Fighting in the Trenches: The Mitigating Effects of Case Managers Between Consumers' Perceived Stigma and Subjective Quality of Life

Background/purpose: A new discussion is occurring within research on community mental health practice. Couched within the concept of mental health recovery, researchers are moving towards understanding common treatment elements and environmental forces that support recovery in mental illness and can help in the design of innovative interventions (Solomon &Stanhope, 2004). Factors for consideration include provider effects (case managers) and environmental factors (perceived stigma). The investigators asked three research questions: to what extent are case managers related to consumer perceptions of quality of life; to what extent is perceived stigma related to consumer perception of quality of life (QOL); and is there an interaction between consumers' level of perceived stigma interact and case manager in consumer perceptions of quality of life?

Methods: The researchers employed a cross-sectional design and purposefully recruited subjects from the lobby of a mental health center in Ohio. Face-to-face interviews were conducted with participants using Lehman's (1988) subjective quality of life and Link's (1987) perceived stigma measures, which are reliable and valid measures of these constructs. Data analyzed are from 160 complete interviews. The researchers used hierarchical linear modeling to test the statistical relationships among these variables.

Results: Case managers did not explain a significant amount of variance in participants' appraisals of their QOL (Intra-class coefficient < .01). Higher levels of perceived stigma were associated with lower levels of QOL (β = -1.01, SE = .26, p <.01). The cross-level interaction between case managers and perceived stigma on QOL was significant (variance component =.74, χ2 = 68.34, p = .02), with the effect of perceived stigma on QOL mitigated for some case managers.

Conclusions/Implications: Results from this investigation point to three conclusions. Consumers' perceived stigma is a barrier to mental health recovery, including how they view their quality of life. Case managers do not directly influence consumer perceptions of quality of life, but can dampen the negative effects of perceived stigma on quality of life. Finally, both case managers and perceived stigma should be including in models of recovery in mental illness.

References

Hohmann, A. (1999). A contextual model for clinical mental health effectiveness research. Mental Health Services Research, 1, 83–91.

Lehman, A.F. (1988). A quality of life interview for the chronically mentally ill. Evaluation and Program Planning, 11, 51-62.

Link, B.G. (1987). Understanding labeling effects in the area of mental disorders: An assessment of the effects of expectation of rejection. American Sociological Review, 52, 96-112.

Solomon, P. & Stanhope, V. (2004). Recovery: Expanding the vision of evidence-based practice. Brief treatment and crisis intervention, 4, 311-321.