Evaluating outcomes of rehabilitation for severe mental illness.

Abstract

Improving the quality of life of individuals with severe mental illness has been the focus of considerable research. With advances in treatments for severe mental illness, particularly in psychiatric rehabilitation, evaluating outcomes has become increasingly important. Given the complex and multidimensional nature of severe mental illness, outcome evaluation of psychiatric rehabilitation is particularly difficult. This article addresses issues in evaluating psychiatric rehabilitation outcomes, including key outcome domains, selection of methods and measures, and meaningful use of results. Continuing conceptual and methodological issues are discussed. Also, future directions are explored, including evaluating multidimensional treatment effects and interactions and building an integrated understanding of all of the outcomes involved in psychiatric rehabilitation. More than 8% of individuals 18 years of age or older in the United States, or approximately 17.5 million people, have a severe mental illness resulting in significant functional impairment in their daily lives (Substance Abuse & Mental Health Services Administration, 2003). The social and economic costs of these illnesses are high. Needless to say, the suffering of affected individuals and their families is immeasurable. The Global Burden of Disease Study (Murray & Lopez, 1996) identified mental illness as one of the leading burdens, second only to cardiovascular conditions, in market economies such as the United States. Although individuals with severe mental illness represent a small proportion of all individuals having a mental illness, they account for a significant proportion of the economic burden. Reducing the costs of and improving the quality of life of individuals with severe mental illness have thus been the foci of considerable research during the past three decades. Severe mental illness (also labeled severe and persistent, serious, disabling, or chronic mental illness) encompasses a group of