Treatment engagement of individuals experiencing mental illness: review and update

Abstract

Individuals living with serious mental illness are often difficult to engage in ongoing treatment, with high dropout rates. Poor engagement may lead to worse clinical outcomes, with symptom relapse and rehospitalization. Numerous variables may affect level of treatment engagement, including therapeutic alliance, accessibility of care, and a client's trust that the treatment will address his/her own unique goals. As such, we have found that the concept of recovery-oriented care, which prioritizes autonomy, empowerment and respect for the person receiving services, is a helpful framework in which to view tools and techniques to enhance treatment engagement. Specifically, person-centered care, including shared decision making, is a treatment approach that focuses on an individual's unique goals and life circumstances. Use of personcentered care in mental health treatment models has promising outcomes for engagement. Particular populations of people have historically been difficult to engage, such as young adults experiencing a first episode of psychosis, individuals with coexisting psychotic and substance use disorders, and those who are homeless. We review these populations and outline how various evidence-based, recovery-oriented treatment techniques have been shown to enhance engagement. Our review then turns to emerging treatment strategies that may improve engagement. We focus on use of electronics and Internet, involvement of peer providers in mental health treatment, and incorporation of the Cultural Formulation Interview to provide culturally competent, person-centered care. Treatment engagement is complex and multifaceted, but optimizing recovery-oriented skills and attitudes is essential in delivery of services to those with serious mental illness.

Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia

“…For the engagement of family members in the treatment, the nursing team, allied with the multidisciplinary team, should seek to understand the barriers and identify the specific necessities of family members to determine which factors may assist in the promotion of their improved involvement with the services, when necessary (29) . Moreover, these teams should induce organizational changes in the services, share treatment objectives with the patients and their family members and insert family involvement into the work routine (30) .…”

The Relationship Between Race, Patient Activation, and Working Alliance: Implications for Patient Engagement in Mental Health Care

“…Active patient engagement in mental healthcare is important because treatment requires knowledge and skills to follow medication regimens, to practice self-care activities, and to participate in treatment decisions. Patient engagement in healthcare services, including mental health services, has been associated with positive patient health outcomes, higher quality patient-provider communication, better healthcare quality, and decreased costs (Alegria et al, 2014;Dixon, Holoshitz, & Nossel, 2016;Kotwicki, Balzer, & Harvey, 2016).…”

“…Furthermore, ineffective communication, distrustful interactions, and weak working alliance between minority patients and their providers are implicated as contributing factors to this group's low level of engagement in mental health services (Davis, Ancis, & Ashby, 2015;Dixon et al, 2016;Fortuna et al, 2010). In particular, working alliance, also referred to as therapeutic bond, alliance, or therapeutic alliance, is a collaborative relationship between patient and provider and has been associated with positive psychotherapy outcomes for a wide range of diagnoses and populations, including patient engagement and retention in treatment, (Castonguay, Constantino, & Holtforth, 2006;Sharf, 2010).…”

Psychiatric rehabilitation in Europe

“…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.…”