Psychiatric rehabilitation does not focus on symptoms but on role outcomes. To avoid the inflation of the term rehabilitation to include any program that the patient attends, a pioneer of rehabilitation in the United States, William Anthony, has suggested considering skill building to be the critical element of rehabilitation. If an activity does not involve skill building, it is better called enrichment. Going bowling with peers is enrichment, not rehabilitation in this narrow sense (unless the goal is to build the skill of becoming a proficient bowler). In a broader sense, however, even bowling can be rehabilitation if a stated goal is teaching social skills and not merely killing time. Good programs focus on acquiring one specific skill at a time and provide ongoing support down the road, as needed. Successful rehabilitation decreases social isolation, improves skills and confidence, enlarges social networks, and increases the chances of returning to work or school. Successful rehabilitation should allow the patient to be a member of society and contribute to the greatest extent possible. Psychiatric rehabilitation is complicated by a sociocultural
context of stigma, exclusion, and discrimination. Changing societal attitudes and discriminatory laws are part of rehabilitation in a larger sense.

The starting point for rehabilitation is helping patients figure out or clarify their goals and then provide them with the skills and supports they need to attain these goals. It should be obvious that rehabilitation must be tailored to the individual patient’s needs and abilities.

It will come as no surprise that most patients have dreams and aspirations similar to the rest of us: To live a life with security, friends, a sense of belonging, and with something meaningful to do. “Wellness” is a new focus of rehabilitation. Not all patient goals are psychiatric rehabilitation goals in its narrow sense (skill building). Instead, patients often have a host of social needs that are nondisease issues, for example, poverty or homelessness that must be dealt with before educational or vocational rehabilitation attempts. It is difficult to learn a skill if you are hungry and have no place to sleep. Note that “housing” is not a psychiatric rehabilitation goal per se, even though stable and secure housing is obviously desired and necessary for rehabilitation. There is an advantage of restricting rehabilitation to skill building as you can design programs that address needed skills and provide support: Maintaining housing can be easily conceptualized as a rehabilitation goal if loss of housing is the result of poor budgeting skills resulting in eviction because of not paying rent. What rehabilitation can do is provide supported housing and teach budgeting skills.