Motivation for psychiatric treatment in patients with severe mental illness: Disagreement between patients and clinicians

SUMMARYAim – To identify whether financial or material incentives improve treatment adherence in people with severe mental illness. Method – A systematic review of studies published between 1950 and 2008 was conducted. EMBASE, MEDLINE, EBM, AMED and PsycINFO were searched. Studies were included if a financial or material incentive was offered and if the sample had a severe mental illness. Results – Fourteen articles were identified; three studies on adherence to psychiatric treatment and one on physical exercise. Ten articles used incentives for adherence to substance misuse treatment programmes. In all studies, financial incentives were associated with an increase in adherence; however the effect was not always maintained once the incentive was withdrawn. Conclusion – While existing research suggests that financial incentives may improve treatment adherence in severely mentally ill populations, very few studies focus on psychiatric treatment. Further research may address the long term effectiveness of incentives on adherence in this population.Declaration of Interest: The authors on this paper were supported by funds from the Wellcome Trust. All authors worked on a Wellcome Trust funded qualitative focus group study exploring stakeholder views on offering patients financial incentives to adhere to antipsychotic medication. Priebe is also lead applicant on a National Institute of Health Research (England) (NIHR) awarded grant to conduct a clinical trial on the use of financial incentives to achieve maintenance antipsychotic medication adherence.

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Brief Family Psycho-Education Program for Caregivers of Inpatients with Severe Mental Illness

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1511 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s789-s789

Author(s):

F. Lima ◽

T. Selau ◽

V. Menegalli ◽

P. Magalhães ◽

A. Rosa

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Education Program ◽

Psychiatric Treatment ◽

Bipolar Disorders ◽

Community Resources ◽

Porto Alegre ◽

Manualized Intervention ◽

Problem Solving Strategies ◽

Competing Interest

IntroductionFamily psycho-education is an essential part of the treatment for people with severe mental illness (SMI), however this relevant intervention is underutilized. Shortened variations of family psycho-education have been described in attempts to make it more attractive, efficient, and feasible.Objectives/aimsConsidering the lack of manualized intervention for families in Brazil, our study comes up with a proposal to implement and to evaluate the feasibility of brief family psycho-education program (BFPP) during inpatient psychiatric treatment.MethodsAn extensive review using a combination of the words: “family psychoeducation”; “severe mental illness”; “schizophrenia”; “bipolar disorder” was conducted in PubMed/Medline with the aim to select reports of multifamily group psycho-educational programs. Studies involving adults with severe mental illness published until March 2016 were included.ResultsAfter the review of literature and meeting with experts in SMI, the BFPP was developed collaboratively by bipolar disorders’ team at Hospital de Clínicas de Porto Alegre (HCPA). The standard BFPP consists of four sessions: (1) causes, symptoms, course, prognosis and stigma of severe mental disorder; (2) treatment; (3) community resources, communication skills and importance of healthy and regular habits; and (4) problem-solving strategies: preventing relapses and establishing plans for crisis. Each session will occur weekly, lasting 90 min, with 8–12 caregivers. The patients did not attend the group.ConclusionWe purposed a standard, brief, cheap and simple intervention to apply. We believe that BFPP is highly suitable for caregivers of patients with SMI. We hope that this program demonstrates feasibility among participants and become a useful and effective intervention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The Impact of Perceived Need for Treatment on Risk of Arrest and Violence Among People With Severe Mental Illness

Criminal Justice and Behavior ◽

10.1177/0093854806290326 ◽

2007 ◽

Vol 34 (2) ◽

pp. 197-210 ◽

Cited By ~ 15

Author(s):

Eric B. Elbogen ◽

Sarah Mustillo ◽

Richard van Dorn ◽

Jeffrey W. Swanson ◽

Marvin S. Swartz

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Psychiatric Treatment ◽

Management Strategies ◽

Public Mental Health ◽

Need For Treatment ◽

Perceived Need ◽

Risk Management Strategies ◽

Demographic Covariates ◽

The Impact

One clinical strategy for managing risk of arrest and violence among people with severe mental illness (SMI) involves targeting potentially treatable factors related to these risks. The current study examines the association between individuals’ perceived need for psychiatric treatment and their risk of arrest and violence among people with SMI. Adults meeting criteria for psychotic and affective disorders receiving public mental health services in four states are interviewed ( N = 907), with 26% reporting being arrested or violent in the past year. Participants in this group are more likely to deny needing psychiatric treatment. Multivariate analyses confirm this pattern for participants both arrested and violent, controlling for clinical and demographic covariates. As a result, clinical interventions that address a patient’s perceived need for psychiatric treatment, such as compliance therapy and motivational interviewing, appear to hold promise as risk management strategies for clinicians providing services for individuals with SMI.

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Consumer Satisfaction with Inpatient Psychiatric Treatment Among Persons with Severe Mental Illness

Community Mental Health Journal ◽

10.1007/s10597-007-9098-3 ◽

2007 ◽

Vol 43 (6) ◽

pp. 551-564 ◽

Cited By ~ 23

Author(s):

Ann Hackman ◽

Clayton Brown ◽

Ye Yang ◽

Richard Goldberg ◽

Julie Kreyenbuhl ◽

...

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Consumer Satisfaction ◽

Psychiatric Treatment ◽

Inpatient Psychiatric Treatment

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Informed consent and mental health, mainly in Spain, EU

10.36811/ijpmh.2020.110007 ◽

2020 ◽

pp. 01-08

Author(s):

Jose Manuel BERTOLIN-GUILLEN

Keyword(s):

Mental Illness ◽

Informed Consent ◽

Severe Mental Illness ◽

Elderly People ◽

Psychiatric Treatment ◽

Living Will ◽

Involuntary Outpatient Treatment ◽

Vulnerable People ◽

Valid Consent ◽

Sliding Scale

Introduction: Lawfully given, informed or valid consent is considered by Spanish jurisprudence a fundamental right and entails important repercussions. Method: Critical and theoretical examination of the matter, with special emphasis on the case of the most vulnerable people and those who require involuntary outpatient psychiatric treatment (IOT). Results: Valid informed consent must fulfil the requirements of capacitation, willingness, information and understanding. Timely knowledge and agreement regarding by whom and how this consent must be granted are important in biomedicine and psychology in general, as well as in the specialities of psychiatry and clinical psychology in particular. It is also important to ensure valid consent for any psychotherapy, as it generally also occurs in the case of psychopharmacological treatments. This article will revise the so-named “sliding scale” to determine mental degree of competence. This concept is especially important in order to consider whether a supposed valid consent is appropriate in vulnerable people. We will talk about living will and severe mental illness concerning valid consent. The current state of psychiatric involuntary outpatient treatment in Spain will be mentioned as well as the wills of legally incapacitated individuals, elderly people or when the carer, either an individual or institution, is the main beneficiary. Conclusions: Valid consent is necessary in every biomedical or sanitary action in general. The matter is potentially controversial if wrongful influences bear upon elderly people, incapacitated individuals and others. Keywords: Informed consent; Valid consent; Spain; Will; Severe mental illness

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