College of Psychology, Illinois Institute of Technology, 3424 S. State St., Chicago, IL 60616, USA.
Psychiatr Serv. 2012 Feb 1;63(2):169-73. doi: 10.1176/appi.ps.201100065.
Treatment adherence and nonadherence is the current paradigm for understanding why people with serious mental illnesses have low rates of participation in many evidence-based practices. The authors propose the concept of self-determination as an evolution in this explanatory paradigm. A review of the research literature led them to the conclusion that notions of adherence are significantly limited, promoting a value-based perspective suggesting people who do not opt for prescribed treatments are somehow flawed or otherwise symptomatic. Consistent with a trend in public health and health psychology, ideas of decisions and behavior related to health and wellness are promoted. Self-determination frames these decisions as choices and is described herein via the evolution of ideas from resistance and compliance to collaboration and engagement. Developments in recovery and hope-based mental health systems have shepherded interest in self-determination. Two ways to promote self-determination are proffered: aiding the rational actor through approaches such as shared decision making and addressing environmental forces that are barriers to choice. Although significant progress has been made toward self-determination, important hurdles remain.
治疗依从性和不依从性是目前理解为什么患有严重精神疾病的人参与许多基于证据的实践的比例较低的范式。作者提出了自我决定的概念，作为这一解释范式的演变。对研究文献的回顾使他们得出结论，认为依从性的概念有很大的局限性，这促进了一种基于价值的观点，即选择不接受规定治疗的人在某种程度上有缺陷或有其他症状。与公共卫生和健康心理学的趋势一致，与健康和健康相关的决策和行为的概念得到了推广。自我决定将这些决策框定为选择，并通过从抵抗和服从到合作和参与的观念演变来描述。康复和基于希望的心理健康系统的发展引导了对自我决定的兴趣。提出了两种促进自我决定的方法：通过共享决策等方法帮助理性行为者，并解决阻碍选择的环境力量。尽管在自我决定方面已经取得了重大进展，但仍有重要的障碍需要克服。
