Starting Where the Client Is at: Adult Mental Health Consumers' Explanatory Models of Mental Illness

Background and Purpose: The NIMH strategic plan objective 3.1 explicitly calls for building knowledge on how to personalize mental health care. Incorporating a person's own explanation of his/her mental illness into assessment and treatment planning offers a mechanism for potentially increasing such personalization of treatment. However, while plentiful research exists on possible causes of and contributing factors to mental illness, little is known about how people who are actually living with a severe mental illness subjectively explain/causally attribute their own mental illness experiences. The aim of this exploratory qualitative study is to describe how adult mental health consumers explain and causally attribute their mental illness experiences. Methods: Data was collected through tape-recorded, semi-structured interviews with a purposive sample of 25 adults living with a severe mental illness who were members of a consumer-operated service center (COSP). The semi-structured interview was an adapted version of the McGill Illness Narrative Interview (MINI), which was designed to obtain: 1)a temporal narrative of symptom and illness experiences; 2) prototypes related to participants' mental health problems and 3)explanatory models/causal attributions utilized by participants to explain their respective illness/recovery experiences (Groleau, Young and Kirmayer, 2006). Atlas.ti was used to manage and analyze data. Interviews were transcribed and uploaded into Atlas.ti. All transcriptions were initially line-by-line coded, and these line-by-line codes were then sorted into shared themes. Thematic analysis continued until no new codes were being generated and all data were accounted for. Member checking was done via sharing analysis with participants, getting feedback, and making revisions accordingly.

Results: Analysis yielded descriptive information about causal attributions and explanatory models mental health consumers utilized to understand and explain to their respective mental health/illness experiences. Salient themes included: • Nearly all participants self-identified a DSM-IV diagnosis when asked about their mental health concerns, e.g., “I have schizophrenia”. • Nearly all participants attributed having an initial mental illness experience due to family trauma issues. • In terms of “nature vs. nurture”, participants identified environmental/nurture causes of (re)occurrences of their mental illness symptoms over time. • Despite a “nurture” causal orientation, medical model language was also prominent • When asked how having a mental illness (using whatever term the participant uses to self-identify his/her illness) impacted one's life, the responses were overwhelmingly positive. “Becoming stronger because of the experience” was repeatedly referenced across interviews. • Neither self-stigma nor societal stigma concerns about mental illness figured prominently in participants' explanations/understandings of having a mental illness.

Conclusions and Implications: Explicitly incorporating how individuals living with a mental illness understand and explain their mental illness into assessment and treatment planning may increase personalization and thus relevance of best practice services for such individuals. The intentional eliciting and utilization of consumers' explanatory models may also deepen the assessment process and more fully engage mental health consumers in service use. Additional research is needed to explore how consumers' explanatory models can be integrated into specific interventions. Funding for this study provided by the Ohio Department of Mental Health.