ABSTRACT
PURPOSE: Lack of motivation for treatment makes a subgroup of patients with severe mental illness (SMI) difficult to engage in psychiatric treatment. Such difficult-to-engage patients may also be the most in need of treatment. We hypothesized that the level of psychosocial problems would be inversely related to motivation for treatment. METHODS: Cross-sectional study in two independent samples. The first sample (n = 294) included SMI patients who participated in a randomized controlled trial and were assessed using the Health of the Nation Outcome Scales (HoNOS) and self-rated and clinician-rated motivation-for-treatment scales. The second sample (n = 1,170) included SMI patients who were treated in Assertive Outreach Teams and were routinely assessed with the HoNOS and a motivation-for-treatment scale. In both samples, patients also self-rated their quality of life. RESULTS: In both samples, patients with HoNOS scores of 16 and higher had lower motivation scores on all motivation scales than patients with lower HoNOS scores, and also a lower quality of life. CONCLUSIONS: A motivation paradox seems inherent to this association between higher psychosocial problems levels, less motivation for treatment, and lower quality of life. Such a paradox has clinical relevance, as it may provide an ethical basis for outreach services which aim to engage marginally motivated SMI patients with severe psychosocial problems into mental health care.
Subject(s)
Behavior Therapy/methods , Mental Disorders/psychology , Mental Disorders/therapy , Mentally Ill Persons/psychology , Motivation , Adult , Aged , Assertiveness , Community Mental Health Services , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Netherlands , Psychiatric Status Rating Scales/statistics & numerical data , Quality of Life , Self Report , Severity of Illness Index , Social Support , Treatment OutcomeABSTRACT
In a population of dually diagnosed patients receiving assertive community treatment we used the theoretical framework of the transtheoretical model to establish (a) the proportions and characteristics of patients who were not motivated for treatment for psychiatric symptoms and substance use, (b) the proportion of patients who moved towards behavioral change after about 1 year, and examine how this change was related with clinical outcome; and (c) the sequence of change processes. Chi square tests and T tests were used to compare the patient characteristics and outcomes of patients who remained in precontemplation with those who progressed. During follow-up, 47 % of the patients came out of the precontemplation phase for treatment of psychiatric symptoms and 38 % for substance use behavior. Those who remained in precontemplation benefited less from treatment. Of those who did move forward, most appeared to become motivated for psychiatric treatment before becoming motivated to reduce substance use.
Subject(s)
Community Mental Health Services , Mental Disorders/therapy , Motivation , Patient Acceptance of Health Care/psychology , Substance-Related Disorders/therapy , Adult , Diagnosis, Dual (Psychiatry)/psychology , Female , Health Services Needs and Demand , Humans , Male , Mental Disorders/psychology , Social Adjustment , Substance-Related Disorders/psychologyABSTRACT
BACKGROUND: Patients with severe mental illness (SMI) generally receive long-term treatment. Interrupting treatment or leaving treatment early can lead to problems with the interpretation of routine outcome monitoring (ROM) data. AIM: To describe the link between early drop-out and treatment duration on the one hand, and patient characteristics and scores on a ROM outcome measure, namely the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), on the other hand. METHOD: Annual CANSAS assessments of patients in assertive community treatment (ACT). RESULTS: 2946 CANSAS assessments were performed on 1041 patients who had been treated by an ACT team for an average of 1.4 years since their first ROM assessment. Patients who remained under treatment by an ACT team were more frequently male, born outside the Netherlands and had a psychotic or addiction disorder more frequently than patients who had left the ACT team treatment early. Patients who remained in ACT had, both at the start of treatment and at their last assessment, more unfulfilled needs than patients who had been treated for a shorter period. CONCLUSION: For the correct interpretation of ROM data for patients with SMI, one needs to have information about patient characteristics and the treatment duration.
Subject(s)
Emigrants and Immigrants/psychology , Mental Disorders/therapy , Mental Health Services/standards , Outcome Assessment, Health Care , Adult , Benchmarking , Emigrants and Immigrants/statistics & numerical data , Female , Humans , Male , Netherlands , Psychiatric Status Rating Scales , Severity of Illness Index , Sex Factors , Time FactorsABSTRACT
In an observational study of severely mentally ill patients treated in assertive community treatment (ACT) teams, we investigated how treatment outcome was associated with demographic factors, clinical factors, and motivation for treatment. To determine psychosocial outcome, patients were routinely assessed using the Health of the Nation Outcome Scales (HoNOS). Trends over time were analyzed using a mixed model with repeated measures. The HoNOS total score was modeled as a function of treatment duration and patient-dependent covariates. Data comprised 637 assessments of 139 patients; mean duration of follow-up was 27.4 months (SD = 5.4). Substance abuse, higher age, problems with motivation, and lower educational level were associated with higher HoNOS total scores (i.e., worse outcome). To improve treatment outcome, we recommend better implementation of ACT, and also the implementation of additional programs targeting subgroups which seem to benefit less from ACT.
