Treatment engagement of individuals experiencing mental illness: review and update

Lisa B Dixon, Yael Holoshitz, Ilana Nossel, Lisa B Dixon, Yael Holoshitz, Ilana Nossel

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 person-centered 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.

Keywords: Engagement; alliance; first episode psychosis; person-centered care; recovery; schizophrenia; shared decision making.

© 2015 World Psychiatric Association.

References

    1. Kreyenbuhl J, Nossel IR, Dixon LB. Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. Schizophr Bull 2009;35:696‐703.
    1. MacBeth A, Gumley A, Schwannauer M et al. Service engagement in first episode psychosis: clinical and premorbid correlates. J Nerv Ment Dis 2013;201:359‐64.
    1. Del Vecchio P. SAMHSA's working definition of recovery updated 2012. .
    1. Department of Health and Human Services. Achieving the promise: transforming mental health care in America. Rockville: U.S. Department of Health and Human Services, 2003.
    1. Le Boutillier C, Leamy M, Bird VJ et al. What does recovery mean in practice? A qualitative analysis of international recovery‐oriented practice guidance. Psychiatr Serv 2011;62:1470‐6.
    1. Sowers WE. Recovery and person‐centered care: empowerment, collaboration and integration In: McQuistion H, Sowers WE, Ranz JM. et al (eds). Handbook of community psychiatry. New York: Springer, 2012:79‐89.
    1. Slade M, Amering M, Farkas M et al. Uses and abuses of recovery: implementing recovery‐oriented practices in mental health systems. World Psychiatry 2014;13:12‐20.
    1. JM Kane, DG Robinson, NR Schooler et al. Factors contributing to engagement during the initial stages of treatment for psychosis. Qual Health Res 2012;23:336‐47.
    1. Horvath AO, Del Re AC, Fluckinger C et al. Alliance in individual psychotherapy. Psychotherapy 2011;48:9‐16.
    1. Frank AF, Gunderson JG. The role of the therapeutic alliance in the treatment of schizophrenia. Arch Gen Psychiatry 1990;47:228‐36.
    1. Melau M, Harder S, Jeppesen P et al. Clinical and functional outcome in a cohort of 400 patients with first‐episode psychosis: a cross‐sectional study. J Clin Psychiatry 2015;76:83‐90.
    1. Kvrgic S, Cavelti M, Beck E et al. Therapeutic alliance in schizophrenia: the role of recovery orientation, self‐stigma and insight. Psychiatry Res 2013;209:5‐20.
    1. Adams N, Grieder DM. Treatment planning for person‐centered care, shared decision making for whole health. Waltham: Elsevier, 2014.
    1. Stanhope V, Tondora J, Davidson L et al. Person‐centered care planning and service engagement: a study protocol for a randomized controlled trial. Trials 2015;16:180.
    1. Moran GS, Baruch Y, Azaiza F et al. Why do mental health consumers who receive rehabilitation services, are not using them? A qualitative investigation of users’ perspectives in Israel. Community Ment Health J (in press).
    1. Chan KKS, Mak WWS. The mediating role of self‐stigma and unmet needs on the recovery of people with schizophrenia living in the community. Qual Life Res 2014;23:2559‐68.
    1. Cuevas C, Penate W. To what extent psychiatric patients feel involved in decision making about their mental health care? Relationships with socio‐demographic, clinical and psychological variables. Acta Neuropsychiatr 2014;26:372‐81.
    1. Hamann J, Cohen R, Leucht S et al. Shared decision making and long‐term outcome in schizophrenia treatment. J Clin Psychiatry 2007;68:992‐7.
    1. Hamann J, Mendel R, Reiter S et al. Why do some patients with schizophrenia want to be engaged in medical decision making and others do not? J Clin Psychiatry 2011;72:1636‐43.
    1. Park SG, Derman M, Dixon LB et al. Factors associated with shared decision‐making preferences among veterans with serious mental illness. Psychiatr Serv 2014;65:1409‐13.
    1. Deegan PE, Rapp C, Holter et al. A program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatr Serv 2008;59:603‐5.
    1. Krieke L, Emerencia AC, Boonstra N et al. A Web‐based tool to support shared decision making for people with a psychotic disorder: randomized controlled trial and process evaluation. J Med Internet Res 2013;15:e216.
    1. Lieberman JA, Dixon LB, Goldman H. Early detection and intervention in schizophrenia: a new therapeutic model. JAMA 2013;301:689‐90.
    1. Dixon LB, Lieberman J. Early psychosis intervention services: a work in progress. Schizophr Bull 2015;41:23‐4.
    1. Mihopoulos C, Harris M, Henry L et al. Is early intervention in psychosis cost‐effective over the long term? Schizophr Bull 2009;35:909‐18.
    1. Dixon LB, Goldman HH, Bennett ME et al. Implementing coordinated specialty care for early psychosis: the RAISE Connection Program. Psychiatr Serv 2015;66:691‐8.
    1. Kane JM, Robinson DG, Schooler NR et al. Comprehensive versus usual community care for first‐episode psychosis: 2‐year outcomes from the NIMH RAISE Early Treatment Program. Am J Psychiatry (in press).
    1. Frueh BC, Knapp RG, Cusack KJ et al. Patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatr Serv 2005;56:1123‐33.
    1. Kaplan S, Busner J, Chibnall J et al. Consumer satisfaction at a child and adolescent state psychiatric hospital. Psychiatr Serv 2001;52:202‐6.
    1. Lucksted A, Essock SM, Stevenson J et al. Client views of engagement in the RAISE Connection Program for early psychosis recovery. Psychiatr Serv 2015;66:699‐704.
    1. Lecompte T, Spidel A, Leclerc C et al. Predictors and profiles of treatment non‐adherence and engagement in services problems in early psychosis. Schizophr Res 2008;102:295‐302.
    1. Kryda AD, Compton MT. Mistrust of outreach workers and lack of confidence in available services among individuals who are chronically street homeless. Community Ment Health J 2009;45:144‐50.
    1. Substance Abuse and Mental Health Services Administration. Behavioral health services for people who are homeless. Treatment Improvement Protocol (TIP) Series 55. Rockville: Substance Abuse and Mental Health Services Administration, 2013.
    1. Coldwell CM, Bender WS. The effectiveness of assertive community treatment for homeless populations with severe mental illness: a meta‐analysis. Am J Psychiatry 2007;164:393‐9.
    1. Lehman AF, Dixon LB, Kernan E et al. A randomized trial of assertive community treatment for homeless persons with severe mental illness. Arch Gen Psychiatry 1997;54:1038‐43.
    1. George M, Manuel JI, Gandy‐Guedes ME et al. “Sometimes what they think is helpful is not really helpful”: understanding engagement in the Program of Assertive Community Treatment (PACT). Community Ment Health J (in press).
    1. Killaspy H, Johnson S, Pierce B et al. Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial. Soc Psychiatry Psychiatr Epidemiol 2009;44:532‐40.
    1. Herman DB, Conover S, Gorroochurn P et al. Randomized trial of critical time intervention to prevent homelessness after hospital discharge. Psychiatr Serv 2011;62:713‐9.
    1. Herman D, Opler L, Felix A et al. A critical time intervention with mentally ill homeless men: impact on psychiatric symptoms. J Nerv Ment Dis 2000;188:135‐40.
    1. Chen FP, Ogden L. A working relationship model that reduces homelessness among people with mental illness. Qual Health Res 2012;22:373‐83.
    1. Drake RE, Essock SM, Shaner A et al. Implementing dual diagnosis services for clients with severe mental illness. Psychiatr Serv 2001;52:469‐76.
    1. Hasan A, Falkai P, Wobrock T et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia Part 3: Update 2015 Management of special circumstances: depression, suicidality, substance use disorders and pregnancy and lactation. World J Biol Psychiatry 2015; 16:142‐70.
    1. Ho AP, Tsuang JW, Liberman RP et al. Achieving effective treatment of patients with chronic psychotic illness and comorbid substance dependence. Am J Psychiatry 1999;156:1765‐70.
    1. Pettersen H, Ruud R, Ravndal E et al. Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use. Int J Ment Health Syst 2014;8:40.
    1. Flyn PM, Brown BS. Co‐occurring disorders in substance abuse treatment: issues and prospects. J Subst Abuse Treat 2008;34:36‐47.
    1. Brown CH, Bennett ME, Li L et al. Predictors of initiation and engagement in substance abuse treatment among individuals with co‐occurring serious mental illness and substance use disorders. Addict Behav 2011;36:439‐47.
    1. Hellerstein DJ, Rosenthal RN, Miner CR. Integrating services for schizophrenia and substance abuse. Psychiatr Q 2001;72:291‐306.
    1. Mueser KT, Noordsy DL, Drake RE et al. Integrated treatment for dual disorders: a guide to effective practice. New York: Guilford Press, 2003.
    1. Drake RE, Bartels SJ, Teague GB et al. Treatment of substance abuse in severely mentally ill patients. J Nerv Ment Dis 1993;181:606‐11.
    1. Dixon LB, Dickerson F, Bellack AS et al. Schizophrenia Patient Outcomes Research Team (PORT). The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull 2010;36:48‐70.
    1. Bogenschutz MP, Siegfreid SL. Factors affecting engagement of dual diagnosis patients in outpatient treatment. Psychiatr Serv 1998;49:1350‐2.
    1. Tracy K, Burton M, Nich C et al. Utilizing peer mentorship to engage high recidivism substance‐abusing patients in treatment. Am J Drug Alcohol Abuse 2011;37:525‐31.
    1. Daker‐White G, Rogers A. What is the potential for social networks and support to enhance future telehealth interventions for people with a diagnosis of schizophrenia: a critical interpretive synthesis. BMC Psychiatry 2013;13:279.
    1. Clarke G, Yarborough BJ. Evaluating the promise of health IT to enhance/expand the reach of mental health services. Gen Hosp Psychiatry 2013;35:339‐44.
    1. Birnbaum ML, Rizvi AF, Correll CU et al. Role of social media and the internet in pathways to care for adolescents and young adults with psychotic disorders and non‐psychotic mood disorders. Early Interv Psychiatry (in press).
    1. Cunningham JA, Gulliver A, Farrer L et al. Internet interventions for mental health and addictions: current findings and future directions. Curr Psychiatry Rep 2014;16:521.
    1. Johnston L, Dear BF, Gandy M et al. Exploring the efficacy and acceptability of internet‐delivered cognitive behavioural therapy for young adults with anxiety and depression: an open trial. Aust N Z J Psychiatry 2014;48:819‐27.
    1. Rotondi AJ, Anderson CM, Haas GL et al. Web‐based psychoeducational intervention for persons with schizophrenia and their supporters: one‐year outcomes. Psychiatr Serv 2010;61:1099‐05.
    1. Haslett WR, McHugo GJ, Bond GR et al. Use of software for tablet computers to promote engagement with supported employment: results from an RCT. Psychiatr Serv 2014;65:954‐6.
    1. Neale J, Stevenson C. Homeless drug users and information technology: a qualitative study with potential implications for recovery from drug dependence. Subst Use Misuse 2014;49:1465‐72.
    1. Noblin A, Cortelyou‐Ward K, Servan RM. Cloud computing and patient engagement: leveraging available technology. J Med Pract Manage 2014;30:89‐93.
    1. Naslund JA, Grande SW, Aschbrenner KA et al. Naturally occurring peer support through social media: the experiences of individuals with severe mental illness using YouTube. PLoS One 2014;9:e110171.
    1. Mead S, Hilton D, Curtis L. Peer support: a theoretical perspective. Psychiatr Rehab J 2001;25:134‐41.
    1. Substance Abuse and Mental Health Services Administration. Peer providers. .
    1. Jones N, Corrigan PW, James D et al. Peer support, self‐determination, and treatment engagement: a qualitative investigation. Psychiatr Rehabil J 2013;36:209‐14.
    1. Sells D, Davidson L, Jewell C et al. The treatment relationship in peer‐based and regular case management for clients with severe mental illness. Psychiatr Serv 2006;57:1179‐84.
    1. Pfeiffer PN, Blow AJ, Miller E et al. Peers and peer‐based interventions in supporting reintegration and mental health among national guard soldiers: a qualitative study. Mil Med 2012;177:1471‐6.
    1. Interian A, Lewis‐Fernandez R, Dixon LB. Improving treatment engagement of underserved U.S. racial‐ethnic groups: a review of recent interventions. Psychiatr Serv 2013;64:212‐22.
    1. Aggarwal NK, Desilva R, Nicasio AV et al. Does the Cultural Formulation Interview for the Fifth Revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) affect medical communication? A qualitative exploratory study from the New York Site. Ethn Health 2015;20:1‐28.
    1. Abdullah T, Brown TL. Mental illness stigma and ethnocultural beliefs, values, and norms: an integrative review. Clin Psychol Rev 2011;31:934‐48.
    1. Martin S. Illness of the mind or illness of the spirit? Mental health‐related conceptualization and practices of older Iranian immigrants. Health Soc Work 2009;34:117‐26.
    1. Musa D, Schulz R, Harris R et al. Trust in the health care system and the use of preventive health services by older black and white adults. Am J Public Health 2009;99:1293‐9.
    1. Office of the Surgeon General (US); Center for Mental Health Services (US); National Institute of Mental Health (US). Mental health: culture, race, and ethnicity. Rockville: Substance Abuse and Mental Health Services Administration, 2001.
    1. Smith ME, Lindsey MA, Williams CD et al. Race‐related differences in the experiences of family members of persons with mental illness participating in the NAMI family to family education program. Am J Commun Psychol 2014;54:316‐27.
    1. Lewis‐Fernandez R, Aggarwal NK. Culture and psychiatric diagnosis. Adv Psychosom Med 2013;33:15‐30.
    1. Aggarwal NK, Pieh MC, Dixon L et al. Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: a systematic review. Patient Educ Couns 2015;15:1‐9.
    1. Davidson L, O'Connell M, Tondora J et al. The top ten concerns about recovery encountered in mental health system transformation. Psychiatr Serv 2006;57:640‐5.
    1. Torrey WC, Drake RE. Practicing shared decision making in the outpatient psychiatric care of adults with severe mental illnesses: redesigning care for the future. Community Ment Health J 2010;46:433‐40.

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