Effectiveness of the Boston University Approach to Psychiatric Rehabilitation in Improving Social Participation in People With Severe Mental Illnesses: A Randomized Controlled Trial.

Sarita A Sanches,Wilma E Swildens,Jooske T Van Busschbach,Unna N Danner,Talitha L Feenstra,Antoinette D I Van Asselt,Mirjam Moerbeek,Barbara Schaefer,Jaap Van Weeghel

doi:10.3389/fpsyt.2020.571640

Abstract

BackgroundPeople with severe mental illnesses (SMIs) have difficulty participating in society through work or other daily activities.AimsTo establish the effectiveness with which the Boston University Approach to Psychiatric Rehabilitation (BPR) improves the level of social participation in people with SMIs, in the Netherlands.MethodIn a randomized controlled trial involving 188 people with SMIs, we compared BPR (n = 98) with an Active Control Condition (ACC, n = 90) (Trial registration ISRCTN88987322). Multilevel modeling was used to study intervention effects over two six-month periods. The primary outcome measure was level of social participation, expressed as having participated in paid or unpaid employment over the past six months, as the total hours spent in paid or unpaid employment, and as the current level of social participation. Secondary outcome measures were clients’ views on rehabilitation goal attainment, Quality of Life (QOL), personal recovery, self-efficacy, and psychosocial functioning.ResultsDuring the study, social participation, QOL, and psychosocial functioning improved in patients in both groups. However, BPR was not more effective than ACC on any of the outcomes. Better social participation was predicted by previous work experience and a lower intensity of psychiatric symptoms.ConclusionsWhile ACC was as effective as BPR in improving the social participation of individuals with SMIs, much higher percentages of participants in our sample found (paid) work or other meaningful activities than in observational studies without specific support for social participation. This suggests that focused rehabilitation efforts are beneficial, irrespective of the specific methodology used.

Highlights

Severe mental illnesses (SMIs) have an enormous impact on people’s daily lives and social participation [1]
Ninety-eight participants were assigned to BPR and 90 to active” control condition (ACC)
The groups did not differ with regard to patient and practitioner characteristics and to outcome measures at baseline, ACC practitioners were significantly more experienced than BPR practitioners (p = 0.007)

Summary

Introduction

Severe mental illnesses (SMIs) have an enormous impact on people’s daily lives and social participation [1]. Common problems include unemployment rates that range from 65% to 93% [2], and difficulties with other daytime activities such as education, unpaid employment, or activities outside the home [3, 4]. This is a serious issue, because social participation is an important facilitator of many definitions of recovery and because it enhances financial independence and promotes Quality of Life (QOL) [4, 5]. Psychiatric rehabilitation methods could help people with SMIs increase their social participation, and as a consequence, support them in their recovery process by helping them lead meaningful lives [8]. People with severe mental illnesses (SMIs) have difficulty participating in society through work or other daily activities

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Results

Conclusion