Effectiveness of Resource Groups for Improving Empowerment, Quality of Life, and Functioning of People With Severe Mental Illness

Abstract

IMPORTANCEAlthough the importance of recovery-oriented care for people with severe mental illness (SMI) is widely acknowledged, essential elements such as personalization and involvement of significant others are not adequately implemented in practice.OBJECTIVE To determine whether using resource groups (RGs) within flexible assertive community treatment (FACT) has favorable effects on empowerment and recovery-related outcomes in people with SMI. DESIGN, SETTING, AND PARTICIPANTSThis assessor-blind, multisite randomized clinical trial was conducted from September 1, 2017, to September 30, 2020, with follow-up at 9 and 18 months. A total of 158 participants aged 18 to 65 years meeting the criteria for SMI were randomly allocated to FACT plus RG vs FACT as usual (1:1) in 20 FACT teams throughout the Netherlands. Data were analyzed from September 1, 2020, to January 31, 2021. The study was prespecified in the trial protocol and data from the intent-to-treat population were analyzed. INTERVENTIONSIn the FACT plus RG condition, patients chose members from their informal and formal networks to form an RG that meets quarterly to discuss self-formulated recovery goals. The RG was integrated into the multidisciplinary support provided by the FACT team. In the FACT as-usual condition, empowerment (defined as overcoming powerlessness and gaining control of one's life) and involvement of significant others was also part of the provided care, but without the structure of the RG. MAIN OUTCOMES AND MEASURESThe primary outcome was self-reported empowerment, measured with the Netherlands Empowerment List.RESULTS A total of 158 participants with SMI (median age, 38 [median absolute deviation, 13] years; 93 men [58.9%]) were randomized to FACT plus RG (n = 80) or FACT as usual (n = 78) care. Intention-to-treat analyses showed that randomization to the RG condition was associated with a clinically significant increase in empowerment (Cohen d, 0.54; 95% CI, 0.21-0.86) and improved outcomes with small to medium effect sizes in terms of quality of life (Cohen d, 0.25; 95% CI, −0.07 to 0.56), personal recovery (Cohen d, 0.38; 95% CI, 0.06-0.69), quality of social contact (Cohen d, 0.24; 95% CI, −0.07 to 0.56), disability (Cohen d, 0.29; 95% CI, −0.03 to 0.60), general functioning (Cohen d, 0.30; 95% CI, −0.01 to 0.62), and social functioning (Cohen d, 0.28; 95% CI, −0.04 to 0.59). No differences between conditions were found regarding psychopathological symptoms, attachment, frequency of social contact, and employment. Compared with FACT as usual, participants who stayed with the assigned treatment in the RG condition were more satisfied with treatment at 9 (Cohen d = 0.45; t 135 = −2.62; P = .009) and 18 (Cohen d = 0.41; t 116 = −2.22; P = .02) months.CONCLUSIONS AND RELEVANCE These findings show that working with RGs improves empowerment and other mental health outcomes in people with SMI who receive community-based mental health services. This method of network-oriented care empowers people with SMI within their own environment.

Storytelling and training to advance individual recovery skills (STAIRS). A feasibility study of a blended program to support personal recovery among patients with a major depressive disorder in remission

“…In particular, social support by significant others, peers and trainers was highly valued and experienced as helpful. This is in line with a recently published study among 158 patients with a serious mental illness, which also showed that involving relatives and significant others in treatment facilitated the personal recovery process (39). As reported in previous research, our study also demonstrates that involving significant others can be challenging, e.g., because no significant other was available or participants did not want to involve them (40-42).…”

Current insights of community mental healthcare for people with severe mental illness: A scoping review

“…In addition, several papers describe the Resource Group methodology that also promotes citizenship because the main feature of this methodology is that ownership and direction lie with the client. Of the included studies, there were two RCTs ( 73 , 74 ) with positive results, one meta-analysis ( 71 ), one review ( 72 ), and one qualitative paper ( 75 ). Finally, we found some papers on self-reliance.…”

Case Study in Youth Flexible Assertive Community Treatment: An Illustration of the Need for Integrated Care

“…In this case, a “resource group” involving care providers, parents, and other important relatives could help. A resource group is a network that can help better navigate critical transitions in life ( 37 ). Such a combination of informal and formal networks is already deployed within Adult Flexible ACT and is usually set up right at the start ( 37 ).…”

“…A resource group is a network that can help better navigate critical transitions in life ( 37 ). Such a combination of informal and formal networks is already deployed within Adult Flexible ACT and is usually set up right at the start ( 37 ). Working with a resource group could ensure continuity of care and prevent the client from falling back on (specialized) mental health care services.…”