Psychosocial rehabilitation in psychosis — multi-component package (MEQ)

(i) Recovery constructs. Clinical recovery = symptoms, relapse, hospital days. Functional recovery = work, housing, relationships, ADLs. Personal recovery = person-defined meaningful life. CHIME: Connectedness, Hope, Identity, Meaning, Empowerment. In this man, clinical recovery is partial (residual voices), functional recovery is poor (unemployment, isolation), personal recovery goals (retail work) are present — do not collapse all three into a single PANSS score.[7]

(ii) Disability drivers. Residual positives, negatives, cognitive slowing, high-EE family environment, understimulation, service disengagement, possible secondary contributors (sedation, depression, substances — reassess). Opportunity barrier: team cream-skimming ("not ready") and offering only a token art group without competitive pathway.[1][10]

(iii) Multi-component package (PORT-aligned). (1) Optimise medication with shared decision-making around work (current aripiprazole 15 mg daily — review side-effects and residual symptoms; avoid unnecessary polypharmacy). (2) IPS for competitive retail goals: rapid placement, integrated employment specialist, zero exclusion based on readiness — desire to work is eligibility.[2][3] (3) Cognitive remediation with bridging to job tasks (Wykes meta-analytic support for cognitive gains; transfer better when integrated).[4] (4) Social skills training for customer-facing retail demands. (5) Illness management / relapse plan and CBTp elements for residual distress if available.[1][10] Art group may be adjunctive activity, not a substitute for IPS.

(iv) Intensity and family. Three admissions and poor clinic attendance → consider ACT/ICM intensity (low shared caseload, in-vivo outreach) rather than clinic-only DNA.[9] Family psychoeducation (structured multi-session: education, communication, problem-solving, reduce high EE) — not unstructured criticism; evidence for relapse reduction.[5][6]

(v) Pitfalls. Recovery language used to deny care or force discharge (Slade abuses); train-and-place delays; low-fidelity "ACT"; CR without transfer; ignoring secondary causes; family contact that increases EE; fragmentation without fixed responsibility; equating symptom quieting with rehab completion.[8][10]