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A 2-year follow-up study of people with severe mental illness involved in psychosocial
rehabilitation
Svedberg, Petra; Svensson, Bengt; Hansson, Lars; Jormfeldt, Henrika
Published in:
Nordic Journal of Psychiatry
DOI:
10.3109/08039488.2013.851737
2014
Link to publication
Citation for published version (APA):
Svedberg, P., Svensson, B., Hansson, L., & Jormfeldt, H. (2014). A 2-year follow-up study of people with severe
mental illness involved in psychosocial rehabilitation.
Nordic Journal of Psychiatry
,
68
(6), 401-408.
https://doi.org/10.3109/08039488.2013.851737
Total number of authors:
4
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A two-year follow-up study of people with severe mental illness involved in psychosocial
rehabilitation
Svedberg, Petra, Associate professor
1
., Svensson, Bengt, Associate professor
2
., Hansson,
Lars, Professor
2
., Jormfeldt, Henrika, Associate professor
1
.
1. School of Social and Health Sciences, Halmstad University, Sweden
2. Department of Health Sciences, Lund University, Sweden
Corresponding author:
Petra Svedberg
School of Social and Health Sciences
Halmstad University
SE - 301 18 Halmstad
Sweden
Phone: +46-35167786
Fax: +46-35167264
Email: petra.svedberg@hh.se
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Abstract
Backgrounds
A focus on psychiatric rehabilitation in order to support recovery among persons with severe
mental illness (SMI) has been given great attention in research and mental health policy, but
less impact on clinical practice. Despite the potential impact of psychiatric rehabilitation on
health and wellbeing, there is a lack of research regarding the model called “Psychiatric
Rehabilitation Approach from Boston University (BPR)”.
Aim: The aim was to investigate the outcome of the BPR intervention regarding changes in
life situation, use of health care services, quality of life, health, psychosocial functioning and
empowerment.
Methods: The study has a prospective longitudinal design and the setting was seven mental
health services who worked with the BPR in the county of Halland in Sweden. In total 71
clients completed the assessment at baseline and of these 49 completed the 2-year follow-up
assessments.
Results: The most significant finding was an improved psychosocial functioning at the
follow-up assessment. Furthermore, 65% of the clients reported that they had mainly or
almost completely achieved their self-formulated rehabilitation goals at the 2-year follow-up.
There were significant differences with regard to health, empowerment, quality of life and
psychosocial functioning for those who reported that they had mainly/completely had
achieved their self-formulated rehabilitation goals compared to those who reported that they
only had to a small extent or not at all reached their goals.
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Conclusions: Our results indicate that the BPR approach has impact on clients’ health,
empowerment, quality of life and in particular concerning psychosocial functioning.
Key words: psychiatric rehabilitation, psychosocial rehabilitation, severe mental illness,
Choose–Get–Keep Model, Boston psychiatric rehabilitation approach
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Background
A focus on psychiatric rehabilitation in order to support recovery among persons with severe
mental illness (SMI) has been given great attention in research and mental health policy, but
still lacks implementation in clinical practice in a broader perspective [1] [2]. The
development of mental health systems in Sweden have in recent decades been characterized
by a shift from traditionally hospital-based care to community-based care [3]. However,
moving toward a recovery-oriented approach takes time and presents several challenges for
mental health services [4]. With the increasing emphasis on an evidence-based practice and
research findings which confirm that people with SMI can recover from their illness [5] there
is a promising future for a further focus on recovery-oriented mental health care services [2].
!
The development of new models for psychiatric rehabilitation have resulted in a number of
intervention programs designed to improve health, social functioning and the quality of life of
persons with SMI. Common elements of these programs are that they offer extensive and
person-centred support aimed at strengthening the person’s ability to take responsibility for
their lives and thereby improve their quality of life [6]. Most programs include interventions
aimed to improve social skills, to create opportunities for independent living, to get persons
into work and actions to achieve a meaningful leisure time. The most common rehabilitation
oriented models are the Fountain House model of psychiatric rehabilitation [7], case-
management [8] [9], assertive community treatment (ACT) [10] [11] [2] and supported
employment (SE) [12]. Both ACT [13] [14] and supported employment according to the IPS
model [12] [15] have been identified as evidence-based practices that support people with
severe mental illness. Despite the potential impact of psychiatric rehabilitation on wellbeing
and health, there is a lack of research regarding the model called Psychiatric Rehabilitation
Approach from Boston University (BPR)
1
[16] [17] although it is established in clinical
practice in a number of countries. The BPR model has been investigated in some empirical
studies from United States [18] [19] and in a few studies from European countries [20-23].
Four of these studies used a randomized controlled design [18] [19] [22] [23]. Swildens et al
[22] showed that the BPR was effective in supporting persons with SMI in societal
participation and to achieve self-formulated goals, but no effects were found regarding social
functioning, needs for care, and quality of life. Rogers, Anthony, Lyss and Penk [18] found no
significant differences between the intervention group and a control group regarding
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1
"Sometimes "called"Choose–Get–Keep Model (CGK)"
