in light of cognizant self-evaluative considerations and feeling or in short as global emotional placement of self” (p. 636). In other words, self-worth is a broad concept that can be simplified and roughly defined as a positive evaluation and perception of different aspects of the self. The subjective nature of this construct highlights that self-esteem does not necessarily represent the objective competencies and characteristics of an individual (Orth & Robins, 2019). A person’s awareness and assessment of their own abilities and aspirations are essential to maintain a healthy view of life. Hence, restoring self-esteem would be an appropriate rehabilitation intervention for Jack that can help address his issues and improve his condition.

Research findings related to various environments and people of different backgrounds support the hypothesis that self-worth is interconnected with people’s well-being. In particular, Shimizu et al. (2021) emphasize that numerous studies have shown a positive association between self-esteem and mental and physical health. They suggest that people with high self-worth are marked by a tendency to have an adaptive approach to life (Shimizu et al., 2021). For Jack, adaptation is essential since his condition, complicated by numerous factors, requires acknowledging the problem and entering the rehabilitation phase. However, low self-esteem works as a demotivational attribute and prevents the patient from succeeding in real-world circumstances (Orth & Robins, 2014; Okwaraji et al., 2017). In this regard, the connection between one’s confidence and various challenges affecting the condition must be considered.

Self-Esteem and Depression

Mental health can be particularly severely affected by low self-esteem, decreasing the individual’s resilience and quality of life. According to Auttama et al. (2021), “resilience is one of the powerful concepts that has been widely adopted and used as a critical preventative measure against mental health problems” (p. 1213). Psychological care recognizes the importance of this factor in preventing health issues, counteracting suicidal ideation, and improving the person’s approach to life challenges.

Depression is a common problem that can derive from a lack of self-confidence and resilience. A study by Hilbert et al. (2019) emphasizes that low self-esteem can contribute to depressive symptoms, which should be treated in “a cognitive behavioural group therapy in a naturalistic setting” (p. 244). Hence, Jack’s readmission to the rehabilitation program can have a positive effect on his recovery. At the same time, the patient’s intellectual disability increases his exposure to social determinants of poorer health, and this issue must be addressed by health care professionals (Emerson & Brigham, 2013). In particular, providing support, active listening, and encouraging the patient’s participation in recovery activities are the primary methods that can boost his self-esteem while addressing the issues associated with a speech articulation disorder.

Depression and Drug Abuse and Homelessness

Furthermore, a history of substance abuse and homelessness are two other complicating factors contributing to the patient’s depression, low confidence, and developed feelings of unworthiness and resentment. The connection between these two constructs has been established by numerous research findings (Khajehdaluee et al., 2013; Kim et al., 2018; Manoj & Lakhan, 2017; McGillivray & Moore, 2001; Bhunu, 2014). Furthermore, intellectual disability, along with socio-economic issues, increases the risk of drug abuse (Chapman & Wu, 2012; Shukla & Kang, 2017). The addiction can lead to one’s stagnation in a cycle of abuse and helplessness, which contribute to the feeling of guilt and failure. As can be seen, this is the case of the patient from the given scenario; hence, supporting his willingness to participate in the rehabilitation program is critical to improving self-esteem and breaking the vicious circle.

The Impact of Self-Stigma on Self-Esteem

Self-stigma is a serious problem that originates from the person’s internalization of negative public attitudes and prejudices. This concept has a harmful effect on the self-esteem and life opportunities of psychiatric patients (Oexle et al., 2018; Crowe et al., 2018). Dubreucq et al. (2020) studied self-stigma in patients with serious mental illness and autism spectrum disorder in the French National Centers of Reference for Psychiatric Rehabilitation cohort and concluded that over a quarter of the total sample had self-stigma. These findings suggest that treatment outcomes can be compromised by negative effects attributed to prejudices. Maharjan and Panthee (2019) emphasize such adverse consequences of self-stigma as “increased severity of symptoms, low treatment adherence, increased rate of suicidality and decreased quality of life” (p. 1). These factors compromise a person’s quality of life and endanger mental and physical health.

Hence, there is a need for programs aiming to improve self-esteem in psychiatric patients for better health-related outcomes. A study by Dupasquier et al. (2020) highlights the potential effectiveness of self-compassion enhancing interventions that can facilitate the disclosure of distressing events threatening self-worth. Hansson et al. (2017) report the effectiveness of “narrative enhancement and cognitive therapy (NECT) as an add-on to treatment as usual” in improving self-esteem and reducing self-stigma. Furthermore, group therapy can be beneficial to lessen both self-stigma and depressive symptoms in the patient from the given scenario (Young, 2016). As can be seen, restoring self-esteem is an evidence-based rehabilitation intervention, and a positive effect on the patient’s recovery can be expected. The caregiver’s primary mission is to engage in the treatment process and support Jack in his efforts to improve personal satisfaction and depression management. It is worth mentioning that other recommended rehabilitation interventions can include developing an individualized support plan and assistance in employment or education.

To conclude, psychiatric rehabilitation can be beneficial for the patient with depression aggravated by a number of factors such as speech articulation disorder, drug abuse, homelessness, and unemployment. In particular, restoring self-esteem can be the primary rehabilitation intervention aiming to counteract symptoms and improve the patient’s mental health. Self-worth is a critical factor of a person’s well-being, and its lack can decrease resilience and quality of life.

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