How to Improve Aging for Older Adults with Serious Mental Illnesses? a Community-Based Participatory Research Project

Background and Purpose

Compared to peers in the general population, persons aging with serious mental illnesses (SMI) face increased morbidity and mortality rates, and decreased subjective experiences of quality of life and wellbeing. To date, limited intervention research focuses on addressing specific needs of persons aging with SMI. Innovations over the past two decades have determined that SMI recovery is not absence of illness, but the ability to find meaning and purpose. This approach is endorsed by the federal Substance Abuse and Mental Health Services Administration and runs parallel to the “positive psychology” approach to mental health.

Defined by the PERMA theory of wellbeing, positive psychology can be defined as the study of positive emotions, character traits, and strengths that enable people to confront challenges, create meaning, and feel life is worth living. From PERMA’s framework, optimal psychosocial interventions focus on helping people thrive across important areas of their lives. Growing evidence supports positive-psychology interventions for many populations, but to date, they have not been used to improve the experience of aging with SMI.

Therefore, the aim of this project was to use a participatory action process to: 1. Identify meaningful outcomes for a positive-psychology intervention designed to improve the experience of aging with SMI; 2. Identify empowering delivery methods for such an intervention; and 3. Identify key aspects of the intervention.

Methods

This project used five focus groups and 5 individual interviews with a group of purposively recruited Certified Older Adult Peer Specialists (COAPS) to gather data. COAPS are adults age 50+ with lived experience of SMI and training in peer support provision. Focus groups asked participants to respond to and discuss topics related to the above-described three study aims.  Verbatim transcripts were analyzed using constant comparison to find common themes and consensus points; member-checking confirmed results.

Results

Results of the analysis found: 1. PERMA theory needed to be modified by merging it with Maslow’s hierarchy of needs. For example, those who are experiencing or recovering from homelessness can enhance their subjective wellbeing and also work towards housing stability. 2. Meaningful outcomes should be the traditional psychosocial markers for interventions with persons with SMI (i.e., “number days hospitalized”) as well as ones re-framed using PERMA-theory (i.e., “number days engaged in meaningful activities”). 3. Key aspects of the intervention included that it should be framed as a “course,” to contextualize it as wellbeing-focused achievement. Framing it as treatment would make it pathology, not strengths, driven. Ongoing groups run through psychosocial clubhouses was the preferred modality/setting, and COAPS trained in positive psychology were described as uniquely suited to instruct the course.

Conclusions and Implications

This project used a participatory-action approach to develop an innovative positive psychology-informed intervention/course aiming to improve the experience of aging for those with SMI. Results hold additional value as they encompass themes of meaning-making in the context of psychiatric illness and aging, contributing to depth of understanding of those phenomena. Future research will pilot the newly designed intervention/course, with participants from the present project serving as advisors.