- The psychotic stage
This involves hospitalization and a biological line of treatment.
- Gentle reassurance and counseling
The patient and his relatives are explained the nature of the illness, the need for a gradual step–ladder approach to work, the fragility of the patient’s ego and the need for continued supervised medication.
- Usage of simple capabilities and faculties
The patient is entrusted with easy work which involves usage of very simple abilities and takes to task his mechanical capabilities and rote functioning. Manual work involving sweeping, swabbing, cleaning, dusting, embroidery, stitching, packaging, counting or light duty work such as that of a security person, helper or clerk is allotted to the patients. This phase by and large does not take into account the intellectual or the decision–making or the memory faculties of the patient, even though the prior functioning before the onslaught of the illness may be that of a highly qualified person.
- Part–time functioning with high schedules of reinforcement
The patient is involved in work patterns of schedules on a part–time basis viz. 2–3 hours per day as per the patient’s convenience viz. morning shift or afternoon shift. In this phase the patient is subjected to a lot of reinforcement or praise. Monetary payment or any other appropriate reward is made to him on a frequent basis, may be even daily. Often the reward or reinforcement may far surpass the actual quality or the quantum of work achieved, with the sole criterion of the reinforcement being to increase the patient’s confidence and instill in him/her the desire to keep functioning.
- Full time functioning but still involving easy nature of work
This phase involves qualitatively the same easy work as before, but over a stretch of time and with monetary payment, reward or reinforcement being awarded on a fortnightly or a monthly basis.
- Repeat reassurance and further counseling
The patient and his family members are gradually made to understand the need to give up the earlier mechanical work and seek an outlet in tune with the patient’s actual caliber and true potential.
- Phase of intellectual work
In this phase the patient is assigned work more in touch with his intellectual faculties e.g. a tutor, an accountant, an assistant to a specialized professional etc. If the patient himself is a doctor or a lawyer or a chartered accountant, then this phase may involve his taking up apprenticeship under other professionals with similar qualifications. Again, this phase wherever practical and feasible, should be in a protected environment with the patient being subjected to a lot of morale boosting and reinforcement, and his occasional mistakes and blunders being neglected and tided over by his superiors.
- Phase of full utilization of patient’s potential
In this phase the patient does what he wants to do in any field of his choice, something which he would have done either way had he not been afflicted with the illness. The disclosure of the fact that he had a prior illness is made without any expectations of sympathy or adjustments. The duration of each phase of rehabilitation is not predetermined but instead is dependent upon the individual case, based on how stable the patient is in each phase. By and large, each phase may involve anywhere between 1 to 6 months. Medication may be added, or adjusted depending upon:
- Clinical progress.
- The re–immergence of psychotic features.
- The need to treat concomitant post–psychotic depression.
- The hampering of work caused by side–effects of medicines e.g. tremors or drowsiness.
- The need to protect and buffer the patient from stress.
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