Finding the right rehab center for your loved one

As a caregiver to a person with a mental illness, you may have to – at some point during or after treatment – have to pick a rehabilitation center that will help your loved one learn or relearn some skills that will help them return to a functional state of living. You can choose the rehabilitation center by assessing two important factors: first, the needs of your loved one to determine what kind of facility they will most benefit from; and second, the credentials of the center: is all well and aboveboard? 

Types of rehabilitation facilities

There are different types of rehabilitation facilities. The choice of facility is made depending on the nature of illness, availability and accessibility of facilities, and the patient’s needs.

Community-based rehabilitation is the ideal form of rehabilitation for people with mental illnesses. This rehabilitation process takes place within the community that the person lives in. After the person receives treatment, they return to their community, where they can learn or relearn skills in their own environment. In the community-based rehabilitation set-up, the psychiatrist or mental health professional plays a small role; the community (family, friends, neighbors) is invested in the person’s journey towards recovery, supports them and creates opportunities for them.

Community-based rehabilitation can be powerful in creating awareness about mental health and erasing stigma. The community can also create employment opportunities for the person with a realistic understanding of their strengths and limitations. This helps in integrating the person and their family with the larger community. There are only a handful of community-based rehabilitation initiatives in India.

Day care facilities are those in which the person spends about eight hours a day every day, for a few weeks to months. The patient is trained in skills that they are interested in, and may later help them in getting a job or achieve other life goals such as socializing or developing a hobby. This is done in an environment that accepts them with their problems. Such an environment enables the patient to go out, socialize with other people with and without mental illnesses, understand that there are others with similar problems, be respected and treated normally. This can have a huge positive impact on the person. Once trained, the person may be able to get a job, which returns their sense of purpose while also providing them with livelihood options.

Day care helps the person structure their daily routine, and transition from the role of a patient to the role of a productive person.

Sometimes, a person who has significant challenges in participating in the rehabilitation process may require hospitalization to help them understand the benefits and enhance their motivation. Rehabilitation cannot be done without the will of the person. The person may need some counseling to gradually realize the benefit of rehabilitation and get rehab-ready. There exists a small proportion of people with severe mental illnesses for whom intervention in the form of day care facilities may not be possible. In such cases, the focus of rehabilitation – which can be on day care basis, short-term or long-term residential basis – is on taking care of them, rather than to enable them. Ideally, this is the last resort.

Checking the credentials of the center

The main aim of rehabilitation is to empower the patient. However, there are several rehabilitation centers that may focus only on taking care of the patient rather than enabling them. There are also several rehab centers that operate illegally, have unqualified staff, or use therapies that are of little or no use to the patient at all.  In some rehabilitation centers, the patients may be kept locked up or subjected to human rights violations. Meanwhile their families, desperate to see them get better, believe that it is being done for the good of the patient.

For some mental illnesses, the person may need months of rehabilitation; in other cases, the patient may need rehabilitation and support for longer periods of time. Different kinds of facilities have varying levels of fees. Rehabilitation centers attached to government hospitals and institutions may charge a nominal fee, while private centers may cost a substantial amount on a monthly basis. As a caregiver, you could opt for a center that has the facilities that your loved one needs, and is also suited to your financial situation.

How can you identify a rehab center that is legal and aboveboard?

• It is safest to choose a rehabilitation center that is recommended by your treating psychiatrist.

• A legal and authorized facility must be licensed as a hospital or a rehabilitation center. The license must be granted by an authority such as the National Accreditation Board for Hospitals and Healthcare Providers (NABH) or the Rehabilitation Council of India. 

• A legal facility has a board of visitors appointed by the government, which makes a surprise visit every two or three months to ensure compliance with rules and regulations. If the board of visitors observes that there are any human rights violations in the facility, they have the authority to order its closure.

• The facility should also have a suggestion box prominently displayed in the premises. All patients (and sometimes visitors) have access to the box, which can be opened only by the board of visitors.

• How open is the rehab center to having visitors on the premises? Their transparency (or lack of it) could be an indicator of how the patients are being treated. If a rehab center is averse to having family members or friends speak to the patient, it may be that they have something to hide.

• An ideal rehab facility would encourage patients and families to visit their premises, and clarify doubts. Talking to the users and their families may help you decide whether the facility is suitable for you.