Life and treatment goals of individuals hospitalized for first-episode nonaffective psychosis

Abstract

First-episode psychosis typically emerges during late adolescence or young adulthood, interrupting achievement of crucial educational, occupational, and social milestones. Recoveryoriented approaches to treatment may be particularly applicable to this critical phase of the illness, but more research is needed on the life and treatment goals of individuals at this stage. Open-ended questions were used to elicit life and treatment goals from a sample of 100 people hospitalized for first-episode psychosis in an urban, public-sector setting in the southeastern United States. Employment, education, relationships, housing, health, transportation were the most frequently stated life goals. When asked about treatment goals, participants' responses included wanting medication management, reducing troubling symptoms, uncertainty, a desire to simply be well, engaging in counseling, and attending to their physical health. In response to queries about specific services, most indicated a desire for both vocational and educational services, as well as assistance with symptom and drug abuse. These findings are interpreted and discussed in light of emerging or recently advanced treatment paradigms—recovery and empowerment, shared decision-making, community and social reintegration, and phase-specific psychosocial treatment. Integration of these paradigms would likely promote recovery-oriented tailoring of early psychosocial interventions, such as supported employment and supported education, for first-episode psychosis.

A Qualitative Study of Career Exploration Among Young Adult Men With Psychosis and Co-occurring Substance Use Disorder

“…Third, career motivations may explain why young adults with psychosis often identify education as a treatment outcome priority (Nuechterlein et al, 2008; Ramsay et al, 2011). Although efforts to support the process of finding and supporting educational placements began in the 1990s (Unger, 1998), supported education has not yet crystalized into one evidence-based model (Mueser & Cook, 2012).…”

The NAVIGATE Program for First-Episode Psychosis: Rationale, Overview, and Description of Psychosocial Components

“…This new understanding of recovery is consistent with models of positive health that advocate the association of mental health with a purposeful life and quality social connections (32, 33). Thus, the goal of the NAVIGATE program is recovery , defined by each individual in their own terms, including: the quality of role functioning (e.g., school, work), social/leisure functioning, and well-being (e.g., self-esteem, sense of purpose), all of which are important life goals of people with a recent first episode of psychosis (34). Furthermore, in order to counter pessimistic messages from the public, some treatment providers, and the experience of personal disempowerment, NAVIGATE embraces recovery-oriented services , including person orientation (i.e., interest in the individual as a whole person, including their strengths, resources, and talents, and not just as a “patient” with impairments and deficits), person involvement in program design and in guiding one’s own treatment, self-determination and choice informed by education to facilitate decision-making and reinforce a sense of self, and hope for the future to instill motivation for pursuing a rewarding life (35).…”

“…For many clients recovering from a first episode, help with returning to work or school is a particularly relevant and attractive service (34, 65). In NAVIGATE, the assumption is that all clients have these goals and that SEE can facilitate their achievement.…”

Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research

“…We also found no evidence of additional strain on public systems, via increased psychiatric service use or costs, after rejoining the workforce. People with a severe mental illness identify employment as a central goal of treatment and prefer to pursue competitive employment over protected work experiences such as set-aside jobs, prevocational training, and day treatment centers (McQuilken et al, 2003;Frounfelker et al, 2011;Ramsay et al, 2011). Fulfilling patients' treatment goals is good clinical practice, especially when it comes at no risk to clinical outcomes, and especially when it does not otherwise increase service use and costs.…”