Utilization of Psychiatric Rehabilitation Services Among People Coping with Severe Mental Illnesses: The Contribution of Knowledge, Attitudes, Relationship with the Professional Mental Healthcare Provider, and Shared Decision-Making

Background and purpose

People coping with severe mental illness (SMI) experience serious debilitation, decrease in quality of life and a decline in daily life functioning. Psychiatric rehabilitation services (PRS) are aimed at integrating people with SMI into the community, with the goal of enhancing their quality of life, recovery and functioning. Yet many do not utilize these services. For instance, in Israel only 30% of eligible individuals utilize PRS. This study aimed at examining service users’ personal factors (i.e., level of knowledge about PRS and attitudes towards seeking professional mental health treatment) alongside service user-provider collaborative factors (i.e., quality of relationship between the mental health care provider and the individual coping with SMI [hereafter: provider-client quality of relationship] and the degree of provider-client shared decision-making) which may contribute to the utilization of PRS. The working hypothesis posited that utilization of PRS is dependent on the individual who has a need for these services as well as on the provider-client interaction and collaborative work.

methods

In this cross-sectional study 227 people with SMI who were entitled to Israeli PRS filled out a self-administered online questionnaire distributed through social media and within a psychiatric outpatient clinic. The research survey included questionnaires assessing utilization of PRS (yes/no, dependent variable), level of knowledge about rehabilitation services, attitudes toward seeking mental health services, provider-client quality of relationship and degree of provider-client shared decision-making (independent variables). Differences between users of PRS and non-users regarding the independent variables were assessed using T-tests, and a path analysis was conducted to explain the likelihood of utilizing PRS and to examine mediation models.

Results

PRS users exhibited a higher level of knowledge (M=8.17) and more positive attitudes (M=3.40) compared to those who did not utilize these services (M=5.96, M=2.41, t=-3.97,-8.29, respectively, p<.001). Provider-client quality of relationship (M=4.77) and degree of provider-client shared decision-making (M=31.73) were higher among PRS users compared to non-users (M=2.92, M=11.96, t=-9.85,-10.68, respectively, p<.001). In the path analysis, only quality of relationship and attitudes significantly explained the likelihood of using PRS, with attitudes mediating the association between provider-client quality of relationship and utilization of PRS (Beta=.19, 95%CI=.08,.33).

Conclusions and implications

The focus in research and treatment on personal factors contributing to services utilization should shift to include a more provider-client collaborative perspective. In order to do such collaborative work, enhancing the quality of provider-client relationship is crucial. Hence, Policy makers should advocate for increasing human resources within PRS systems in order to enhance service availability and reduce staff workload. Such investments can contribute to fostering trust and a more positive relationship between service users and providers. In addition, public campaigns against stigma can raise awareness and knowledge about PRS. At the practice level, it is recommended that professional development programs improve therapeutic relationships, particularly among social workers who constitute a significant portion of PRS workforce. Future research should further develop the provider-client collaborative perspective in examining pathways to utilizing PRS. As such, factors contributing to PRS utilization should be examined from both service users and providers’ perspectives.