A 2-year follow-up study of people with severe mental illness involved in psychosocial rehabilitation
Summary (3 min read)
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.
- 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 2.
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.
- There is a lack of research regarding the model called “Psychiatric Rehabilitation Approach from Boston University (BPR)”.
- 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.
- In total 71 clients completed the assessment at baseline and of these 49 completed the 2-year follow-up assessments.
- 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.
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].
- 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].
- 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].
- 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.
- This study was conducted as a part of an implementation project in the county of Halland that aimed to develop mental health rehabilitation services and to initiate a recovery-oriented approach for persons with severe mental illness.
Aims
- The aims of the present study were to investigate outcome of the intervention in terms of changes in life situation, use of health care services, quality of life, health, psychosocial functioning and empowerment.
- A further aim was to investigate to what extent the clients’ self-formulated rehabilitation goals were attained.
Design
- The study has a prospective longitudinal design and the data collection at baseline started in August 2007 and a 2-year follow-up data collection ended in December 2010.
- At both baseline and follow-up all clients were interviewed by either of two of the authors (PS or HJ).
- The interviewers had no involvement in the clients’ care or rehabilitation.
Settings and participants
- The setting was seven mental health services who implemented the BPR approach in the county of Halland in Sweden.
- Six of these were municipal services for persons with mental illness and one was an outpatient specialist psychiatric service.
- Two of the six municipal services only provided vocational rehabilitation.
- A total of 71 clients consented to participate and completed the assessment at baseline, and of these 49 completed the 2-year follow-up data collection.
Intervention
- The BPR approach is based on the principles and practices of psychiatric rehabilitation developed by Anthony, Cohen and Farkas [24] at Boston University.
- The model was first applied in vocational rehabilitation, and then extended to educational and housing situations [17].
- The model is highly individualized and is based entirely on the individual’s unique needs and preferences.
- The purpose of the BPR intervention in Halland was to support and guide the client to formulate and achieve his/her own goals for various life areas such as work/occupation, 7 housing, education and leisure time.
- A program fidelity evaluation was carried out using a new instrument developed by the research group inspired by a Dutch questionnaire [25].
Outcome measures
- Subjective quality of life was assessed by the Manchester Short Assessment of Quality of Life scale.
- The instrument contains 16 items including satisfaction with work, finances, social relations, leisure, living situation, safety, family relations, sexual relations, and health using a 7-point scale ranging from could not be worse to could not be better.
- Needs of care were measured using the Camberwell Assessment of Needs Short Appraisal Schedule, [29].
- This is a 22-item self-report questionnaire with three subscales: autonomy, social involvement and comprehensibility.
- The instrument has showed good reliability and validity in a Swedish context [33- 35].
Ethics
- The study was approved by the Regional Ethical Review Board for southern Sweden, Dnr 316/2007.
- All participants were informed both orally and in writing about the purpose and the structure of the study before they gave their informed consent.
- Participation was voluntary, and the participants were informed about the ethical considerations of confidentiality and that they could withdraw from the study at any time.
Statistical analysis
- Differences between baseline and 2-year follow-up were analyzed with Student’s t-test.
- Analyses of differences between subcategories of clients were made using the χ2 test.
- The statistical software used was SPSS version 15.
Socio-demographic characteristics
- The mean years since first admission were 8 years (range 0-24).
- A majority (57 %) of the participants were single, 30.6 % were married or co-habiting and 98% had an independent living.
- The patients who did not participate in the follow-up were not different in any of the sociodemographic variables measured at baseline compared with the patients who completed the study (See table 1).
External life situation
- The clients’ external life situation in terms of housing, education and leisure activities showed no significant differences between baseline and the two-year follow-up.
- Quality of life, health, empowerment and psychosocial functioning Quality of life, health, empowerment as well as psychosocial functioning were significantly improved between baseline and the two year follow up (table 2).
- Effect sizes for all these domains were generally small, with the exception of psychosocial functioning where the effect size was large.
- Thirty-two of the clients (65%) considered that they mainly or almost completely had achieved their goals.
Discussion
- The most significant finding of the present study was an improved psychosocial functioning (large effect size) at the two-year follow-up.
- Health, empowerment, quality of life and psychosocial functioning improved over time, with large significant differences between clients who mainly/completely achieved their self-formulated rehabilitation goals and the clients who only to a small extent or not at all achieved their goals.
- In the study by Rogers, Anthony and Farkas [17] there were no significant differences between the intervention group and the control group regarding work situation at a two-year follow up.
- There is a risk regarding self-reported data that the client under-estimate their symptoms and dysfunction as well as diagnosis.
- In spite of these limitations the authors still suggest that the BPR approach can be an important factor in improving clients’ clinical and social situation.
Conclusion
- In conclusion this study provides support for that BPR contribute to an improved life situation in terms of employment and sheltered employment/job training, and a decrease in number of people with disability pension, while no changes were shown concerning housing situation, education and leisure time.
- This study also provides support for that BPR contribute to an increased quality of life, health, empowerment and psychosocial functioning as well as to a reduced utilization of psychiatric services.
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References
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...Common elements of these programs are that they offer extensive and person-centered support aimed at strengthening the person ’ s ability to take responsibility for their lives and thereby improve their quality of life (6)....
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