Abstract
Long-term admissions in psychiatric facilities often result in a gradual erosion of the identity of people diagnosed with severe mental illnesses (SMIs) into merely “patient.” Moreover, experiences of loss often reduced people's sense of purpose. Although regaining a multidimensional identity and a sense of purpose are essential for personal recovery, few interventions specifically address this, while at the same time take people's often considerable cognitive and communicative disabilities into consideration. This study describes the development process of a new intervention through user-centered design (UCD). UCD is an iterative process in which a product (in this case, an intervention) is developed in close cooperation with future users, such that the final product matches their needs. The design process included three phases: an analysis, design, and evaluation phase. In the analysis phase, the “problem” was defined, users' needs were identified, and design criteria were established. In the design phase, the collected information served as input to create a testable prototype using a process of design and redesign, in close collaboration with service users and other stakeholders. This resulted in an intervention entitled “This is Me” (TiM) in which service users, together with a self-chosen teammate, actively engage in new experiences on which they are prompted to reflect. Finally, in the evaluation phase, TiM was implemented and evaluated in a real-life setting. In a small feasibility pilot, we found indications that some people indeed demonstrated increased reflection on their identity during the intervention. Furthermore, TiM seemed to benefit the relationship between the service users and the mental health professionals with whom they underwent the experiences. The pilot also revealed some aspects of the (implementation of) TiM that can be improved. Overall, we conclude that UCD is a useful method for the development of a new psychosocial intervention. The method additionally increased our knowledge about necessary factors in targeting personal recovery for people with complex mental health needs. Moreover, we conclude that TiM is a promising tool for supporting people with SMI in redeveloping a multidimensional identity and a renewed sense of purpose.
Highlights
People diagnosed with a severe mental illness (SMI; e.g., schizophrenia, bipolar disorder) frequently experienced meaningful losses [e.g., losing employment/housing/(romantic) relationships/dreams], because of their illness and lengthy admissions
We describe the development of a new psychosocial intervention that aims to stimulate thedevelopment of a multidimensional self-identity and that is closely tailored to the recovery-related needs of the service users with SMI
The first step in the user-centered design (UCD) process was the formation of a design team, including a peer support worker, family peer support worker, and mental health nurse, alongside a junior and senior scientist, to ensure firm embedding of experiential knowledge in the process of intervention development
Summary
People diagnosed with a severe mental illness (SMI; e.g., schizophrenia, bipolar disorder) frequently experienced meaningful losses [e.g., losing employment/housing/(romantic) relationships/dreams], because of their illness and lengthy admissions. 20% of people with SMI need these lengthy admissions in psychiatric hospitals or sheltered housing facilities [1,2,3], because of the severity and persistence of problems in multiple life domains [e.g., treatment-resistant symptoms [4], severe cognitive impairments [5], somatic health problems [6], poor self-care [7], and psychosocial dysfunction [8]]. These lengthy admissions often lead to losing a sense of purpose, which makes formulating (and obtaining) long-term recovery goals extremely challenging [9]. Supporting service users in their process of personal recovery requires (among other highly related concepts as highlighted in the CHIME taxonomy) attention for the (re)development of a multidimensional self-identity
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