From adherence to self-determination: evolution of a treatment paradigm for people with serious mental illnesses.
Treatment adherence and nonadherence is the current paradigm for understanding why people with serious mental illnesses have low rates of participation in many evidence-based practices. The authors propose the concept of self-determination as an evolution in this explanatory paradigm. A review of the research literature led them to the conclusion that notions of adherence are significantly limited, promoting a value-based perspective suggesting people who do not opt for prescribed treatments are somehow flawed or otherwise symptomatic. Consistent with a trend in public health and health psychology, ideas of decisions and behavior related to health and wellness are promoted. Self-determination frames these decisions as choices and is described herein via the evolution of ideas from resistance and compliance to collaboration and engagement. Developments in recovery and hope-based mental health systems have shepherded interest in self-determination. Two ways to promote self-determination are proffered: aiding the rational actor through approaches such as shared decision making and addressing environmental forces that are barriers to choice. Although significant progress has been made toward self-determination, important hurdles remain.
College of Psychology, Illinois Institute of Technology, 3424 S. State St., Chicago, IL 60616, USA. corrigan@iit.edu
Patrick W
PW
Corrigan
Beth
B
Angell
Larry
L
Davidson
Steven C
SC
Marcus
Mark S
MS
Salzer
Petra
P
Kottsieper
Jonathon E
JE
Larson
Colleen A
CA
Mahoney
Maria J
MJ
O'Connell
Victoria
V
Stanhope
D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D055317:Evidence-Based Practice; D015438:Health Behavior; D006801:Humans; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D010349:Patient Compliance / Q000523:psychology*; D010358:Patient Participation / Q000523:psychology; D026684:Personal Autonomy