Abstract
Background: Self-determination within mental health services is increasingly recognized as an ethical imperative, but we still know little about the impact of choice on outcomes among people with severe mental illnesses. This study examines whether choice predicts outcomes and whether this relationship is mediated by therapeutic alliance. Method: The study sample of 396 participants completed a survey measuring choice, therapeutic alliance, recovery, quality of life and functioning. Multivariate analyses examined choice as a predictor of outcomes, and Sobel tests assessed alliance as a mediator. Results: Choice variables predicted recovery, quality of life and perceived outcomes. Sobel tests indicated that the relationship between choice and outcome variables was mediated by therapeutic alliance. Implications: The study demonstrates that providing more choice and opportunities for collaboration within services does improve consumer outcomes. The results also show that collaboration is dependent on the quality of the relationship between the provider and consumer.
Highlights
In providing services, users’ choice about their treatment is a key aspect of healthcare reform in the21st century
To support the shift to service user choice within mental healthcare, the National Institute of Mental Health [5] is calling for research on ―personalization‖, which is the matching of interventions to individual characteristics and preferences
Empirical support for the notion that giving people choices within mental health services leads to positive outcomes is vital as agencies take steps to transform their services according to the principles of recovery
Summary
Driving this transformation within mental healthcare is the concept of recovery, which posits that all people with severe mental illnesses can pursue meaningful lives and have a right to services that are oriented towards their individualized goals [1]. Choice has been identified as a fundamental human capability [3], which in mental health settings means varying approaches depending on individual preference rather than prescribing based on the provider perspective [4]. To support the shift to service user choice within mental healthcare, the National Institute of Mental Health [5] is calling for research on ―personalization‖, which is the matching of interventions to individual characteristics and preferences. Self-determination within mental health services is increasingly recognized as an ethical imperative, but we still know little about the impact of choice on outcomes among people with severe mental illnesses. This study examines whether choice predicts outcomes and whether this relationship is mediated by therapeutic alliance
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