Background: Self-determination within mental health services is increasingly recognized as an ethical imperative, but we still know little about the impact of choice on outcomes among people with severe mental illnesses. This study examines whether choice predicts outcomes and whether this relationship is mediated by therapeutic alliance. Method: The study sample of 396 participants completed a survey measuring choice, therapeutic alliance, recovery, quality of life and functioning. Multivariate analyses examined choice as a predictor of outcomes, and Sobel tests assessed alliance as a mediator. Results: Choice variables predicted recovery, quality of life and perceived outcomes. Sobel tests indicated that the relationship between choice and outcome variables was mediated by therapeutic alliance. Implications: The study demonstrates that providing more choice and opportunities for collaboration within services does improve consumer outcomes. The results also show that collaboration is dependent on the quality of the relationship between the provider and consumer.
References
[1]
President’s New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Healthcare in America; Department of Health and Human Services: Rockville, MD, USA, 2003.
[2]
Corrigan, P.W.; Angell, B.; Davidson, L.; Marcus, S.C.; Salzer, M.S.; Kottsieper, P.; Larson, J.E.; Mahoney, C.A.; O’Connell, M.J.; Stanhope, V. From adherence to self-determination: Evolution of a treatment paradigm for people with serious mental illnesses. Psychiatr. Serv. 2012, 63, 169–173, doi:10.1176/appi.ps.201100065.
[3]
Sen, A. Human rights and capabilities. J. Hum. Dev. 2005, 6, 151–166, doi:10.1080/14649880500120491.
[4]
O’Connell, M. Self-Determination, Beneficence, Choice, and Adherence; Center on Adherence and Self-Determination: Chicago, IL, USA, 2011.
[5]
Strategic Plan; National Institute of Mental Health: Rockville, MD, USA, 2008.
[6]
Dixon, L.; Lewis-Fernandez, R.; Goldman, H.; Interian, A.; Michaels, A.; Kiley, M.C. Adherence disparities in mental health: Opportunities and challenges. J. Nerv. Ment. Dis. 2011, 199, 815–820, doi:10.1097/NMD.0b013e31822fed17.
[7]
Pilnick, A.; Dingwall, R. On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review. Soc. Sci. Med. 2011, 72, 1374–1382, doi:10.1016/j.socscimed.2011.02.033.
[8]
Mead, N.; Bower, P. Patient-centredness: A conceptual framework and review of the empirical literature. Soc. Sci. Med. 2000, 51, 1087–1110, doi:10.1016/S0277-9536(00)00098-8.
[9]
Adams, J.R.; Drake, R.E. Shared decision-making and evidence-based practice. Community Ment. Health J. 2006, 42, 87–105, doi:10.1007/s10597-005-9005-8.
[10]
Davidson, L.; Roe, D.; Stern, E.; Zisman-Ilani, Y.; O’Connell, M.; Corrigan, P. If I choose it am I more likely to use it? The role of choice in medication and service use. Int. J. Pers. Cent. Med. 2012, 2, 577–592.
[11]
Bunn, H.M.; O’Connor, A.M.; Tansey, M.S.; Jones, B.D.W.; Stinson, L.E. Characteristics of clients with schizophrenia who express certainty or uncertainty about continuing treatment with depot neuroleptic medication. Arch. Psychiat. Nurs. 1997, 11, 238–248.
[12]
Ludman, E.; Katon, W.; Bush, T.; Rutter, C.; Lin, E.; Simon, G.; von Korff, M.; Walker, E. Behavioural factors associated with symptom outcomes in a primary care-based depression prevention intervention trial. Psychol. Med. 2003, 33, 1061–1070, doi:10.1017/S003329170300816X.
[13]
Malm, U.; Ivarsson, B.; Allebeck, P.; Falloon, I. Integrated care in schizophrenia: A 2‐year randomized controlled study of two community‐based treatment programs. Acta Psychiatr. Scand. 2003, 107, 415–423, doi:10.1034/j.1600-0447.2003.00085.x.
[14]
Cooper, L.A. At the center of decision making in mental health services and interventions research: Patients, clinicians, or relationships. Clin. Psychol. Sci. Pract. 2006, 13, 26–29, doi:10.1111/j.1468-2850.2006.00003.x.
[15]
Drake, R.E.; Deegan, P.E. Shared decision making is an ethical imperative. Psychiatr. Serv. 2009, 60, 1007, doi:10.1176/appi.ps.60.8.1007.
[16]
Institute of Medicine. National Academies Press: Washington, DC, USA, 2001.
[17]
Center for Mental Health Services. Shared Decision-Making in Mental Healthcare: Practice, Research, and Future Directions; Substance Abuse and Mental Health Services Administration: Rockville, MD, USA, 2010.
[18]
Bordin, E.S. The generalizability of the psychoanalytic concept of the working alliance. Psychother. Theor. Res. Pract. 1979, 16, 252–260, doi:10.1037/h0085885.
[19]
Horvath, A.O.; del Re, A.C.; Fluckiger, C.; Symonds, D. Alliance in individual psychotherapy. Psychotherapy 2011, 48, 9–16, doi:10.1037/a0022186.
[20]
Marsh, J.C.; Angell, B.; Andrews, C.M.; Curry, A. Client-provider relationship and treatment outcome: A systematic review of substance abuse, child welfare, and mental health services research. J. Soc. Soc. Work Res. 2012, 3, 233–267, doi:10.5243/jsswr.2012.15.
[21]
Kirsh, B.; Tate, E. Developing a comprehensive understanding of the working alliance in community mental health. Qual. Health Res. 2006, 16, 1054–1074, doi:10.1177/1049732306292100.
[22]
Ware, N.C.; Tugenberg, T.; Dickey, B. Practitioner relationships and quality of care for low-income persons with serious mental illness. Psychiatr. Serv. 2004, 55, 555–559, doi:10.1176/appi.ps.55.5.555.
[23]
Bryne, M.K.; Deane, F.P. Enhancing patient adherence: Outcomes of medication alliance training on therapeutic alliance, insight, adherence, and psychopathology with mental health patients. Int. J. Ment. Health Nurs. 2011, 20, 284–295, doi:10.1111/j.1447-0349.2010.00722.x.
[24]
Weiss, K.A.; Smith, T.E.; Hull, J.W.; Piper, A.C.; Huppert, J.D. Predictors of risk of nonadherence in outpatients with schizophrenia and other psychotic disorders. Schizophr. Bull. 2002, 28, 341–349, doi:10.1093/oxfordjournals.schbul.a006943.
[25]
Corrigan, P.W.; Liberman, R.P.; Engel, J.D. From noncompliance to collaboration. Hosp. Community Psychiatr. 1990, 41, 1203–1211.
[26]
Diamond, R.J. Enhancing medication use in schizophrenic patients. J. Clin. Psychiatry 1983, 44, 7–14.
[27]
Cruz, M.; Pincus, H.A. Research on the influence that communication in psychiatric encounters has on treatment. Psychiatr. Serv. 2004, 53, 1253–1265, doi:10.1176/appi.ps.53.10.1253.
[28]
Strauss, J.L.; Johnson, S.L. Role of treatment alliance in the clinical management of bipolar disorder: Stronger alliances prospectively predict fewer manic symptoms. Psychiatry Res. 2006, 145, 215–223, doi:10.1016/j.psychres.2006.01.007.
[29]
Zeber, J.E.; Copeland, L.A.; Good, C.B.; Fine, M.J.; Bauer, M.S.; Kilbourne, A.M. Therapeutic alliance perceptions and medication adherence in patients with bipolar disorder. J. Affect. Disord. 2008, 107, 53–62, doi:10.1016/j.jad.2007.07.026.
[30]
Guadiano, B.A.; Miller, I.W. Patient’s expectancies, the alliance in pharmacotherapy, and treatment outcomes in bipolar disorder. J. Consult. Clin. Psychol. 2006, 74, 671–676, doi:10.1037/0022-006X.74.4.671.
[31]
Shern, D.L.; Wilson, N.Z.; Coen, A.S.; Patrick, D.C.; Foster, M.; Bartsch, D.A.; Demmler, J. Client outcomes II: Longitudinal client data from the Colorado treatment outcome study. Milbank Q. 1994, 72, 123–148, doi:10.2307/3350341.
[32]
Boothroyd, R.A.; Chen, H.J. The psychometric properties of the Colorado Symptom Index. Adm. Policy Ment. Health 2008, 35, 370–378, doi:10.1007/s10488-008-0179-6.
[33]
Stewart, M.; Brown, J.B.; Donner, A.; McWhinney, I.R.; Oates, J.; Weston, W.W.; Jordan, J. The impact of patient-centered care on outcomes. J. Fam. Practice 2000, 49, 796–804.
[34]
Hudon, C.; Fortin, M.; Haggerty, J.L.; Lambert, M.; Poitras, M.E. Measuring patients’ perceptions of patient-centered care: A systematic review of tools for family medicine. Ann. Fam. Med. 2011, 9, 155–164, doi:10.1370/afm.1226.
[35]
Tracey, T.J.; Kokotovic, A.M. Factor structure of the Working Alliance Inventory. Psychol. Assess. 1989, 1, 207–210, doi:10.1037/1040-3590.1.3.207.
[36]
Hatcher, R.L.; Gillaspy, J.A. Development and validation of a revised short version of the Working Alliance Inventory. Psychother. Res. 2006, 16, 12–15, doi:10.1080/10503300500352500.
[37]
Corrigan, P.W.; Salzer, M.; Ralph, R.O.; Sangster, Y.; Keck, L. Examining the factor structure of the Recovery Assessment Scale. Schizophr. Bull. 2004, 30, 1035–1041, doi:10.1093/oxfordjournals.schbul.a007118.
[38]
Lehman, A.F. A quality of life interview for the chronically mentally ill. Eval. Program Plann. 1988, 11, 51–62, doi:10.1016/0149-7189(88)90033-X.
[39]
Lehman, A.F. Measures of quality of life among persons with severe and persistent mental disorders. In Mental Health Outcome Measures; Thronicoft, G., Tansella, M., Eds.; Springer: Berlin, Germany, 1996; pp. 75–92.
[40]
Teague, G.; Ganju, V.; Hornik, J.A.; Johnson, J.R.; McKinney, J. The MHSIP mental health report card. Eval. Rev. 1997, 21, 330–341, doi:10.1177/0193841X9702100307.
[41]
Jerrell, J.M. Psychometrics of the MHSIP adult consumer survey. J. Behav. Health Serv. Res. 2006, 33, 483–488, doi:10.1007/s11414-006-9033-3.
[42]
Torrey, E.F. The Insanity Offense; W.W. Norton: New York, NY, USA, 2008.
[43]
Amador, X.F.; David, A. Insight and psychosis; Oxford University Press: New York, NY, USA, 1998.
[44]
Davidson, L.; O’Connell, M.J.; Tondora, J.; Lawless, M.; Evans, A.C. Recovery in serious mental illness: A new wine or just a new bottle. Prof. Psychol. Res. Pract. 2005, 36, 480–487, doi:10.1037/0735-7028.36.5.480.
[45]
Mancini, A.D. Self-determination theory: A framework for the recovery paradigm. Adv. Psychiatr. Treat. 2008, 14, 358–365, doi:10.1192/apt.bp.107.004036.
[46]
Lloyd, C.; King, R.; Moore, L. Subjective and objective indicators of recovery in severe mental illness: A cross-sectional study. Int. J. Soc. Psychiatry 2010, 56, 220–229, doi:10.1177/0020764009105703.
[47]
Roe, D.; Mashiach-Eizenberg, M.; Lysaker, P.H. The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders. Schizophr. Res. 2011, 131, 133–138, doi:10.1016/j.schres.2011.05.023.
Stanhope, V.; Marcus, S.; Solomon, P. Examining the impact of coercion on services from the consumer perspective. Psychiatr. Serv. 2009, 60, 183–188, doi:10.1176/appi.ps.60.2.183.
[50]
Davidson, L. The top ten concerns about recovery encountered in mental health system transformation. Psychiatr. Serv. 2006, 57, 640–645, doi:10.1176/appi.ps.57.5.640.
