ADHERENCE AND EMPOWERMENT: Service Participation and Meaningful Outcomes

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DESCRIPTION (provided by applicant): Despite evidence that suggests many psychiatric services help people with serious mental illness manage their illness and attain their life goals, some individuals who might benefit from these services opt not to participate or not to fully engage after beginning treatment. Treatment adherence is a complex and sometimes contentious concept that has been discussed for decades to explain failures to fully participate in and benefit from services. In this same time period, mental health consumers, service providers and researchers have begun to develop frameworks around concepts of empowerment, which emphasize consumer choice in treatment and services. The goal of our proposed Developing Center for Interventions and/or Services Research (DCISR) is to better understand relationships among these phenomena and to examine change strategies that enhance empowerment and adherence, which, in turn, influence participation in quality services and achievement of personally meaningful goals. Treatment adherence research has a rich empirical base which, unfortunately, offers little in terms of theory or treatment concepts (except perhaps for research on extended or intensive monitoring). The empowerment literature, by comparison, have developed a strong conceptual and theoretical approach but lack much empirical testing or development. We contend that generative, positive development in both these fields can be fostered by the intentional effort to develop a national scale research program, grounded in the efforts of productive investigators. Such a research program would support developmental activities that produce emergent theoretical frameworks that can be empirically tested, and theoretically driven research that contributes to new knowledge. Such knowledge could drive public health policy towards new, pro-active directions that improve the lives of people with mental illness. RELEVANCE (See instructions): One prominent goal of services research is to identify evidence-based practices (EBPs) that help people with serious mental illness achieve these outcomes. Many people who might benefit from EBPs and other psychiatric services decide not to seek them out or fully participate in them. One way in which service participation may be understood is in terms of the number of people who might benefit from psychiatric services but never seek them out.