Treatment engagement of individuals experiencing mental illness: review and update
Treatment engagement of individuals experiencing mental illness: review and update
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DOI：
10.1002/wps.20306
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发表时间：
2016-02-01
期刊：
影响因子：
73.3
通讯作者：
Nossel, Ilana
中科院分区：
文献类型：
--
作者：
Dixon, Lisa B.;Holoshitz, Yael;Nossel, Ilana
患有严重精神疾病的人往往很难接受持续治疗，辍学率很高。参与度不佳可能会导致更糟糕的临床结果，导致症状复发和再次住院。许多变量可能会影响治疗参与程度，包括治疗联盟、护理的可及性以及客户对治疗将实现他/她自己独特目标的信任。因此，我们发现以康复为导向的护理概念优先考虑接受服务者的自主权、赋权和尊重，是一个有用的框架，可以在其中查看增强治疗参与度的工具和技术。具体来说，以人为本的护理，包括共同决策，是一种注重个人独特目标和生活环境的治疗方法。在心理健康治疗模式中使用以人为本的护理具有良好的参与效果。历史上很难接触到特定人群，例如首次出现精神病的年轻人、同时患有精神病和药物滥用障碍的人以及无家可归的人。我们回顾了这些人群，并概述了各种基于证据、以康复为导向的治疗技术如何被证明可以提高参与度。然后我们的评论转向可能提高参与度的新兴治疗策略。我们重点关注电子设备和互联网的使用、同行提供者参与心理健康治疗，以及纳入文化形成访谈，以提供具有文化能力、以人为本的护理。治疗参与是复杂且多方面的，但优化以康复为导向的技能和态度对于向患有严重精神疾病的人提供服务至关重要。
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.