Table 1 Clinical rehabilitation (CR) processes

Aspirations - Hope of a better life may include: wellness enjoyment, participation, contribution and opportunity.

Personal - working with an individual’s goals no matter how well grounded, is pivotal in fostering commitment to recovery processes.

Self-identified – imposing goals that are incongruent with the individual’s is simply counter-productive and diametrically opposed to the tenants of CR.

Well formulated - using assessment tools^a that have credibility with a person may assist in discussing and formulating recovery goals.

Comprehensive – thorough and holistic, not adopting a pathological view of SMI, but unashamedly a comprehensive appraisal of relevant factors to assist in the formulation of a collaborative recovery plan.

Multiple domains - may include: medication, treatment, co-morbidity, substance-use, physical & cognitive issues, coping, daily living skills, living arrangements, education & employment, family interactions, social, sexual and existential needs & stage of change.

Function oriented – may include an array of issues in domains of functioning, activity & participation, role & impact on environmental and personal factors.

Promoting hope – the knowledge gleaned assists clinicians to work effectively with clients & their family in generating and validating hope.

Collaborative – may be developed using tools such as the MHRS^a. Recovery-oriented plan outlines individual recovery needs and develops strategies dependent on motivation for change in specific domains.

Evidence-based - guiding access to a range of interventions (e.g., cognitive remediation, skills training, family interventions, employment & education strategies), as well as support & environmental adaptation.

Delivery methods - interventions may be detailed as concurrent, sequential, in individual or group settings, as well as identifying who participates (family, carers, friends, support workers).

Coordinated – across clinical and non-clinical interfaces, as well as addressing the interaction of CR & pharmacological intervention.

Goal focused - related to a range of personal, social & environmental factors, not diagnosis dependent. Interventions assist in achieving goals & improving mental & physical health.

Individually tailored –interventions are individually tailored but, to assist clinicians in recovery-oriented service provision, core interventions may be linked with domains of recovery (e.g., using the MHRS^a).

Integrated programs – provide a foundation for developing strategies and interventions. Core & elective programs operate in individual, group, milieu/residential and community settings.

Structured – collaborative, goal focused, evidence-based and motivational to promote generalisation, and accommodate different learning styles and abilities. To support achievement, higher level therapy programs are run in parallel to compliment activity-based programs.

Time demands - time intensive due to complexity of issues & need to ensure a positive and productive milieu. Recovery trajectories are complex & dynamic. Work contexts can be demanding, particularly when the time course is extensive & progress minimal.

Processes – innovative, recovery-focused, inclusive & holistic. Review should be led by a senior CR clinician due to complex processes & time-frames, & include client, family, peer-support & relevant agencies. Feedback informs goal development & collaborative interventions.

Recovery pathways - may be simple & linear or interspersed with minor setbacks, even relapse. Incremental recovery in some domains & profound in others. Gains may be interdependent. Numerous reiterations of CR processes may be required to trigger a decision to adopt a more inclusive & adaptive approach (e.g., for SMI & substance misuse).

Achievements – Clinical review can objectively affirm achievements; facilitate development of options &/or determine when another strategy is warranted; & aid making complex decisions regarding level of service need. Achievement of self-determination in several domains may require minimal short-term interventions accompanied by follow-up & review.