The Therapeutic Relationship and Adherence to Antipsychotic Medication in Schizophrenia

McCabe, Rose; Bullenkamp, Jens; Hansson, Lars; Lauber, Christoph; Martínez‐Leal, Rafael; Rössler, Wulf; Salize, Hans Joachim; Svensson, Bengt; Torres-González, Francisco; Brink, Rob van den; Wiersma, Durk; Priebe, Stefan

doi:10.1371/journal.pone.0036080

Cited by 118 publications

(92 citation statements)

References 30 publications

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“…As would be expected based on the treatment adherence literature [35][36][37][38], the experts endorsed positive expectations about the potential benefits of treatment, a good therapeutic alliance with the HCP, good occupational and cognitive functioning, and a readiness to change among characteristics that are very likely to promote engagement with DHTs. The survey responses suggested that many of the characteristics that promote favorable outcomes in any psychosocial intervention are similar to those that promote favorable outcomes when interventions are delivered via a DHT, except that patients will also need access to and the ability to use technology.…”

Section: Identifying Appropriate Patientsmentioning

confidence: 70%

Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support (Preprint)

Hatch¹,

Hoffman²,

Ross³

et al. 2018

Preprint

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Background: Digital technology is increasingly being used to enhance healthcare in various areas of medicine. In the area of serious mental illness (SMI), it is important to understand the special characteristics of target users that may influence motivation and competence to use digital health tools (DHTs), as well as the resources and training necessary for these patients to facilitate the use of this technology. Objective: To conduct a quantitative expert consensus survey to identify key characteristics of target users (patients and healthcare professionals [HCPs]), barriers and facilitators for appropriate use, and resources needed to optimize the use of DHTs in patients with SMI. Methods: A panel of 40 experts in digital behavioral health who met the participation criteria completed a 19-question survey rating predefined responses on a 9-point Likert scale. Consensus was determined using a chi-square test of score distributions across 3 ranges (1-3, 4-6, 7-9). Categorical ratings of first, second, or third line were designated based on the lowest category into which the confidence interval of the mean ratings fell, with a boundary >6.5 for first line. Here, we report experts' responses to 9 questions (265 options) that focused on (1) user characteristics that would promote or hinder the use of DHTs, (2) potential benefits/motivators and barriers/unintended consequences of DHT use, and (3) support and training for patients and HCPs. Results: Among patient characteristics most likely to promote use of DHTs, experts endorsed interest in using state-of-the-art technology, availability of necessary resources, good occupational functioning, and perception of the tool as beneficial. Certain diseaseassociated signs and symptoms (eg, more severe symptoms, substance abuse problems, a chaotic living situation) were considered likely to make it difficult for patients to use DHTs. Enthusiasm among HCPs for DHTs and availability of staff and equipment to support their use were identified as variables to enable HCPs to successfully incorporate DHTs into their practices. The experts identified a number of potential benefits of and barriers to use of DHTs by patients and HCPs. Most experts agreed that both HCPs and patients would need to be trained in the use of these new technologies. Conclusions: These results provide guidance to the mental health field on how to optimize the development and deployment of DHTs for patients with SMI.

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Section: Identifying Appropriate Patientsmentioning

confidence: 70%

Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support (Preprint)

Hatch¹,

Hoffman²,

Ross³

et al. 2018

Preprint

View full text Add to dashboard Cite

show abstract

“…Engaging people with the most serious disorders in a trusting relationship (McCabe et al 2012;Dixon et al 2016) is essential. Coercion can undermine success: a perceived loss of autonomy may create a more negative dynamic between client and clinician (Theodoridou et al 2012), while a good relationship improves quality of life and functional outcomes (Catty et al 2010(Catty et al , 2011.…”

Section: Engagement and Relationshipmentioning

confidence: 99%

Psychiatric rehabilitation in Europe

Rössler

Drake

2017

Epidemiol Psychiatr Sci

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To describe the core elements of modern psychiatric rehabilitation. Based on selected examples we describe the discussion about values in mental health care with focus on Europe. We present outcome data from studies, which have tried to implement care structures based on this value discussion. In the second half of the 20th century, mental health care in all European and other high-income countries changed conceptually and structurally. Deinstitutionalisation reduced the number of psychiatric beds and transferred priority to outpatient care and community-based services, but community mental health programs developed differently across and within these countries. High-income countries in Europe continued to invest in costly traditional services that were neither evidence-based nor person-centered by emphasising inpatient services, sheltered group homes and sheltered workshops. We argue that evidence-based, person-centred, recovery-oriented psychiatric rehabilitation offers a parsimonious solution to developing a consensus plan for community-based care in Europe. The challenges to scaling up effective psychiatric rehabilitation services in high-income countries are not primarily a lack of resources, but rather a lack of political will and inefficient use and dysfunctional allocation of resources.

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“…Knowing more about the consumer as an individual and not just their diagnosis or presenting problem reduces the likelihood of a consumer feeling labelled or judged, as they feel they are being related to as a person [32]. Outcomes and compliance with management plans and treatment has been shown to improve if there is a good therapeutic relationship [33,34].…”

Section: Interpersonal/therapeutic Factorsmentioning

confidence: 99%

Psychiatric assessment in the emergency department: preliminary data from consumers about risk assessment following a suicide attempt or deliberate self-harm

Donley¹

2015

Emerg Med Health Care

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Suicide continues to be a world-wide problem. For every suicide there are many more suicide attempts and acts of deliberate self-harm. The Emergency Department (ED) of the public hospital is at the forefront of an increasing presentation rate of patients in the acute phase of mental illness or suicide risk, requiring specialised mental health risk assessment. Little is known of mental health patient views about their experience in the ED, yet consumer views are seen as an important factor in measuring the quality of psychiatric assessment and treatment. This paper sets out to examine consumer experiences of psychiatric assessment in the ED. Twenty participants, assessed in one of three public hospital EDs in Melbourne, Australia, following a suicide or deliberate self-harm (DSH) attempt, completed an anonymous online mixed method questionnaire. Participants reported an overall improvement in mood and expressed a positive view of the quality of service from the ED psychiatric team. Most helpful to participants was being listened to, not feeling judged, and having time to talk. What they found unhelpful was the lack of a private area for assessment, feeling 'labelled', and at times a lack of individual focus. What became apparent during this study was the difficulty in recruiting participants. A more direct-approach design to encouraging consumers to participate may increase response rates, however, privacy and power dynamics would pose an ethical challenge. Even though participation rate was low, the preliminary message from these ED consumers is still useful in formulating the beginnings of an important conversation with this group.

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The Therapeutic Relationship and Adherence to Antipsychotic Medication in Schizophrenia

Cited by 118 publications

References 30 publications

Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support (Preprint)

Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support (Preprint)

Psychiatric rehabilitation in Europe

Psychiatric assessment in the emergency department: preliminary data from consumers about risk assessment following a suicide attempt or deliberate self-harm

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