The journal Health Expectations recently published research by Finnish researchers Johanna Cresswell-Smith and colleagues, who studied how psychiatric rehospitalization impacted service users’ daily lives. They aim to reduce rehospitalization by improving patient-centered care. According to the research team:
“Person-centered perspectives are increasingly being incorporated into different areas of health and can be considered to be a distinctive feature of a recovery-oriented approach… Taking the whole person into account lies at the base of these approaches, and collaborative action is needed, which acknowledges the multidimensionality of mental health and the impact of social determinants and community action.”
During the last decade, there has been increased interest in understanding and highlighting social determinants of mental health. By using qualitative methods (via interviews, focus groups, and other forms of data collection), researchers learn from those who have experienced psychiatric hospitalization and rehospitalization firsthand. Their insights and expertise about mental health systems and their experiences with social determinants help professionals improve patient-centered care and adjust their recovery models.
Addressing social determinants becomes essential to the recovery process as they increase the likelihood of psychiatric hospitalization, hindering the recovery process. Some social determinants that have been found to be detrimental to the recovery process have been community inclusion (or exclusion), unemployment, and inequality.
The purpose of this study was to explore how community-based actions could support person-centered approaches to psychiatric rehospitalization by looking at how participants relate to their communities and how these influence their daily life and mental health.
The research team facilitated 9 focus groups with 59 participants from Austria, Finland, Italy, Slovenia, and Romania who had experienced psychiatric rehospitalizations. These focus groups were transcribed verbatim and then systematically analyzed to identify recurring themes.
Participants described financial difficulties, challenging family circumstances and situations, and stigma as barriers to recovery that contributed to psychiatric rehospitalization. Financial difficulties were described as not meeting basic needs or choosing to meet some needs and not others.
For some, psychiatric rehospitalization served as a way of meeting those basic needs. However, they also identified interpersonal conflicts with family or community members as a barrier to mental health. Many of these conflicts were the result of stigma and prejudice regarding mental health.
On the other hand, positive interpersonal and community relationships were understood to be facilitators of recovery. This included the relationships with NGOs and other centers in which they received services. Some described NGOs as their second home. Community organizations also provided support, psychoeducation, signposting, and a space in which participants could go about their daily activities, all of which were identified as buffering the chance of rehospitalization.
Among the subthemes identified as fostering recovery were family and friends, work and recreation, hope (both individual and societal), and meaning (both personal and environmental).
Family and friends referred to feeling connected to family, friends, partners, and their community. Positive relationships provided the participants with a reason to recover and a sense of being understood while seeking help. These connections also instilled a sense of hope and meaning.
Hope was also instilled by organizations where services were provided or where they went about their daily activities. When service providers in these spaces acknowledged their humanity and identities beyond their diagnoses, participants also reported feeling a sense of hope in society.
Participants felt meaningful when using their lived experience of psychological distress and navigating the mental health system as peer support, mentoring, or advocacy. In addition, having personal and environmental meaning (or things in the external environment that were important to the participants) – such as gardening, taking care of pets, or being in nature – were also important factors in the recovery process.
By listening to those who have experienced psychiatric services firsthand, the researchers were able to identify barriers to and facilitators of rehospitalization and described some of the important experiences in the process of recovery.
Taking their experience and expertise into account, mental health professionals interested in person-centered care and who are committed to recovery should be able to better attend to the needs of their patients before their hospital leave by fostering meaning, hope, and positive relationships during their stay while making sure patients can meet their needs, find meaning, and will make positive connections with others after leaving.
Further research and practices should attend to the distal social determinants that influence the barriers and facilitators that influence rehospitalization and recovery.
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Cresswell-Smith, J., Donisi, V., Rabbi, L., Sfetcu, R., Šprah, L., Straßmayr, C., Wahlbeck, K., & Ådnanes, M. (2021). ‘If we would change things outside, we wouldn’t even need to go in…’ supporting recovery via community-based actions: A focus group study on psychiatric rehospitalization. Health expectations: an international journal of public participation in health care and health policy, 24 Suppl 1(Suppl 1), 174–184. https://doi.org/10.1111/hex.13125 (Link)
