What are “good outcomes” in public mental health settings? A qualitative exploration of clients’ and therapists’ experiences

Abstract

BackgroundThe mental health field sees a surge of interest in Routine Outcome Monitoring, mandated by a wish to help better those not-on-track to recovery. What constitutes positive outcomes for these patients is not fully understood.AimsTo contribute knowledge into what constitutes meaningful outcome concepts in the experiences of patients with long and complex mental health suffering and treatment, and the clinicians who work to help them.MethodsA qualitative in-depth study of 50 participants’ experiences. Data are collected through focus groups and individual interviews, and analyzed using a team based structured thematic analytic approach.ResultsWe found an overarching theme of outcome as an ongoing process of recovery, with the four constituent themes: (1) strengthening approach patterns for new coping; (2) embodying change reflected by others; (3) using new understandings developed in dialogue; and (4) integrating collaborative acceptance.ConclusionsWe discuss our findings in light of existing empirical studies and different recovery concepts, and suggest that if outcomes monitoring is to become an integral part of routine practice, it might be beneficial to integrate an understanding of outcomes as ongoing processes of recovery within mental health suffering into these systems.

Review: What Outcomes Count? Outcomes Measured for Adolescent Depression Between 2007 and 2017

“…26,[48][49][50] Two recent taxonomies emphasized the importance of measuring domains beyond symptoms, 17,20 as did a small number of qualitative studies. 51,52 However, with the exception of 1 study, 53 none of the reviewed studies referred to this emerging literature or discussed their measurement approach from a multidimensional perspective.…”

Client descriptions of outcomes compared with quantitative data: A mixed‐methods investigation of a quantitative outcome measure

“…We do not know whether these changes reflect unequivocal success or successful progress along a journey towards achieving desired personal goals and well‐being. Moltu et al () found that participants at the ‘severe end of mental health suffering’ (p. 3) experienced symptom elimination as less important than having built meaningful ways of living with challenging conditions. Further research involving clients who fail to show improvement or who worsen would help clarify what it means to both clinicians and outcome researchers.…”

Topic-focused analysis in a case of integrative psychotherapy with a father fearing his own anger

“…Taken together, the findings of this case are highly consistent with the ways in which clients describe positive outcomes, in the context of qualitative interviews carried out after the end of therapy. Moltu et al (2017) found that clients described themselves as having used dialogue with their therapist to develop new coping strategies and a deeper sense of acceptance of aspects of self, which then made it possible to be resolute in facing up to life situations and issues that had previously been avoided. The process of purposeful engagement with issues was informed by feedback from other people with significant roles in their everyday life.…”