Elsevier

Psychiatry Research

Volume 249, March 2017, Pages 94-101
Psychiatry Research

Perceived assistance in pursuing personal goals and personal recovery among mental health consumers across housing services

https://doi.org/10.1016/j.psychres.2017.01.013Get rights and content

Highlights

  • Supported-housing residents had more personal goals than group-home service recipients.

  • Supported-housing residents had more proactive, self-improving goals than group home residents.

  • Regardless of their type, having personal goals are associated with recovery and rehabilitation.

  • Perceiving practitioners as helpful in pursuit of personal goals is related to personal recovery.

Abstract

Personal goals/plans play a central role in personal recovery and psychiatric rehabilitation of persons with mental illnesses. Yet, few studies have explored whether perceiving practitioners' assistance towards the pursuit of goals are associated with personal recovery and other favorable rehabilitation outcomes. A total of 2121 mental health consumers, of which 1222 use supported-housing services and 899 use group-home services, completed self-report questionnaires as part of a larger quality-assurance study conducted during the years 2013–2014. Eighty percent of participants living in supported-housing and 72% living in group-homes reported having personal goals/plans for the forthcoming year. Furthermore, their type of goals was different. Irrespective of the type of goal or housing service, participants who reported having goals/plans (compared with those who did not) showed higher levels of personal recovery and more favorable psychosocial outcomes. Regression analyses showed that perceiving professional staff members (but not para-professionals) as assisting in pursuing goals/plans was positively associated with personal recovery. This study empirically validates the value of having personal goals and professionals' assistance in pursuing goals/plans in regards to personal recovery. We propose that recovery-oriented services should seek to enhance goal setting and goal-pursuit, and to train practitioners in these areas.

Introduction

The field of mental health has been on a transformational path since the mid-1990s, with policy and practice shifting from a sole focus on clinical treatment of symptoms towards a recovery-oriented approach (Adams and Grieder, 2005, Anthony, 1993, Borg et al., 2009, Davidson et al., 2009). In parallel, a distinction has been made in the literature between clinical recovery and personal recovery. The former is commonly understood as an objective outcome judged by an observer with emphasis on symptom reduction and effective treatment (Andersen et al., 2010, Slade, 2009, Slade, 2010), while the latter – personal recovery – refers to subjective experiences involving a process of transformation in attitudes to life and illness, with emphasis on the role of hope and optimism about the future despite mental illness (Andersen et al., 2003, Andersen et al., 2010; Leamy et al., 2011). Individuals with mental illnesses in personal recovery report on empowerment and community integration and take-on responsibility for their own well-being (Deegan, 1996, Moran and Nemec, 2013). Internationally, mental health systems are veering services to a personal recovery focus (Slade, 2010), and this more subjective and psychological aspect of recovery is also the area of interest in the present study (henceforth on referred to as "recovery").

Goal striving is known as a facilitator of psychological recovery (Andersen et al., 2003). Recovery occurs when individuals with mental illness discover, or rediscover, their strengths and abilities for pursing personal goals that allow them to grow beyond their mental illness and develop a sense of identity (Mueser et al., 2002). Slade (2010) further proposed to include personal goals in service evaluation, in addition to the traditional focus on attainment of valued social roles. This addition is expected to support the development of new meaning and purpose in one's life. Personal goals are closely related to the recovery process because they are often accompanied by self-directedness enabled by having a sense of hope (Andersen et al., 2003; Deegan, 1996; Leamy et al., 2011). The association between hope and goal striving can be understood on basis of the Snyder's hope theory: in his theory Snyder defines hope as comprising of: (i) identifying goals, (ii) developing pathways to meet desired goals, and (iii) a belief in one's ability to attain goals. Snyder et al. (2006) has suggested that the hope construct may be helpful in fostering adaptive rehabilitation processes. Along similar lines, Clarke et al. (2006) maintained that, establishing personally meaningful goals with people with psychiatric disabilities promotes hopefulness and motivation regarding one's recovery. Generally, goal setting is an important part of psychosocial rehabilitation and a focus of many case-management interventions. An illustrative example is the Collaborative Goal Technology which is a goal striving technology used to support the autonomy and recovery processes of persons with psychiatric disabilities (Clarke et al., 2006). Training staff in goal setting techniques was found to significantly improve the frequency and quality of documenting goals by the consumers (Clarke et al., 2009a). Yet these studies did not examine the association of personal goal formulation, per se, with personal recovery. Such a putative association was tested in the present study.

Many psychiatric rehabilitation programs have incorporated support for pursuing personal goals as part of the treatment protocol. For example, in a study employing the Boston University model of Diagnosis, Planning and Intervention, 65% of consumers had largely achieved their self-formulated rehabilitation goals and manifested significant improvement in psychosocial functioning (Svedberg et al., 2014). Additionally, psychiatric rehabilitation services were found effective in attainment of self-formulated rehabilitation goals and societal participation as compared with a control group (Swildens et al., 2011). Finally, psychosocial interventions have resulted in an increase in mean goal-attainment scores (Tabak et al., 2015). Yet, none of these studies tested the association between pursuing personal goals and the experience of personal recovery.

Only one study tested the associations between case management goal-attainment and progress in psychological recovery over a three month period (Clarke et al., 2009b). Goal attainment was found to mediate the relationship between symptom distress and self-rated recovery. More research with larger samples and more diversified rehabilitation settings that focus on pursuing short and long term goals is needed. Furthermore, such a line of inquiry can help establish if the support by mental health practitioners in attaining these goals plays a role in the promotion of personal recovery. The current study seeks to address these gaps in the literature. Herein, we sought to examine the relationship between personal recovery and goal-setting/striving, and, in a first effort of its kind, to determine whether the level of a consumer's recovery is influenced by the level of perceived assistance of mental health service providers towards achieving personal goals.

In numerous countries, policy makers and stakeholders have been exerting systemic efforts to develop a recovery-oriented, person-centered approach to mental health services. In particular, in Israel, the year 2000 witnessed a crucial step towards the advancement of this agenda: legislation of the Rehabilitation in the Community of Persons with Mental Disabilities Law (RMD, 2001; Aviram, 2010; Hornik-Lurie et al., 2012; Lerner et al., 2012: Shershevsky, 2006). In addition to providing mental health consumers with an array of support systems, services and resources the RMD has facilitated the development of a diverse array of housing services, including: 1. Independent living arrangements with one to five participants in shared flats in the community (supported housing) with staff visits on a regular basis 1–5 h a week. 2. Group-homes (also named 'hostels') with about 20–30 tenants, involving 24-h wrap-around services and support. Consumers are assigned to supported-housing or to group-homes by a committee, based on functioning levels of these persons as defined by the RMD. Group-home residents will often need and receive more intensive services from mental health staff than do residents of supported-housing services. Mental health staff include both professionals—e.g., social workers and occupational therapists who support residents in their goal strivings and rehabilitation plans and non-professionals (also termed ‘rehabilitation instructors’) who are non-trained individuals who provide more tangible supportsand attend to needs and activities of daily living (ADL). A major challenge in these services continues to be helping individuals pursue and meet personal goals (Lerner et al., 2012, Moran et al., 2015).

This study was designed to examine several aspects of goal-associated characteristics and outcomes among a large sample of residents living either in supported-housing facilities or in group-homes, across several districts in Israel. First, we sought to find out how many of the residents of these housing facilities have personal goals and rehabilitation plans, and to examine the type of goals/plans they have. Second, we wanted to determine whether those reporting having personal goals and plans for the near future report better personal recovery and more favorable psychosocial outcomes (specifically, with respect to employment status), compared with those who do not report having such goals. Third, to investigate nearly for the first time in a large scale study whether those residents who reported that the rehabilitation team (professional and non-professional staff members) assist them in pursuing their goals would experience enhanced recovery. Lastly, we aimed to explore whether having more intensive contact with staff in group-homes as compared with the lower intensity of contact that exist in supported housing tenants, would have impact on goal setting and pursuit of goals among mental health consumers residing in these two housing settings.

A secondary focus of this study involved the examination of several factors' impact on the magnitude of perceived recovery, including the specific types of personal goals, the type of rehabilitation staff (professional vs. paraprofessional) and/or the type of residential service.

Section snippets

Design and procedure

The present study was carried out as part of a larger quality assurance project that took place during the years 2013–2014: a study on satisfaction with rehabilitation services and quality of life among persons with mental illness who are entitled to rehabilitation and receive Psychiatric Rehabilitation Basket services under the provision of the RMD. Receiving rehabilitation services is contingent upon having been diagnosed with mental illness which has caused at least a 40% psychiatric

Results

The characteristics of persons with and without defined personal goals by housing setting are presented in Table 1. Statistical analyses of the data yield several notable findings, as outlined below.

Discussion

Transition of the field of mental health to a person-centered, recovery-oriented focus elicited the need for rehabilitation services to support consumers’ capacity to set and pursue personal goals (Clarke et al., 2006, Davidson et al., 2009; Slade et al., 2014). This study examined whether 2121 mental health consumers who reside in diverse housing services report having personal goals and rehabilitation plans, and whether having such goals or plans is associated with personal recovery.

Acknowledgements

The authors wish to thank Ronit Dudai and the team of the Rehabilitation Unit at the Department of Mental Health in the Israeli Ministry of Health Office, for the promotion and the financial support of the program.

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