Determinants of Quality of Life and Treatment Satisfaction During Long-Term Involuntary In-patient Treatment of Dual-Diagnosis Patients.

Grieke D Van Kranenburg,G H M Pijnenborg,Rob H S Van Den Brink,Wijnand G Mulder,C L Mulder,Wout J Diekman

doi:10.3389/fpsyt.2022.801826

Grieke D Van Kranenburg, G H M Pijnenborg + Show 4 more

Open Access

https://doi.org/10.3389/fpsyt.2022.801826

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Abstract

IntroductionTreatment resistance and disengagement from mental health services are major obstacles in the treatment of dual diagnosis patients with Severe Mental Illness. The patients in this study were admitted to a long-term involuntary treatment facility.Aim of the studyTo study which patient experiences and perceptions are related to the outcome measures Subjective Quality of Life (SQOL) and Treatment Satisfaction (TS) during the long-term involuntary treatment.MethodsPatients were invited for an interview by an independent researcher, which included self-report questionnaires. The structured interviews included self-assessing Helping Alliance, Insight, Attitude toward involuntary admission, Perceived coercion and Perceived benefit were studied as determinants of SQOL and TS. The relationship between the determinants and the outcomes were analyzed by linear regression analysis.ResultsPatient reported outcomes from dual diagnosis patients in a long-term treatment facility, showed that most of the patients, in spite of the involuntary character of the treatment, were satisfied with the treatment. With respect to the determinants of SQOL and TS the perceptions that “My opinion is taken into account” and “Perceived benefits of the treatment” are strong predictors of both the outcomes.ConclusionsThe current study shows that the most important aspects for treatment satisfaction and quality of life of dual-diagnosis patients admitted involuntary to long-term treatment, are being listened to (being taken seriously) and experiencing improvements during treatment. These qualities reflect the goals of Shared Decision Making and Perceived Procedural Justice in treatment. The study also corroborates earlier findings that even when treated involuntarily, patients might not hold particular negative views regarding their treatment.

Highlights

Treatment resistance and disengagement from mental health services are major obstacles in the treatment of dual diagnosis patients with Severe Mental Illness
Helping alliance (HAS) Insight (BIS) Relabeling of symptoms Awareness of mental illness Recognition of a need for treatment Attitude toward involuntary admission Justification of admission Perceived risk to self Perceived risk to others Perceived coercion during treatment I feel free to participate in treatment My opinion is taken into account I decide whether or not to take medication Perceived benefits from inpatient treatment
Helping alliance (HAS Insight (BIS) Relabeling of symptoms Awareness of mental illness Recognition of a need for treatment Attitude toward involuntary admission Justification of admission Perceived risk to self Perceived risk to others Perceived coercion during treatment I feel free to participate in treatment My opinion is taken into account I decide whether or not to take medication Perceived benefits from inpatient treatment

Summary

Introduction

There is evidence that long-term residential dual-diagnosis programs can be effective for dual- diagnosis patients who did not respond to outpatient treatment [2]. When these programs are voluntary, their attrition rate can be as high as 75% [1]. The patients in this study were admitted to a long-term compulsory treatment facility, based on a Dutch civil law court order. To obtain such order, an independent psychiatrist makes an assessment which is requested by the treatment provider. The patients were at high risk of ultimate self-neglect and societal deterioration, and had been treated by all available means— including frequent compulsory hospital-admissions—without lasting improvements

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