Applying futility in psychiatry: a concept whose time has come

2020 ◽  
pp. medethics-2020-106654
Author(s):  
Sarah Levitt ◽  
Daniel Z Buchman
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Mental Illness ◽  
Terminal Illness ◽  
Psychiatric Illness ◽  
Decision Makers ◽  
Benefit Ratio ◽  
Persistent Mental Illness ◽  
Substitute Decision Makers

Since its introduction in the 1980s, futility as a concept has held contested meaning and applications throughout medicine. There has been little discussion within the psychiatric literature about the use of futility in the care of individuals experiencing severe and persistent mental illness (SPMI), despite some tacit acceptance that futility may apply in certain cases of psychiatric illness. In this paper, we explore the literature surrounding futility and argue that its connotation within medicine is to describe situations where patients (or their substitute decision-makers) believe that interventions will almost certainly provide no meaningful benefit. We then provide two arguments in support of the use of futility within the care of individuals experiencing SPMI: that some SPMI can be considered a terminal illness, and that the risk-benefit ratio is a dynamic entity such that futility can help describe what Gillett calls the ‘risk of unacceptable badness’ when it comes to considering how an intervention might impact a patient’s quality of life. We posit that capacity should not pose an obstacle to declaring futility when caring for individuals experiencing SPMI and explain how futility is not antithetical to recovery in mental health. Finally, we describe how using futility within psychiatric practice can allow for a reorientation of care by signalling the need to shift to a palliative approach.

scholarly journals Oral Health–Related Quality of Life Among Publicly Insured Mental Health Service Outpatients With Serious Mental Illness

2019 ◽  
Vol 70 (12) ◽  
pp. 1101-1109 ◽  
Author(s):  
Peter C. Lam ◽  
Dolly A. John ◽  
Hanga Galfalvy ◽  
Carol Kunzel ◽  
Roberto Lewis-Fernández
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Mental Illness ◽  
Oral Health ◽  
Mental Health Service ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Publicly Insured

The Relationship Between Employment Status and Quality of Life For Individuals with Severe and Persistent Mental Illness

1997 ◽  
Vol 28 (4) ◽  
pp. 4-8 ◽  
Author(s):  
Donna C. Vanden Boom ◽  
Daniel C. Lustig
Keyword(s):  
Quality Of Life ◽  
Mental Illness ◽  
Effect Size ◽  
Employment Status ◽  
Community Treatment ◽  
Living Situation ◽  
Persistent Mental Illness ◽  
Global Quality Of Life ◽  
The Relationship

The relationship between quality of life and employment status for individuals with severe and persistent mental illness was investigated. Forty individuals in the Program for Assertive Community Treatment (PACT) participated in the study. PACT is a community-based program for persons with severe and persistent mental illness which emphasizes the importance of employment in rehabilitation. Participants were interviewed using Lehman's Quality of Life Interview. A large effect size for difference between individuals who were employed and those who were unemployed was found for assessment of global quality of life. Medium and small effect sizes were found for satisfaction with family, financial situation, health and social relations, safety, and daily activities. Minimal effect size was found for satisfaction with living situation.

The Quality of Life of Persons with Severe and Persistent Mental Illness: A Typology Based on Cluster Analysis

2000 ◽  
Vol 31 (3) ◽  
pp. 22-29 ◽  
Author(s):  
Daniel C. Lustig ◽  
Michelle Crowder
Keyword(s):  
Quality Of Life ◽  
Cluster Analysis ◽  
Mental Illness ◽  
Mental Health Professionals ◽  
Community Integration ◽  
Subjective Assessment ◽  
Persistent Mental Illness ◽  
Quality Of Life Index ◽  
Life Improvement

Recently rehabilitation and mental health professionals have placed increased emphasis on quality of life as a service outcome for individuals with severe and persistent mental illness. Research has indicated that when services are based on quality of life improvement, consumers are able to achieve higher levels of independence, satisfaction, production, and community integration. Individuals with severe and persistent mental illness completed Lehman's Quality of Life Index. Respondents were grouped based on their subjective assessment of quality of life in specific life domains. Although cluster analysis revealed that most respondents viewed quality of life as satisfactory, the heterogeneous nature of the groups suggested that it is important to view quality of life from a multifaceted perspective. The multifaceted nature of quality of life is discussed in terms of implications for rehabilitation counselors, administrators, and policy makers.

scholarly journals PREDICTORS OF HEALTH-RELATED QUALITY OF LIFE AND RECOVERY AMONG OLDER ADULTS WITH SERIOUS MENTAL ILLNESS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S877-S877
Author(s):  
Anjana Muralidharan ◽  
Clayton H Brown ◽  
Richard W Goldberg
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Older Adults ◽  
Mental Illness ◽  
Physical Health ◽  
Serious Mental Illness ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Abstract Older adults with serious mental illness (i.e., schizophrenia spectrum disorders and affective psychoses) exhibit marked impairments across medical, cognitive, and psychiatric domains. The present study examined predictors of health-related quality-of-life and mental health recovery in this population. Participants (N=211) were ages 50 and older with a chart diagnosis of serious mental illness and a co-occurring medical condition, engaged in outpatient mental health services at a study site. Participants completed a battery of assessments including subtests from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the 24-Item Behavior and Symptom Identification Scale (BASIS-24), the 12-Item Short-Form Health Survey (SF-12), and the Maryland Assessment of Recovery Scale (MARS). Multiple linear regression analyses, with age, race, gender, and BMI as covariates, examined number of current medical conditions, RBANS, and BASIS as predictors of quality-of-life and recovery. Significant predictors of physical health-related quality-of-life (R-squared=.298, F(9,182)=8.57, p<.0001) were number of medical conditions (β=-1.70, p<.0001), BASIS-Depression/Functioning (β=-4.84, p<.0001), and BASIS-Psychosis (β=2.39, p<.0008). Significant predictors of mental health-related quality-of-life (R-squared=.575, F(9,182)=27.37, p<.0001) were RBANS (β=0.03, p=.05), BASIS-Depression/Functioning (β=-6.49, p<.0001), BASIS-Relationships (β=-3.17, p<.0001), and BASIS-Psychosis (β=-1.30, p=.03). Significant predictors of MARS (R-squared=.434, F(9,183)=15.56, p<.0001) were BASIS-Depression/Functioning (β=-4.68, p=.002) and BASIS-Relationships (β=-9.44, p<.0001). To promote holistic recovery among older adults with serious mental illness, integrated interventions are required. For example, to improve physical health-related quality-of-life, one should target depression and psychotic symptoms as well as medical illness burden. To improve mental health-related quality-of-life, depression symptoms and interpersonal functioning may be key targets, as well as neurocognitive function.

scholarly journals Social Determinants of Health for People With Serious Mental Illness After Transitioning to the Community

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 32-33
Author(s):  
Kathy Kellett ◽  
Kaleigh Ligus ◽  
Kristin Baker ◽  
Julie Robison
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Social Determinants ◽  
Community Context ◽  
Improve Quality ◽  
Social Community

Abstract Approximately 10 million, or 6 percent, of the U.S. population experience serious mental illness (SMI) (NAMI, 2019). Social determinants of health (SDOH) associated with this population can provide important information for targeted innovations with the potential to reduce disease burden and improve quality of life. Using secondary data from Connecticut’s Money Follows the Person Rebalancing Demonstration, this research compares people age 50+ who transitioned out of an institution onto the Medicaid HCBS Mental Health Waiver (MHW) (n= 271) to those receiving Mental Health services through the Medicaid State Plan (MHSP) (n=278). Analyses examine SDOH in both groups and are organized around five broad domains: Finances; education; social/community context, health/health care, and neighborhood/built environment. MHSP participants were significantly more likely to report not having enough money at the end of the month at 6 (42% vs. 21%), 12 (37% vs. 20%), and 24 (37% vs. 17%) months. Significantly more MHSP than MHW participants did not like where they lived at 6 (12% vs. 1%) and 24 (24% vs. 5%) months. Significantly more MHSP than MHW participants were unhappy with the help they received in the community at 6 (22% vs. 8%), 12 (23% vs. 7%), and 24 (19% vs. 5%) months. Groups did not differ by education, social/community context, health/health care, feelings of safety where they live, or on post-transition hospitalizations, ED use or reinstitutionalization. To improve quality of life in the community, MHSP participants could benefit from greater assistance with finances, housing, and community services.

scholarly journals ‘Modelling social exclusion in a diagnostically-mixed sample of people with severe mental illness’

2021 ◽  
pp. 002076402110018
Author(s):  
Gillian Mezey ◽  
Sarah White ◽  
Isobel Harrison ◽  
Jennifer Bousfield ◽  
Helen Killaspy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Personality Disorder ◽  
Mental Disorder ◽  
Social Inclusion ◽  
Common Mental Disorder ◽  
Service Users

Background: Social inclusion is an important indicator of recovery in individuals with severe mental illness. The Social Inclusion Questionnaire User Experience (SInQUE) is a new measure of social inclusion for mental health service users which assesses five domains (consumption, production, access to services, social integration and civil engagement). It has good psychometric properties and is acceptable to service users and mental health professionals. It is not clear whether individuals with different diagnostic conditions experience a similar reduction in social inclusion. Aims: (1) Investigate whether current social inclusion differs between diagnostic groups (people with schizophrenia/other psychotic disorders, common mental disorder or personality disorder); (2) Identify factors associated with lower social inclusion; (3) Examine associations between social inclusion and stigma, quality of life and loneliness. Method: Mental health service users with psychotic disorder, personality disorder or common mental disorder, living in the community, completed the SInQUE, alongside other validated outcome measures. Multiple regression investigated associations. Results: About 192 service users (55% with psychotic disorder; 26% with common mental disorder; 19% with personality disorder). Current social inclusion did not vary according to diagnosis, except for the sub-domain of productivity, where individuals with personality disorder were more socially included than the other two groups. Lower social inclusion was associated with older age ( p = .008), lack of higher education ( p < .001), more previous admissions ( p = .005), severity of current symptoms and greater experienced stigma ( p = .006) and anticipated stigma ( p = .035). Greater social inclusion was associated with better quality of life ( p < .001) and less loneliness ( p < .001). Conclusions: Barriers to social inclusion in individuals with severe mental health problems include factors related to the illness, such as symptom severity and external factors, such as stigma and discrimination. Social inclusion is a recovery goal and should be routinely assessed. Increasing people’s social inclusion benefits service users in terms of improved mental health, better quality of life and reduced loneliness.

scholarly journals Organization of Community Mental Health Services for Persons with a Severe Mental Illness and Comorbid Somatic Conditions: A Systematic Review on Somatic Outcomes and Health Related Quality of Life

2021 ◽  
Vol 18 (2) ◽  
pp. 462
Author(s):  
Nicolaas Martens ◽  
Marianne Destoop ◽  
Geert Dom
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Systematic Review ◽  
Mental Illness ◽  
Community Mental Health ◽  
Severe Mental Illness ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

It is well established that persons with a severe mental illness (SMI) have a greater risk of physical comorbid conditions and premature mortality. Most studies in the field of community mental health care (CMHC) have only focused on improving cardiovascular health in people with a SMI using lifestyle approaches. Studies using organizational modifications are rather scarce. This systematic review aimed to synthesize and describe possible organizational strategies to improve physical health for persons with a SMI in CMHC. The primary outcome was Health-related Quality of Life (HR-QOL). Results suggested modest effects on quality of life and were inconsistent throughout all the included studies. Despite these findings, it appears that a more integrated approach had a positive effect on health outcomes, patient satisfaction and HR-QOL. The complexity of the processes involved in community care delivery makes it difficult to compare different models and organizational approaches. Mental health nurses were identified as possible key professionals in care organization, but no clear description of their role was found. This review could provide new insights into contributing factors for integrated care. Future research targeting the identification of the nurses’ role and facilitating factors in integrated care, in order to improve treatment and follow-up of somatic comorbidities, is recommended.

scholarly journals Role of Social Support and Ego Network Characteristics on Quality of Life

2021 ◽  
Vol 20 (3) ◽  
pp. 637-654
Author(s):  
David C. Kondrat ◽  
W. Patrick Sullivan ◽  
Kelli E. Canada ◽  
Jeremiah W. Jaggers
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Social Support ◽  
Social Networks ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Mental Health Court ◽  
Mental Health Courts ◽  
Network Characteristics

Mental health courts offer alternatives to incarceration for persons with severe mental illness who are involved in the criminal justice system. These courts have the dual function of ensuring treatment for persons involved in the court as well as ensuring the safety of the public. Persons with severe mental illness who are involved in mental health courts rely on others for support, such as family members. Others may buttress the participant from engaging in criminal activities and provide for needs of the participant. The supportiveness as well as the composition of one’s network members may play a role in the success of mental health court participants, such as successfully completing the mental health court program and avoiding incarceration. Little research has explored how social support impacts mental health court participants. We explored how the composition and sense of support of network members were associated with mental health court participants’ quality of life. We regressed quality of life on social support and network characteristics of 80 participants in two mental health courts. Findings suggest that perceived support is positively associated with quality of life, and the proportion of family in one’s network was negatively related to quality of life. Findings suggest that persons involved in mental health courts need supportive others in their social networks in addition to family. More research is needed to explore the reasons having a higher proportion of family members in one’s network is associated with lower quality of life. Practitioners need to pay attention to and leverage mental health court participants’ social networks to help improve their quality of life.

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