From Adherence to Self-Determination: Evolution of a Treatment Paradigm for People With Serious Mental Illnesses

College of Psychology, Illinois Institute of Technology, 3424 S. State St., Chicago, IL 60616, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 02/2012; 63(2):169-73. DOI: 10.1176/
Source: PubMed


Treatment adherence and nonadherence is the current paradigm for understanding why people with serious mental illnesses have low rates of participation in many evidence-based practices. The authors propose the concept of self-determination as an evolution in this explanatory paradigm. A review of the research literature led them to the conclusion that notions of adherence are significantly limited, promoting a value-based perspective suggesting people who do not opt for prescribed treatments are somehow flawed or otherwise symptomatic. Consistent with a trend in public health and health psychology, ideas of decisions and behavior related to health and wellness are promoted. Self-determination frames these decisions as choices and is described herein via the evolution of ideas from resistance and compliance to collaboration and engagement. Developments in recovery and hope-based mental health systems have shepherded interest in self-determination. Two ways to promote self-determination are proffered: aiding the rational actor through approaches such as shared decision making and addressing environmental forces that are barriers to choice. Although significant progress has been made toward self-determination, important hurdles remain.

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Available from: Patrick Corrigan, Dec 28, 2013
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    • "In Western health settings, " recovery " for people with a mental illness is defined as a consumer-centered approach that is framed by the principles of self-determination and collaboration, underpinned by the notions of hope and optimism (Bennetts, Cross, & Bloomer, 2011; Corrigan et al., 2012; Davidson, Drake, Schmutte, Dinzeo, & Andres-Hyman, 2009; Piat & Lal, 2012; Slade, Adams, & O'Hagan, 2012). Recovery approaches to health care have been implemented in countries such as Australia, Canada, New Zealand, the United Kingdom, and the United States (Cleary, Walter, & Hungerford, 2014; Hungerford & Kench, 2013). "
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    ABSTRACT: PurposeUtilization of the Recovery Knowledge Inventory (RKI) and Recovery Attitudes Questionnaire (RAQ) in southeastern Australia raised questions about the RAQ, including links between attitudes, faith, and culture in supporting the recovery journey. These questions are particularly important when considered in the context of people with mental illness who live in secular multicultural societies.Conclusions This paper discusses the cultural appropriateness of the RAQ in Australian settings, and identifies the need to develop rigorous, inclusive recovery outcome measures.Practice ImplicationsIt is important to identify what best motivates people in their recovery journey, and to find a way to harness these motivating factors to achieve the best possible outcomes.
    Full-text · Article · Jun 2014 · Perspectives In Psychiatric Care
    • "Of the many findings here, especially noteworthy is the mediating effect of adherence. Contrary to clinical lore, research suggests adherence of psychiatric patients to medication and other prescriptions is not really different from what is seen generally in medical practice (Corrigan et al., 2012). All patients decide at times not to follow medical advice; hence, provider decisions as a result of perceived poor adherence should be no different across the breadth of patients seen across clinics. "
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    ABSTRACT: People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran׳s Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one׳s previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions.
    No preview · Article · Apr 2014
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    • "An atmosphere of hope and possibility should be fostered in a variety of treatment milieus, and collaboration with consumer-operated services ought to be encouraged (Jacobson & Curtis, 2000). More concretely, practices that support selfdetermination and choice should be standard offerings (Corrigan et al., 2012). Examples of these offerings include practices such as supported employment, advanced directives, and person-centered care planning (Adams & Grieder, 2005; Bond, 2004; Elbogen et al., 2007). "
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    ABSTRACT: For more than a decade the principles of mental health recovery have been promoted as an alternative to traditional models of care. Recovery-oriented practices are those that recognize the strengths of service users and empower them within the mental health system. In contrast to a more hierarchical model of care in which service providers make decisions with a pronounced absence of input from service users, recovery-oriented practices emphasize shared decision-making, respect for service user goals, and the recognition of the full humanity of all persons in care relationships. Recovery-oriented care has yet to be embraced by the majority of service providers, however. There are several reasons for this failure but among them is the lack of attention given to the ethical ground of recovery. This article seeks to bring recovery into conversation with moral philosophy by arguing that recovery-oriented care is essentially linked to fundamental rights and values of personhood within a liberal democracy. By joining together a conception of personhood rooted in essential vulnerability and a Rawlsian perspective on justice, this article argues that recovery is not only a desirable approach to mental health practice but that it is ethically necessary. It argues that recovery practices are not exceptional interventions to be reserved for a few but that a recovery-orientation entails fundamental elements of justice and respect to which all persons are entitled. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Full-text · Article · Mar 2014 · American Journal of Orthopsychiatry
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