Treatment outcomes in schizophrenia: what people with schizophrenia consider to be important outcomes
Improving outcomes for people with schizophrenia (PwS) is a key aim of UK health care policy and emerging models are testing how to achieve this through person centred and collaborative care. Such care relies upon a better alignment between services and user perspectives, and greater emphasis on recovery focused principles. Exploring service users’ experiences of treatment and what they consider to be important outcomes is therefore necessary for this to be achieved. This would allow services and professionals to configure person centred care that is both relevant and timely for PwS.
A qualitative study was conducted with PwS and their family members (n. 65) which aimed to explore experiences of treatment and outcomes of importance from their perspective. We used in-depth, semi-structured interviews. JL conducted interviews with family members and HL conducted interviews with PwS. Each interview was transcribed verbatim and analysed thematically with emergent themes discussed frequently by the research team. A selection of transcripts was read by MP to scrutinise the emergent coding structure and themes. Special attention was given to divergent cases. A selection of participants was consulted to validate or refute emergent findings.
The data from the interviews with PwS (n. 23) fell into two narrative patterns. The first, presented here described what PwS felt were important outcomes and the factors that contributed to them; the second (presented in a linked abstract) details their experiences with services and treatment. The separation of the narrative strands reflects the experiences of PwS in our sample, namely that in a predominantly general practice sample important outcomes from their perspective were psychosocial and occupational, and that these were often not related to mental health services once optimum medication therapy had been achieved.Our key finding was that psychosocial and occupational outcomes, most notably ‘Independence’ were highly valued and associated with wellbeing. Medication was viewed as important for its stabilising and enabling role that contributed to the attainment of these outcomes. Alongside social support, medication provided the stable basis upon which participants could strive for ‘independence’; a state achieved through residential autonomy, occupational achievement, meaningful activity and/or routinely structured activity (i.e. hobbies, exercise). Occupational and routinely structured activity also provided a therapeutic diversion from symptoms, and an opportunity to build self-efficacy and self-coping.A number of problem areas were raised in relation to ongoing symptoms, and worries about diet and side-effects. Social connectivity, relationships and stigma were ongoing issues of concern for most of the participants.
Psychosocial and occupational outcomes are important to PwS. ‘Independence’; and potential routes to achieving it, are worthy of further investigation. Providing support for independence related outcomes could contribute to enhanced self management and improved psycho-social and occupational outcomes.
- Helen Lloyd, University of Oxford, Oxford, UK
- Joanne Lloyd
- Ray Fitzpatrick, Staffordshire University, Stoke on Trent, UK
- Michele Peters, Staffordshire University, Stoke on Trent, UK