Mental health rehabilitation models for people with complex psychosis: a systematic review.

BACKGROUND

Mental health rehabilitation services support people with complex psychosis to live successfully in the community. This systematic review aimed to identify and compare the approach and effectiveness of different models of mental health rehabilitation.

METHODS

Six online databases (PsycINFO, EMBASE, Cochrane Library, CINAHL Plus, MEDLINE and Emcare) were searched for quantitative, qualitative, and mixed-methods studies published since 2000 that described mental health rehabilitation models. The search was extended by screening references and citations of included studies. A narrative synthesis of included studies was conducted, describing the characteristics and effectiveness of the different models.

RESULTS

We identified 24 studies which met our inclusion criteria. The studies were categorised based on the rehabilitation model that they described or the main defining feature of the rehabilitation model if it was not a named model (Strengths-Based (n = 4), Goal-Oriented (n = 2), Holistic Care (n = 4), Community Rehabilitation in Low-Income Countries (n = 4), Illness Management and Recovery Programmes (n = 5), Intensive Case Management (n = 2), and Psychosocial Rehabilitation (n = 3)). The rehabilitation models originated from a range of settings, including high-income (Australia, Denmark, Hong Kong, Israel, Italy, Korea, Netherlands, Spain, Sweden, United States), upper-middle-income (China), and low-income countries (Ethiopia, India, Indonesia, South Africa, Sudan, Turkey). While many of the models were shown to be effective in specific areas, such as personal recovery, symptom reduction, and social functioning, none emerged as universally superior, with varying strengths and limitations across different contexts and outcomes.

CONCLUSION

A range of mental health rehabilitation models exists globally. Whilst some appear suited to certain contexts and some have demonstrated effectiveness in regard to specific outcomes, greater consensus on the specific components comprising a comprehensive biopsychosocial approach to mental health rehabilitation for people with complex psychosis is needed. However, a degree of flexibility is required to ensure the model can be effectively implemented in local settings. REVIEW REGISTRATION: This review was prospectively registered on PROSPERO (ID: CRD42024542294) on 2 May 2024.