"Doin It out of the Kindness of Heart:" Experience Driven Preferences Among Young Adults Seeking Psychiatric Stabilization

Purpose:  Young adults have lower rates of outpatient mental health service use (Pottick et al., 2007) and higher rates of emergency room use (Lau et al., 2014) than adolescents or other adults, care that is both expensive and crisis oriented.  Understanding the treatment experiences and preferences of young adults who have accessed crisis services may assist in identifying points of intervention to promote earlier engagement in outpatient services. This study examined data from young adults who accessed psychiatric emergency services to explore two research questions:  1) What do young adults value in mental health treatment? 2) What attitudes, beliefs and perceptions prevent them from using services?

Methods: Fifty-five young adults (age 18-25) diagnosed with Bipolar (47%), Depression (39%) or Schizophrenia (14%) were interviewed following admission to a psychiatric inpatient crisis stabilization unit. Interviewers used a semi-structured interview guide to explore participants’ preferences and prior experiences with treatment services – both positive and negative.  Interviews were audio recorded and transcribed, then reviewed by 4 analysts who used a thematic approach to identify and code major themes.  A second round of open coding with 2 analysts used a constant comparative approach to identify dimensions within each of the major themes.  The sample was ethnically diverse and gender-balanced. 

Results: Young adults described a range of past treatment experiences across inpatient and outpatient settings provided by therapists, psychiatrists, and public systems.  Prominent themes included the characteristics of treatment providers, services offered, and the helpfulness of treatments.  Youth valued providers that listened, conveyed respect and caring [“make me feel like a human being” ], and were genuine [“she had legitimate smiles” ].  Favorable provider behaviors included connecting youth with tangible resources, conveying understanding of their situation, including youth in treatment planning, and demonstrating knowledge in their practice area.  Negative behaviors included forcing youth to take meds, appearing too busy, and pushing their own agenda.  When youth had positive or helpful experiences, they described  talking things out [“getting off my chest what has been sitting there for a long time.”], connecting with peers in similar situations, and learning about themselves and their problems [“taught me a lot about myself… what role I play in these things”].  Negative experiences were related to providers that did not listen, frustrations with the treatment process and adverse medication effects.  Stigma, not wanting to talk, and fear of being drugged up were identified as barriers to seeking treatment.

Implications: Our results support the need for providers to employ relationship building behaviors to get the patient perspective.  Respondents prefer to have a voice in their own treatment, and identified negative experiences with providers not making time to hear their stories. Environments where providers feel pressured to keep appointments short may contribute to the frustrations youth reported.  Providers should pay particular attention to listening to youth and allowing youth preferences to guide treatment.  Interventions such as shared decision making that provide a structure for dialogue about treatment goals may be particularly helpful for engaging young adults.