Israel Pravin, Ruud Torleif, Weimand Bente
Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
Faculty of Health Studies, VID Specialized University, Oslo, Norway.
Front Psychiatry. 2023 Mar 27;14:1135135. doi: 10.3389/fpsyt.2023.1135135. eCollection 2023.
The user and carer movements have come a long way in becoming embedded in mainstream mental health services for individuals with serious mental illness. However, implementing recovery-oriented practice continues to be plagued by an individualistic clinical focus. The carers do not feel integrated despite policies and best intentions. The implementation of Assertive Community Treatment (ACT) provided an opportunity to involve the carers and compare their assessment of personal recovery with the users.
The aims of this study were to examine (i) how family carers and users differed in their assessment of personal recovery, (ii) whether familial and personal relationships influenced how carers assess personal recovery of users, and (iii) if the experience of family carers with the ACT team was associated with personal recovery.
The naturalistic, explorative study recruited 69 users and 36 family carers from 12 Norwegian ACT teams. The users and carers assessed the user's personal recovery. Family carers also reported their experience and satisfaction with the ACT teams. Analyses included independent and paired sample T-tests and correlation analysis.
Family carers were significantly more conservative than the users' assessment of the intrapsychic and interpersonal subscales of personal recovery. The pattern held true whether the family carers were matched to the users or part of the total sample. Lastly, there was a significant negative correlation between the family carer's experience of cooperation with the ACT team and their assessment of the user's intrapersonal process of recovery.
The results of our study were consistent with previous research on carer involvement in MHS. However, it is the first study that engaged carers and assessed personal recovery of the users of ACT services. Discrepancy between carers and users is the rule. Clinicians are encouraged to embrace the discrepancy and diversity carers bring and learn the methodology of multi-informant assessments. There also is a need to address, update, and integrate the personal, familial, and relational aspects of recovery. Modification of recovery measures such as QPR and their creative use with carers has the potential to generate valuable third-party information and to involve them meaningfully in mental health services.
服务使用者及护理者群体在融入针对严重精神疾病患者的主流心理健康服务方面已经取得了长足进展。然而，以康复为导向的实践仍因个人主义的临床关注点而受到困扰。尽管有相关政策且出发点良好，但护理者仍感觉自己未被纳入其中。积极社区治疗（ACT）的实施为让护理者参与进来并比较他们与服务使用者对个人康复的评估提供了契机。
本研究的目的是考察：（i）家庭护理者和服务使用者在个人康复评估上有何不同；（ii）家庭关系和个人关系是否会影响护理者对服务使用者个人康复的评估；（iii）家庭护理者在ACT团队的经历是否与个人康复相关。
这项自然主义的探索性研究从12个挪威ACT团队招募了69名服务使用者和36名家庭护理者。服务使用者和护理者对服务使用者的个人康复进行了评估。家庭护理者还报告了他们在ACT团队的经历及满意度。分析包括独立样本和配对样本T检验以及相关性分析。
在个人康复的心理内部和人际分量表评估上，家庭护理者比服务使用者的评估明显更为保守。无论家庭护理者是与服务使用者匹配还是作为总样本的一部分，这种模式都成立。最后，家庭护理者与ACT团队合作的经历和他们对服务使用者个人康复过程的评估之间存在显著的负相关。
我们的研究结果与之前关于护理者参与心理健康服务的研究一致。然而，这是第一项让护理者参与并评估ACT服务使用者个人康复的研究。护理者和服务使用者之间存在差异是常态。鼓励临床医生接受护理者带来的差异和多样性，并学习多信息源评估的方法。还需要处理、更新并整合康复的个人、家庭和关系方面。修改如QPR这样的康复措施并创造性地与护理者一起使用，有可能产生有价值的第三方信息，并让他们有意义地参与到心理健康服务中。
