BackgroundTreatment non-adherence and service disengagement are commonly attributed to impaired insight. There is evidence that recovery style (i.e. psychological adjustment) may underlie service engagement.AimsWe examined whether insight, psychotic symptoms or individuals' recovery style (‘integration’ v. ‘sealing-over’) predicts service engagement.MethodFifty patients with schizophrenia were assessed during acute psychosis and at 3-month and 6-month follow-ups. Measures included recovery style, psychosis symptoms, insight and service engagement.ResultsSealing-over at 3 months following onset of an episode of psychosis predicted low service engagement at 6 months. Neither insight nor symptoms predicted engagement. The clear shift from integration to sealing-over within the first 3 months was independent of changes in symptoms or insight. Sealing-over between 3 and 6 months was associated with improvement in psychosis symptoms.ConclusionsRecovery style contributed more to engagement than did insight, appears to be dynamic in the short term and is orthogonal to insight. Overall, this study demonstrated the importance of addressing psychological adjustment to psychosis as well as illness status when investigating treatment engagement in people with psychosis.

Sammendrag:Artikkelen oppsummerer dagens forskning på brukermedvirkning i psykiske helsetjenester fra både politiske og praktiske perspektiver. Vi begynner med å undersøke de mange betydningene av begrepet "psykisk helsevern" for brukeren og de politiske imperativer for brukerinvolvering , for å gi eksempler på god praksis. Vi diskuterer hva som menes med "engasjement" og grunner til at brukermedvirkning er spesielt viktig i psykisk helsevern. Til slutt beskriver vi noen av de tradisjonelle barrierer for deltakelse og en rekke eksempler på positiv praksis på tvers av en rekke ulike aspekter ved psykisk helsevern.Omsorgsbiblioteket har ikke tilgang til å publisere dette dokumentet i fulltekst. Kanskje ditt lokale bibliotek kan hjelpe deg, eller kanskje du kommer videre med lenken nedenfor.

The need for a measure of engagement with Community Mental Health Services has been identified. This article reports on the development and preliminary psychometric evaluation of a scale, Service Engagement Scale (SES), to measure engagement with community mental health services. Five Community Psychiatric Nurses completed the SES for 66 clients receiving Assertive Outreach services with an ICD-10 diagnosis of schizophrenia. Test-retest reliability of the subscale items and scale total is in the good to excellent range. Validity is supported by good internal consistency and by the criterion group method. Although preliminary psychometric results are promising, further psychometric study is necessary to evaluate the scale's factor structure. The SES appears to evaluate engagement with services, and may therefore be a useful tool to identify areas of concern with clients experiencing engagement difficulties.

Sealing over was associated with multiple signs of low personal resilience in adapting to psychosis.