Improving empowerment of people with severe mental illness by community mental health care

Despite the improvement of empowerment is a crucial target of contemporary mental health care it has rarely been investigated as primary outcome in studies on the evaluation of services for people with severe mental disorders.

In this study the effectiveness of an implementation of a community mental health care intervention (GBV) in addition to routine care on the empowerment of people with severe mental disorder will be investigated.

In a randomized controlled trial 927 persons were assigned to the GBV intervention (n = 470) or to care as usual CAU (n = 457). Assessments were made at baseline and four follow-ups over 24 months. Primary outcome was empowerment, measured by the empowerment assessment scale (EPAS). Secondary outcomes were functional impairment, measured by the Health of the Nations outcome scale (HoNOS), quality of life, measured by the World Health Organization Quality of Life short form (WHOQOL-Bref), service satisfaction, assessed by the Client Satisfaction Questionnaire (CSQ-8) and met and unmet service needs, measured by the Camberwell Assessment of Needs (CAN). Data were analyzed at an ITT basis by means of mixed effects regression models.

Results of the mixed effects regression models revealed significant improvements of all study outcomes in both groups. Significant interaction effects indicate stronger improvements in the intervention group GBV compared to CAU for the primary outcome of empowerment (d = 0.27), quality of life (d=0.22); service satisfaction (d=0.46), number of met service needs (d=0.19), proportion of met needs to total needs (d=0.26), proportion of unmet needs to total needs (d=-0.26).

The implementation of the GBV intervention in addition to CAU in the German health care system is associated with a stronger improvement of empowerment, quality of life, service satisfaction and an improved need orientation of mental health care in patients with severe mental illness.