Psychiatric Rehabilitation Center Research Articles

Predictors of personal recovery for persons with psychiatric disabilities: An examination of the Unity Model of Recovery

This study examined a comprehensive set of potential correlates of recovery based on the Unity Model of Recovery. Thirty-two community psychiatric rehabilitation centers in Taiwan agreed to participate in this study. A sample of 592 participants were administered the questionnaires. Five groups of independent variables were included in the model: socio-demographic variables, illness variables, resilience, informal support, and formal support. The results of regression analysis provided support for the validity of the Unity Model of Recovery. The independent variables explained 53.5% of the variance in recovery for the full sample, and 55.5% for the subsample of the consumers who have been ever employed. The significance of the three cornerstones (resilience, family support, and symptoms) for recovery was confirmed. Other critical support variables, including the extent of rehabilitation service use, professional relationship, and professional support were also found to be significant factors. Among all the significant correlates, resilience, family support, and extent of rehabilitation service use ranked in the top three. The findings could shed light on paths to recovery. Implications for psychiatric services were discussed and suggested.

Now Is Everything by Amy Giles

Reviewed by: Now Is Everything by Amy Giles Melanie Kirkwood Giles, Amy Now Is Everything. HarperTeen/HarperCollins, 2017 [368p] Trade ed. ISBN 978-0-06-249573-0 $17.99 E-book ed. ISBN 978-0-06-249575-4 $8.99 Reviewed from galleys R Gr. 9-12 When an unexplained private airplane crash leaves Mr. and Mrs. McCauley dead and their eldest daughter in a juvenile psychiatric rehabilitation center, the police scour through the seemingly perfect family's life to rule out any potential for foul play. Prior to the incident, seventeen-year-old Hadley McCauley is apparently flawlessly content with life; she's rich, she's the captain of the lacrosse team, she's the Cornell-bound class salutatorian—but things aren't always as they seem. At home, Hadley's father's obsessive need for control over his wife and daughters' lives often turns physical—a broken arm here, a burn with a fireplace poker there. Determined to protect her ten-year-old sister Lila from their dad's temper and mother's alcohol-induced indifference, Hadley wishes someone could see past her façade to save her family from the wrath of her father. Interviews and police reports from after the crash are interspersed between chapters, and they reveal just how little the people in Hadley's life knew about her troubles and invite readers closer and closer to shocking truth. The book effectively depicts the relentless fear and secrecy that overcomes young people and adults alike when faced with abusive relationships; a note with provides resources for those dealing with domestic abuse. MK Copyright © 2017 Board of Trustees of the University of Illinois

A study to assess the Effectiveness of Aerobic Exercises on Anxiety among Substance Abuse Patients at Selected Psychiatric Rehabilitation Centre, Dehradun

A study to assess the Effectiveness of Aerobic Exercises on Anxiety among Substance Abuse Patients at Selected Psychiatric Rehabilitation Centre, Dehradun

The resilience and quality of life people with mental illness attending psychiatric rehabilitation centre

The resilience and quality of life people with mental illness attending psychiatric rehabilitation centre

Minimal detectable change of the Personal and Social Performance scale in individuals with schizophrenia.

The minimal detectable change (MDC) of the Personal and Social Performance scale (PSP) has not yet been investigated, limiting its utility in data interpretation. The purpose of this study was to determine the MDCs of the PSP administered by the same rater or different raters in individuals with schizophrenia. Participants with schizophrenia were recruited from two psychiatric community rehabilitation centers to complete the PSP assessments twice, 2 weeks apart, by the same rater or 2 different raters. MDC values were calculated from the coefficients of intra- and inter-rater reliability (i.e., intraclass correlation coefficients). Forty patients (mean age 36.9 years, SD 9.7) from one center participated in the intra-rater reliability study. Another 40 patients (mean age 44.3 years, SD 11.1) from the other center participated in the inter-rater study. The MDCs (MDC%) of the PSP were 10.7 (17.1%) for the same rater and 16.2 (24.1%) for different raters. The MDCs of the PSP appeared appropriate for clinical trials aiming to determine whether a real change in social functioning has occurred in people with schizophrenia.

Improving service delivery in mental health through collaboration: an Iranian experience

ABSTRACTOne effective way to meet the demands of clients with mental health issues is through collaboration between the formal educational system and clinical setting. This report shares example of such a collaboration and its benefits for various aspects of services delivery. In this report we discuss a relationship between a psychiatric rehabilitation centre and one department of occupational therapy education in Iran, in the form of three activities: collaboration, education and research activities. This cooperation has improved the services. Moreover, it has encouraged occupational therapy students to have a better understanding of their involvement in the field of psychosocial rehabilitation.

Institutional characteristics affecting the employment rates of Community psychiatric rehabilitation centers

Institutional characteristics affecting the employment rates of Community psychiatric rehabilitation centers

Abstract P115: Effect of an Environmental Intervention on the Nutrient Content of Food Served at Psychiatric Rehabilitation Centers: Results From the ACHIEVE Trial

Introduction: Institutions that serve on-site meals provide an unrealized opportunity to improve health on a broad scale, especially for underserved populations. Psychiatric rehabilitation programs commonly serve meals to adults with serious mental illness (SMI; schizophrenia and bipolar disorder), a population with a markedly increased prevalence of obesity and high risk of cardiovascular disease mortality. In the context of a behavioral weight-loss trial incorporating weight management counseling for persons with SMI, we delivered an environmental-level intervention, focused on the food environment. Hypothesis: We hypothesized the environmental intervention would reduce the overall calories served at the psychiatric rehabilitation program study sites. Methods: We partnered with kitchen supervisors to reduce calories and improve the nutritional quality of meals served at psychiatric rehabilitation programs. Intervention staff met with kitchen staff at the beginning and followed up quarterly to assess progress and to reinforce key nutritional messages. Environmental interventions included decreasing sugar sweetened beverages, increasing whole grains, and reducing saturated fat in meals. Breakfast and lunch menus were collected at baseline and 18 months after intervention. We calculated mean (SD) total energy and nutrient content of each meal. Results: Ten psychiatric rehabilitation programs participated. Eight sites served breakfast and all sites served lunch. Compared to baseline, average breakfast calories decreased significantly after 18-months from 568.4 to 457.1 (p=0.0048) and average lunch calories decreased from 729.4 to 623.8 (p<0.0001). Saturated fat in breakfast decreased by 1.9g (p=0.015) and 1.8g for lunch (p=0.0061). Total sugars at breakfast decreased from 53.3g to 40.1g (p=0.0008) and at lunch from 38.9g to 33.7g (p=0.004). Sodium was not significantly changed for breakfast (713.5mg to 557.3mg, p=0.148) but decreased by 412.4mg (1527.4mg to 1115.1mg, p=0.0008) for lunch. Conclusions: The environmental intervention implemented at psychiatric rehabilitation programs successfully reduced the amount of calories, saturated fat, sugars, and sodium served. This study suggests that modifying the food environment at psychiatric rehabilitation programs is feasible. Such programs can likely be applied to other institutions that serve on-site meals, and may be especially important in preventing cardiovascular disease in other underserved populations.

정신장애인을 위한 프로그램 기획에의 컨셉트 맵핑(concept mapping) 적용 : 클라이언트 참여를 통해 사회복귀시설 종사자와 정신장애인의 기대성과 합의를 이룰 수 있는가?

본 연구는 정신장애인을 대상으로 이루어지는 프로그램에 클라이언트 참여와 자기결정의 가치를 실현하기 위하여 컨셉트 맵핑을 적용한 것이다. 컨셉트 맵핑이 적용되는 프로그램은 A광역시의 B사회복귀시설에서 시행되는 것으로, 정신장애인들이 독거노인과 함께 음식을 교류하며 소통하는 사업이였다. 컨셉트 맵핑을 통해서 정신장애인과 사회복귀시설 종사자가 기대하고 있는 프로그램의 성과가 무엇인지 서로 확인하고, 합의해 나가게 되었다. 정신장애인과 사회복귀시설 종사자 총 24명이 참여하였으며, 총 여섯단계를 거쳤다. 42개의 서술문이 수집되었으며, 분류화 결과, 정신장애인은 6개의 군집, 사회복귀시설 종사자는 3개의 군집이 도출되었다. 사회복귀시설 종사자보다 정신장애인들이 기대성과를 더 세분화시켜 분류하였다. 서로가 기대하는 성과의 차이를 확인하고 기대성과의 중요성을 측정하여 최종적으로 합의된 3가지의 기대성과를 도출하였다. 이번 연구를 통해서 정신장애인들의 프로그램 참여와 그에 따른 자기결정의 가치를 실현하는데 컨셉트 맵핑이 가지는 유용성을 경험적으로 확인할 수 있게 되었다. This study apply concept mapping to realize of client participation and self-determination in social welfare program for the mental disorders. They are relatively easily marginalized in decision-making process of their program. But realization of client participation and self-determination is directly connected with effect of service. For this reason, we confirmed the applicability of concept mapping in program planning that support client participation. Case of this study is social welfare program of B community psychiatric rehabilitation center located in the A city. This program is community interchange service for the mental disorders. Interchange type is to have a food with the mental disorder and the solitary elderly. We took advantage of the concept mapping to derive the outcomes that are expecting the mental disorders and mental health social workers. Concept mapping was proceeding in six steps; preparation stage <TEX>${\rightarrow}$</TEX> idea collection stage <TEX>${\rightarrow}$</TEX> structuralization stage <TEX>${\rightarrow}$</TEX> analysis stage <TEX>${\rightarrow}$</TEX> interpretation stage <TEX>${\rightarrow}$</TEX> application stage. Participants were a total of 25 people including the mental disorders and community psychiatric rehabilitation center employees. The participants produced 42 statements. Sorting results, the mental disorders produced 6 clusters; community psychiatric rehabilitation center employees produced 3 clusters. The mental disorders classified better detail than community psychiatric rehabilitation center employees. Two group were found gap of expected outcomes each other, went narrowed it. They agreed 3 expected outcomes finally. We identified empirically the usefulness of concept mapping to realize self-determination and program participation.

Considering child care and parenting needs in Veterans Affairs mental health services

Child care and parenting needs of adults with mental illness are of growing concern, especially among those seeking Department of Veterans Affairs (VA) mental health services. One area of interest concerns the possible benefits that on-site child care could have for improving veterans’ access to VA mental health care. Child care programs are currently being piloted at the VA for the first time, although the need for them has not been evaluated. We conducted a brief survey of a convenience sample of 147 veterans (132 men, 15 women) seeking mental health care at outpatient clinics and/or at a psychiatric rehabilitation center at one VA. Participants were asked about their attitudes and experiences regarding child care and parenting support at the VA. Of the 52 (35.4%) participants who responded and had children under 18, the majority of both men and women surveyed agreed that the VA should offer child care services and that they would use child care services at the VA if it were available. These results are based on a small sample of participants, but they may contribute to ongoing discussion and efforts to develop “family-friendly” mental health services.

사회복귀시설 사례관리자의 사례관리 과정에 대한 인식과 수행에 관한 연구 -부산지역 사회복귀시설의 사례관리를 중심으로-

본 연구는 부산지역의 사회복귀시설의 사례관리자를 대상으로 사례관리과정에 대한 인식과 사례관리과정이 실제 어떻게 수행되고 있는지를 탐색함에 있다. 사회복귀시설의 사례관리자 12명을 대상으로 포커스 그룹 인터뷰를 실시하여 얻은 자료를 심층분석하였다. 접수는 다양한 휴먼서비스 조직에서의 의뢰가 많고, 클라이언트 중심의 인테이크와 계약이 이루어지고, 사정은 정신장애인의 기능보다는 서비스 욕구중심으로, 기획은 자원발굴과 확보에 어려움을 느꼈다. 개입단계는 직접서비스 위주로 진행되고 여러 기관에서 접근 시에 사례관리에 대한 책임소지가 불분명했다. 점검단계는 주로 매달 시설 내에서 점검이 이루어지고 현실적인 슈퍼비전에 대한 욕구가 높았다. 종결에서는 성과평가 위주였고, 사례관리를 잘 나타낼 수 있는 개별화된 평가척도에 대한 기대를 나타내었다. This study aims to explore how to cognize and perform case management process to community psychiatric rehabilitation center in Busan area. The case of case manager for 12 people obtained by conducting focus group interviews were in-depth analysis. Many commissioned by a variety of human service organizations in the contract and the client-centric intake has been received. Assessment, rather than a function of mental disabilities center service needs, planning difficulties in securing resource discovery and felt. Intervention phase focuses on direct service and when several agencies responsible for the case management approach. The possession of responsibility was unclear. Mainly monthly facilities within the checking step checks are being made, there was a desire for the realistic-supervision. Completion stage expectations showed a performance evaluation oriented, and individualized case management that can be represented well on the rating scale.

The Effects of Musical Activity on the Self-Esteem and Self-Efficacy of Patients With Schizophrenia: A Cultural Study in West Bengal, India

Studies into the effects of therapeutic music making in the treatment of mental illness have increased dramatically in the last decade, but there still remains a dearth of research into its effects in developing countries such as India. Of particular importance in India, where the stigma associated with mental illness is still prominent, is low self-esteem and self-efficacy in people with disorders such as schizophrenia. Using a qualitative approach, this study explored the views of the participants on the effects of musical activity, at a psychiatric treatment and rehabilitation center in India. Five main themes were interpreted from interview transcripts: therapy, moti- vation, mood, self-efficacy, and self-esteem, suggesting that the patients find the sessions to be therapeutic overall, including in the areas of self-esteem and self-efficacy.

Barriers to discharge of patients from a government-run day-care psychiatric rehabilitation center in India

ObjectiveMany psychiatric patients undergoing vocational training do not achieve successful transition to regular work. In this study, we evaluated the barriers for discharge from day care center to actual work place. Materials and methodsIn a cross-sectional study at a government-run day-care center at National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, we studied 76 patients who were undergoing vocational training for more than 1 year. We did a semi-structured interview with patients, their family members, and instructors of various occupational sections. We used a questionnaire of 17 different barriers to assess the obstacles in their discharge from day-care center to actual work place. ResultsThe majority of them had a diagnosis of mental retardation (n=47) followed by schizophrenia (n=29), and bipolar disorder (n=9). The mean (SD) age and duration of illness was 33.6 (9.7) years and 12.5 (9.3) years, respectively. Patients had more than one diagnosis. The median duration of stay in day-care center was 5.9 years. Doubts regarding performance at a new work place (n=60), fear of performance at new work place (n=65), and the fear of transition to regular work (n=64) were the most common barriers reported by patients, their family members and instructors of various occupational sections, respectively. DiscussionEducating patients and their family members, gradual exposure to new working environment, and increased community level vocational opportunities may potentially overcome above barriers. Getting them to the actual job early in their course of treatment will improve their adjustment to a new work place and overall outcome.

Quality of experience during psychosocial rehabilitation: A real-time investigation with experience sampling method.

This study aimed to identify contextual and clinical factors contributing to the quality of experience of people participating in psychosocial rehabilitation activities (RA) and to investigate the association of RA with optimal experience or flow, a state characterized by the perception of high challenges and high skills, deep concentration, positive affect, clear goals, control and autonomous motivation, which contributes to individuals' well-being. Twenty-seven people at an Italian psychiatric rehabilitation center provided real-time information on daily activities and associated experience through experience sampling method. Multilevel models were calculated to assess the factors contributing to participants' quality of experience. Analyses showed that situation-contingent factors-type of activity and relationship between perceived challenges and skills-predicted participants' quality of experience over and above the clinical factors taken into account in this study: level of global functioning (GAF), rehabilitation duration, and type of setting (residential vs. semi-residential). In addition, RA were prominently associated with optimal experience. Results suggest the importance for people involved in rehabilitation programs to engage in challenging tasks, favoring both the onset of positive and complex experiences and skill development. Findings further show the usefulness of real-time assessment methods in monitoring the rehabilitation process.

Polymorphisms of INSIG2, MC4R, and LEP Are Associated With Obesity- and Metabolic-Related Traits in Schizophrenic Patients

Schizophrenic patients have a high prevalence of metabolic adversities. Previous studies have suggested some candidate genes for obesity- and metabolic-related traits, including the insulin-induced gene (INSIG2), melanocortin 4 receptor gene (MC4R), and leptin and leptin receptor genes (LEP and LEPR). We aimed to investigate the associations between these genes and metabolic disturbances in patients with schizophrenia in Taiwan. Patients with a diagnosis of schizophrenia or schizoaffective disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were recruited from 36 community psychiatric rehabilitation centers or hospitals in Taipei. A total of 650 subjects were enrolled, and 577 were included in the genetic analyses. The anthropometric (body mass index, waist circumference [WC], and blood pressure) and biochemical measurements (fasting plasma glucose, insulin, triglyceride, high-density lipoprotein cholesterol, and Homeostasis Model of Assessment - Insulin Resistance index [HOMA-IR]) were assessed. Seven loci in the 4 genes were genotyped using standard TaqMan assays. Genetic association analyses were conducted for binary and quantitative measurements of the previously mentioned traits. Obese patients with schizophrenia exhibited more metabolic disturbances than nonobese patients. Our data showed that INSIG2 was significantly associated with fasting plasma glucose (for rs17587100, P < 0.0001), MC4R was associated with WC (for rs2229616, P = 0.005), and LEP was associated with body mass index and WC (for rs7799039, P < 0.01). In addition, these loci showed suggestive associations with traits including high-density lipoprotein cholesterol and triglyceride, metabolic syndrome, insulin level, and HOMA-IR index (P = 0.05). In addition to the effect from antipsychotic medications and an unhealthy lifestyle, genetic factors also contribute to the high prevalence of obesity and metabolic disturbances in patients with schizophrenia, especially genes involved in metabolic-related pathways.

Pharmacoeconomic comparison of ziprasidone with other atypical oral antipsychotic agents in schizophrenia

Objective: to comparatively investigate – by means of computer simulations – the economic cost and clinical outcomes of five atypical oral antipsychotic agents (ziprasidone, olanzapina, risperidone, paliperidone and aripiprazolo).Methods: a cyclical stochastic model representing patient evolution, taking into account main adverse reactions (akathisia, weight gain and extra-pyramidal ARs), drug efficacy on psychosis stabilization and probability of relapse, was developed. Ten different scenarios were compared, each starting with one of the considered antipsychotics, prescribed either at home or in a hospital setting. Switching to another medication was allowed until no untried drugs were available, in which case clozapine treatment or admission to a Psychiatric Therapeutic Rehabilitation Center were irreversibly assigned. Model inputs were probabilities of ARs, probabilities of stabilization and probabilities of destabilization (assumed equal for all); as well as costs attributable to drugs, hospitalization, outpatient care and costs adverse reactions in terms of concomitant medications. Sources for the inputs were the trials reported in the most recent literature (from the year 2000), selected based on the homogeneity of the observational period and antipsychotic dosage used.Results: in each scenario, the hospitalization cost represented the highest component of the overall cost (approximately 67%). Assuming equal drug effectiveness, ziprasidone fared better than all other considered competitors, showing the lowest average annual costs per patient (and also the lowest average annual hospitalization costs) as well as the largest numbers of controlled months without adverse reactions, independently of the initial setting. Conclusions: the most important determinant of total cost appears to be hospitalization, whose cost is about 600% higher than the medications cost. Medication effectiveness and tolerability remain however of utmost importance for the patients well being and reduction of hospitalization rate.

A Randomized Controlled Trial of the Illness Management and Recovery Program for Persons With Schizophrenia

Objective: The aim of the study was to evaluate the effects of the illness management and recovery (IMR) program on symptoms and psychosocial functioning of individuals with schizophrenia or schizoaffective disorder in an outpatient setting in Sweden. Methods: A total of 41 persons with schizophrenia or schizoaffective disorder who were receiving treatment at six psychiatric outpatient rehabilitation centers were randomly assigned to either an IMR group for nine months or to treatment as usual (control condition). Assessments were conducted at baseline, posttreatment (nine months), and follow-up (21 months) and included self-reports and ratings by clinicians (both blind and nonblind to treatment assignment) of illness management, psychiatric symptoms, recovery, coping, quality of life, hospitalization, insight, and suicidal ideation. Results: As measured by self-report and ratings of nonblinded clinicians, IMR program participants demonstrated significantly greater improvement in illness management than participants in the control condition. Ratings of psychiatric symptoms by blinded clinicians using the Psychosis Evaluation Tool for Common Use by Caregivers and self-reported ratings of psychosocial functioning on the Ways of Coping Questionnaire also showed better outcomes than for participants in treatment as usual. A statistically significant decrease in suicidal ideation between baseline and follow-up was found for IMR program participants. Conclusions: The study supports previous findings and suggests that the IMR program is effective in improving the ability of individuals with schizophrenia to better manage their illness. (Psychiatric Services 62:606–612, 2011)

The Dignity to Fail

Back to table of contents Next article Taking IssueFull AccessThe Dignity to FailPatrick W. Corrigan, Psy.D.Patrick W. CorriganSearch for more papers by this author, Psy.D.Published Online:1 Mar 2011https://doi.org/10.1176/ps.62.3.pss6203_0241AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Although evidence supporting the effectiveness of several treatments for people with serious mental illnesses increases exponentially, adherence to such treatments remains alarmingly low. Service providers are concerned that absence of treatment leads to exacerbation of symptoms and to disabilities. At its extreme, treatment nonadherence becomes a legal issue for psychiatrists or other providers that leads them to make unilateral and sometimes restrictive decisions. Many family members share this concern about a loved one's nonadherence to treatment.Unfortunately, some consumer advocates are troubled that giving this kind of responsibility to providers leads them to make overprotective decisions. The physical disability community refers to this as “dignity of risk” and “right to failure.” Attempting to make life “risk free” robs people of potential opportunities. People do not land a better job, move to a nicer neighborhood, build more intimate relationships, or enjoy fewer medication side effects if they do not consider and pursue the risky option. One of the things that make these pursuits a risk is the absence of a priori clear results. For example, it is uncertain whether meeting new people at a synagogue will broaden one's support network or cause more social anxiety. Many of a person's best achievements come the hard way: falling flat, picking oneself up, and moving on. Without these flops, people are unclear about their potential limits and miss out on unforeseen alternatives that may benefit them.Some people seem to be unable to make clear decisions because of cognitive deficits associated with serious mental illnesses. Evaluating a person's decision capacity, however, is not a black-and-white process. Even people with major psychotic illnesses have lucid periods. What is the final arbiter of whether a person's decision represents a pathological process? Is a decision to stop medications by a person with a formal thought disorder necessarily indicative of poor cognition? Research shows that opting out of a treatment does not necessarily lead to worse symptoms or to disabilities. When an illness intensifies, a person rarely cascades into a situation with irreversible consequences. Most decisions about ending psychosocial treatments related to work or independent living do not lead to relapse and catastrophe. Even nonadherence to medication regimens does not necessarily lead to tragedy. Risk and failure are part of human agency. Saving people from these is taking away their dignity.Joint Center for Psychiatric Rehabilitation, Illinois Institute of Technology, Chicago FiguresReferencesCited byDetailsCited ByPsychiatry Research, Vol. 241Patient-Centered, Recovery-Oriented Psychiatric Care and Treatment Are Not Always VoluntaryJeffrey L. Geller, M.D., M.P.H.1 May 2012 | Psychiatric Services, Vol. 63, No. 5From Adherence to Self-Determination: Evolution of a Treatment Paradigm for People With Serious Mental IllnessesPatrick W. Corrigan, Psy.D., Beth Angell, Ph.D., Larry Davidson, Ph.D., Steven C. Marcus, Ph.D., Mark S. Salzer, Ph.D., Petra Kottsieper, Ph.D., Jonathon E. Larson, Ed.D., Colleen A. Mahoney, Ph.D., Maria J. O'Connell, Ph.D., and Victoria Stanhope, Ph.D.1 February 2012 | Psychiatric Services, Vol. 63, No. 2 Volume 62Issue 3 March 2011Pages 241-241 Metrics PDF download History Published online 1 March 2011 Published in print 1 March 2011

The Dignity to Fail

Back to table of contents Next article Taking IssueFull AccessThe Dignity to FailPatrick W. Corrigan, Psy.D.Patrick W. CorriganSearch for more papers by this author, Psy.D.Published Online:1 Mar 2011https://doi.org/10.1176/ps.62.3.pss6203_0241AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Although evidence supporting the effectiveness of several treatments for people with serious mental illnesses increases exponentially, adherence to such treatments remains alarmingly low. Service providers are concerned that absence of treatment leads to exacerbation of symptoms and to disabilities. At its extreme, treatment nonadherence becomes a legal issue for psychiatrists or other providers that leads them to make unilateral and sometimes restrictive decisions. Many family members share this concern about a loved one's nonadherence to treatment.Unfortunately, some consumer advocates are troubled that giving this kind of responsibility to providers leads them to make overprotective decisions. The physical disability community refers to this as “dignity of risk” and “right to failure.” Attempting to make life “risk free” robs people of potential opportunities. People do not land a better job, move to a nicer neighborhood, build more intimate relationships, or enjoy fewer medication side effects if they do not consider and pursue the risky option. One of the things that make these pursuits a risk is the absence of a priori clear results. For example, it is uncertain whether meeting new people at a synagogue will broaden one's support network or cause more social anxiety. Many of a person's best achievements come the hard way: falling flat, picking oneself up, and moving on. Without these flops, people are unclear about their potential limits and miss out on unforeseen alternatives that may benefit them.Some people seem to be unable to make clear decisions because of cognitive deficits associated with serious mental illnesses. Evaluating a person's decision capacity, however, is not a black-and-white process. Even people with major psychotic illnesses have lucid periods. What is the final arbiter of whether a person's decision represents a pathological process? Is a decision to stop medications by a person with a formal thought disorder necessarily indicative of poor cognition? Research shows that opting out of a treatment does not necessarily lead to worse symptoms or to disabilities. When an illness intensifies, a person rarely cascades into a situation with irreversible consequences. Most decisions about ending psychosocial treatments related to work or independent living do not lead to relapse and catastrophe. Even nonadherence to medication regimens does not necessarily lead to tragedy. Risk and failure are part of human agency. Saving people from these is taking away their dignity.Joint Center for Psychiatric Rehabilitation, Illinois Institute of Technology, Chicago FiguresReferencesCited byDetailsCited byPractice Dilemmas, Successes, and Challenges in the Delivery of Homeless Services: Voices from the Frontline27 June 2019Psychiatry Research, Vol. 241Patient-Centered, Recovery-Oriented Psychiatric Care and Treatment Are Not Always VoluntaryJeffrey L. Geller, M.D., M.P.H.1 May 2012 | Psychiatric Services, Vol. 63, No. 5From Adherence to Self-Determination: Evolution of a Treatment Paradigm for People With Serious Mental IllnessesPatrick W. Corrigan, Psy.D., Beth Angell, Ph.D., Larry Davidson, Ph.D., Steven C. Marcus, Ph.D., Mark S. Salzer, Ph.D., Petra Kottsieper, Ph.D., Jonathon E. Larson, Ed.D., Colleen A. Mahoney, Ph.D., Maria J. O'Connell, Ph.D., and Victoria Stanhope, Ph.D.1 February 2012 | Psychiatric Services, Vol. 63, No. 2 Volume 62Issue 3 March 2011Pages 241-241 Metrics PDF download History Published online 1 March 2011 Published in print 1 March 2011

Dietary intake of adults with serious mental illness.

Suboptimal diet may be related to the high prevalence of obesity and cardiovascular disease (CVD) in persons with serious mental illnesses, but few studies have characterized dietary intake in this population. Participants were 102 overweight/obese adults with serious mental illnesses who were being screened for a weight loss trial in psychiatric rehabilitation centers. Direct observation of participant meals was completed using a standardized measurement form. CVD risk factors were common: mean body mass index was 35.7 kg/m2; 30% had diabetes. Participants consumed 100% of caloric beverages served (7.2 oz/meal) but consumption was significantly less than served for fruits (difference of 0.12 cups/meal, p=0.003) and vegetables (0.14 cups/meal, p=0.021). The majority (56%) of meat consumed was high fat. Interventions designed to improve dietary intake of persons with serious mental illnesses are needed to improve health in this population at high risk for CVD.