1. BioPsychoSocial Rehabilitation of Patients with Mental Illnesses
Ayman Hamdan-Mansour RN MSN PhD
School of Nursing-The University of Jordan

2. The New Era
The world is shifting from psychiatric to psychosocial perspective of care
Leading to
Shift from illness model towards a social functioning model
requiring
Reforming health care systems

3. For any given reform of health care services we need to get sure that reform is done to:
Ensure that consumers are getting the right service, at the right time, in the right place

4. What do we use? The medical model includes the following elements:
recognizing patterns of symptoms and signs—medical history and examination
understanding underlying pathology— diagnosis
applying therapy to that pathology— treatment
expecting the patient to recover—cure

5. Rehabilitation vs. recovery
Rehabilitation refers to the services and technologies that are made available to people who experience disabilities so they may learn to adapt to their world.
Recovery refers to the lived or real life experiences of persons as they accept and overcome the challenge of the disability

6. Rehab vs. Recovery
Recovery is a process not an end point or a destination.
Recovery is an attitude, a way of approaching the day and facing the challenges.
Being in recovery means recognizing limitations in order to see the limitless possibilities.
Recovery means being in control. Recovery is the urge, the wrestle, and the resurrection.’

7. What is recovery: Main description
Recovery is personal, individual and
unique.
People can and do recover from mental
illness
Recovery’ and ‘cure’ do not mean the same thing. People can and do live well in the presence of symptoms of mental illness.
Recovery is supported by collaborative partnerships (interdisciplinary approach)

8. From medical to biopsychosocial
Biological: the physical or mental health condition.
Psychological: the personal/psychological factors that influence functioning.
Social: the importance of the social context, pressures and constraints on functioning

9. What is psychosocial rehabilitation?
Rehabilitation services are collaborative, person- directed, and individualized, an essential element of the human services spectrum, and should be evidence-based.
They focus on helping individuals develop skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning and social environments of their choice.”
United States Psychiatric Rehabilitation Association, 2011

10. WHY
It’s a significant framework that integrates understanding of the interaction of biological factors, psychological factors and social ones of mental illnesses’ causes and treatment approaches.
Allows integrating traditional with prevailing treatment imperatives of pharmacotherapy, supervision, and security and safety.
Applies to all disciplines ranging from medicine to psychology to sociology.

11. Why
It focuses and enhances individual’s strengths and abilities, rather than being totally dependents on others. Biopsychosocial rehabilitation providers work in partnership to provide structured, goal-focused, individually tailored services at a level of intensity and duration appropriate to the consumer’s needs.
Allows people with mental illnesses to receive care at variety of settings; acute, long-term and person’s own home

12. Why BPS Foster hope, self-esteem, and empowerment
Encourage advocacy, peer support, and self- help
Support consumer-identified community goals
Promote education, role models, & self- determination
Teach life, stress, & symptoms management skills ▫ Facilitate community-based normative experiences

13. The purpose of specialist rehabilitation services is to deliver effective rehabilitation and recovery to people whose needs cannot be met by less intensive mainstream adult mental health services.
The focus is on the treatment and care of people with severe and complex mental health problems who are disabled and often distressed, and who are or would otherwise be high users of in- patient and community services.
The aim is to promote personal recovery, ‘whilst accepting and accounting for continuing difficulty and disability’ (Roberts et al, 2006).

14. Referral to rehabilitation services
 Major and complex mental health needs
non-progressive in their recovery;
Transition from a highly supported setting to a less supported placement
Overcoming disabilities associated with severe and complex mental health problems

15. How
The core component of biopsychosocial rehabilitation relies many on adopting the humanistic rather than humanitarian approach; where ethical and a scientific positions form the background of treatment plans.
Biopsychosocial rehabilitation should be adopted as public health policy, and mental health agencies and professional should acknowledge the long-term benefits on customers and mental health services outcomes

16. Components History and assessment Thorough and comprehensive
Interviewing clients and collateral several times.
Information about
Life stages (peri-natal, childhood, adolescence, adulthood)
Biological development ( physiological and sexual)
Psychological development (cognitive, affective, and moral)
Social development ( family, peers, and social network)

17. BIOPSYCHOSOCIAL MODEL (CASE STUDY) Acute stage Recovery begins
Acute stage
Recovery begins
Recovery (stability)
Biological
Sedating medication
Psychotropic medication (larger doses)
Antidepressant medication and/or ECT
Nutrition and safety
Psychotropic medication
Antidepressant medication and/or
ECT
Mood stabilizer
Ongoing review and
adjustment of treatment
Appropriate antidepressant and/or ECT
Ongoing review and adjustment to treatment
Psychological
Reduce stimulation
Provide safety
Sit beside rather than face on
Do not challenge delusions and hallucinations
acknowledge their emotional impact (eg fear)
Assist with medication
Referral of family to appropriate supports
Information about mental illness and service system
Emotional support
Practical strategies of self-care and care of their loved one
Increased stimulation
Increasing levels of self-responsibility
Provide information about the illness
Supportive counseling
Case management
Development of wellness recovery
Debrief experience for themselves
More information
Counseling and support the person with the illness to:
debrief the experience
reflect on how this experience can
inform wellness recovery plan
Maintain and improve connection points (important relationships)
Application of wellness recovery
plan in daily life
Reduce or cease case management
Support networks
Keeping in contact with
new information
Advocacy activities
Social
Hospitalization or clinical intensive support at home
Support and information for family and friends
Engagement with psychosocial rehabilitation services –Home Based Outreach, Psychosocial Day programs, Respite Programs
Enhance relationships with family and friends
Increased independence
Psychosocial rehabilitation services maybe decreasing with increased links to meaningful employment/ volunteerism/ study/ leisure.

18. References
Darawad, M., Khalil, A., & Hamdan-Mansour, A., Nofal, B. (2016). Perceived exercise self-efficacy, benefits and barriers, and commitment to a plan for exercise among Jordanians with chronic illnesses. Rehabilitation Nursing. 41, , doi: /rnj.199
Dreidi, H., & Hamdan-Mansour, A. (2016). Pain, Sleep Disturbance, and Quality of Life Among Palestinian Patients Diagnosed with Cancer. Journal of Cancer Education, 31 (4), 796–803. 
Fawaz, M. & Hamdan-Mansour, A. (2016). Lebanese Student’s Experience of Benefits of High Fidelity Simulation in Nursing Education: A Qualitative Approach. Open Journal of Nursing, 6(10),
Hamdan-Mansour, A. (2016). Social support and adolescents’ alcohol use: An integrative literature review. Health, 8 (12),
Bani-Hani, M., Hamdan-Mansour, A., Atiyeh, H., & Alsalman, E. (2016). Theoretical Perspective of Job Demands Correlates among Nurses: Systematic Literature Review. Health, 8,
Fawaz, M. & Hamdan-Mansour, A. (2016). Effect of using HFS on motivation and clinical; judgment among nursing students in Lebanon. Nurse Education Today. 46 (2) 36–42.
Abdul Kader, R., Arabiat D.H., Holmes, S., Hamdan-Mansour A., (2016). Socio-demographic Correlates of Parents Participation in Care of a Hospitalized Child: A Perspective from a Developing Country. Journal of Child Health Care. 20 (3),
Ghannam, B., Hamdan-Mansour, A., Al Abaiat, D. (2016). Psychosocial predictors of burden among caregivers of patients with serious mental illness in Jordan. Perspectives of Psychiatric Care, doi: /ppc
Hamdan-Mansour, A. (2016). Psychosocial and sociodemographic predictors of depression among older persons in Jordan. Open Journal of Nursing, 6,
Hamdan-Mansour, A., Malkawi, A., Sato, T., Hamaideh, S., & Hanouneh, S. (2016). Males' perception of family planning in Jordan. Eastern Mediterranean Health Journal, 22 (2),
Hamdan-Mansour, A., Nawafeh, D., Hanouneh, S., & A l Omari, H. (2016). Psychosocial aspects of patients diagnosed with Diabetes Mellitus type –II in Jordan. International Journal of Diabetes in the Developing Countries. 36 (1), DOI /s z.
Al-Sagarat, A., Hamdan-Mansour, A., AL-Sarayreh, F., & Nawafleh, H. (2016). Prevalence of aggressive behaviors among inpatients with psychiatric disorder: A case study analysis from Jordan. Nursing and Health Sciences, 18 (2), (DOI:  /nhs.12239).
Al Abaiat, D., Hamdan-Mansour, A., Hanouneh, S., & Ghannam, B. (2016). Psychosocial predictors of relapse among alcohol dependents in Jordan. Current Drug Abuse Reviews, 9 (1),
Darawad, M., Mosleh, S., Khalil, A., Maharmeh, M., Hamdan-Mansour, A., & Samarkandi, O. (2016). Investigating Physical Exercise among Jordanians with Diabetes Mellitus. Health, 8 (02), 181.
Darawad, M., Alfasfos, N., Saleh, Z., Saleh, A. Hamdan-Mansour, A. (2016). Predictors of delay in seeking treatment by Jordanian patients with acute coronary syndrome. International Emergency Nursing, 26, (20-25). DOI:  /j.ienj
2015
Khraisat, F.S., Hanafiah Juni, M., Salmiah, M.S., Abd Rahman, A., & Hamdan-Mansour, A. (2015). Needle Stick Injuries Prevalence among Nurses in Jordanian Hospitals. International Journal of Public Health and Clinical Sciences, 2 (4), 7-16. .

19. Nawafeh, D. , & Hamdan-Mansour, A. (2015)
Nawafeh, D., & Hamdan-Mansour, A. (2015). Correlates of Health locus of control among patients diagnosed with Diabetes mellitus type –II in Jordan. Journal of Diabetes Mellitus, 5 (3),
Arabiat DH., Hamdan-Mansour A., Al Jabery MA., Wardam L., & Altamimi A (2015). The Refined Family Inventory of Needs- Paediatric (FIN-PED II): Translation and Validation Study of the Arabic Version. Journal of Nursing Measurement, 23 (2)
Hamdan-Mansour, A. Al Abeiat, Alzoghaibi, I., Ghannam, B., & Hanouneh, S. (2015).Psychosocial and Sociodemographic correlates of life satisfaction among patients diagnosed with cancer in Jordan. Journal of Cancer Education, 30,
Hamdan-Mansour, A., Aboshaiqah, A., Thultheen, I., & Salim, W. (2015).  Psychological wellbeing of Saudi patients diagnosed with chronic illnesses. Psychology, 6,
Hamdan-Mansour, A., Hamaideh, S., Azzeghaiby, S., Hanouneh, S., & Aboshaiqah, A. (2015). Psychosocial correlates of motivation for academic accomplishment among university students. Open Journal of Medical Psychology , 4, 1-8
Darawad, M., Hammad, S., Al-Hussami, M., Haourani, E., Aboshaiqah, A., Hamdan-Mansour, A. (2015). Investigating Critical Care Nurses' Perception Regarding Enteral Nutrition. Nursing Education Today, 35 (2),
Shaheen, A., Nassar, O., Amre, H.M., & Hamdan-Mansour, A. (2015). Factors Affecting Health-Promoting Behaviors of University Students in Jordan. Health, 7, 1-8.
Darawad, M., Nawafleh, H., Maharmeh, M., Hamdan-Mansour, A., & Azzeghaiby, S.N. (2015). The Relationship between Time Pressure and Burnout Syndrome: A Cross-Sectional Survey among Jordanian Nurses. Health, 7,
2014
Hamdan-Mansour, A. Azzeghaiby, S.N., Alzoghaibi, I.N., Al Badawi, T.H., Nassar, O.S., Shaheen, A.M (2014). Correlates of resilience among university students. American Journal of Nursing Research, 2 (4),
Ratrout, H., Hamdan-Mansour, A., Seder. S.S., Salim, W., (2014). Patient satisfaction about using patient controlled analgesia in managing pain post-surgical intervention. Clinical Nursing Research. 23(4) 353–368.
Alghzawi, H.M., Hourani, R.A., Alrashaida, B.M., Hamdan-Mansour, A. & Bayomi, M. (2014). Discharge Policy Analysis in Prince Hamzah Hospital. Health, 6,
Aboshaiqah, A., Hamdan-Mansour, A., Sherrod, S.R., Alkhaibary, A., & Alkhaibary, S. (2014). Nurses’ perception of managers’ leadership styles and its associated outcomes. American Journal of Nursing Research, 2, (4),
Hamdan-Mansour, A., Ghannam, B., Al Abeiat, D. Al Badawi, T., Thulthian, I., & Shamali, I. (2014). Predicting Depression among Jordanian Patients Diagnosed with Physical Illnesses. Psychology, 5,
Sutari, M., Abdul-Rahim, M., Hamdan-Mansour, A., Ayasreh, S. (2014). Pain among mechanically ventilated patients in critical care units. Journal of Research in Medical Sciences, 19,
Amer, N., & Hamdan-Mansour, A. (2014). Psychosocial predictors of suicidal ideation among patients diagnosed with chronic illnesses in Jordan. Issues in Mental Health Nursing, 35, 864–871.
Al Abeiat, D., Hamdan-Mansour, A., Ghannam, B., Azzeghaiby, S.N., & Dawood, L. (2014). Psychosocial health status of patients diagnosed with chronic illnesses in Jordan. Open Journal of Medical Psychology, 3 (4),
Hamdan-Mansour, A., Marmash, L., Elayyan, R., & Hyarat, S. (2014). Difference in perception between nurses and patients related to patients’ health locus of control. International Journal of Nursing Practice, 20,

20. Hamaideh, S. , & Hamdan-Mansour, A. (2014)
Hamaideh, S., & Hamdan-Mansour, A. (2014). Psychological, cognitive, and personal variables that predict college academic achievement among health sciences students. Nurse Education Today, 34,
Ghannam, B., Hamdan-Mansour, A., Arabiat, D., Azzeghaiby, S.N., Al Abeiat, D., Talal Al Badawi, T. (2014). Psychosocial wellbeing of patients diagnosed with coronary artery disease, Psychology, 5,
Hamdan-Mansour, A., Azzeghaiby, S.N., Arabiat, D., & Al Badawi, T. (2014).   Psychological and social health status of patients with lung diseases in Jordan. Health, 6 (11),
Al-Shuaibi, J. Hamdan-Mansour, A.M., Arabiat, D.H. (2014). Foreign language anxiety among students studying foreign languages. Life Science Journal, 11(8),
Hamdan-Mansour, A., AboShaiqah, A., Salim, W., Thulthain, I., Azzghgaibi, S., & AlAnani, M. (2014). Patient satisfaction about nurses’ competency in practicing communication skills: The Saudi experience. Life Science Journal, 3 (11),
Dawani, H., & Hamdan-Mansour, A., & Ajlouni M. (2014). Users’ perception of home health care services in Jordan. Health, 6 (4),
Constantino, R., Hamdan-Mansour, A. Noll-Nelson, B., Doswell, W., & Braxter, B. (2014). Assessing the Readability and Usability of Online H-E-L-P Intervention for IPV Survivors. Open Journal of Nursing, 4 (2)
Bani-Mustafa, R., Hamdan-Mansour, A. Hijazeen, J.K., Abed, H.S., Abdallah, F.W., Abu El Haija, H.M., Omari, H. (2014). Social Phobia among University Students. Life Science Journal, 11 (2),
2013
Hamdan-Mansour, A., Al Badawi, T., Marmash, L., & AL Haourani, E. (2013). Depression, Stress and Coping among patients diagnosed with Diabetes Mellitus type-II. Life Science Journal, 10(4),
Shuaibi, J., Hamdan-Mansour, A., & AL Haourani, E. (2013). Correlates of moral commitment among university students in Jordan. Life Science Journal, 10(4),
Al Hadid, L.A., Becker, C.M., Hamdan-Mansour, A., Al-Shuaibi, J.T.M., Tharwat, H. & Glascoff, M. (2013). Salutogenic Wellness Promotion Scale: Validation of the Arabic Version. American Journal of Health Education. 44 (4),
Attallah, M., Hamdan-Mansour, A., Al-Sayyed, M., Aboshaiqa, A. (2013). Patient Satisfaction with the quality of nursing care provided: the Saudi experience. International Journal of Nursing Practice, 19, 584–590
Al-Gamal, E., Hamdan-Mansour, A. Matrook, R., & Nawayseh, M. (2013). The psychosocial impact of child labour in Jordan. International Journal of Psychology, 48 (6),
Hamdan-Mansour, A. Al-Gamal, E. Matrook, R., & Nawayseh, M. (2013). Health status of working children in Jordan: Comparison between working and nonworking children at schools and industrial sites. Open Journal of Nursing, 3 (1), 55-62
Yehia, D., Callister, L., & Hamdan-Mansour, A. (2013). Prevalence and Predictors of Postpartum Depression among Arabic Muslim Jordanian Women Serving in the Military. Journal of Perinatal & Neonatal Nursing, 27(1), 25–33. doi: /JPN.0b013e31827ed6db.
Al-Haj Hassan, Hamdan-Mansour, A. Zailani, R. Nabulsi, N. (2013). Femoral sheath removal after cardiac cauterization in the Jordanian Hospitals: explorative study. Health. 5(3),
Safadi, R., Swigert, V., Hamdan-Mansour, A., & Constantino, R., Bani-Mustafa, R. (2013). An Ethnographic-Feminist Study of Jordanian Women's Experiences of Domestic Violence and Process of Resolution. Health Care for Women International, 34(9),