First-episode psychosis typically emerges during late adolescence or young adulthood, interrupting achievement of crucial educational, occupational, and social milestones. Recovery-oriented approaches to treatment may be particularly applicable to this critical phase of the illness, but more research is needed on the life and treatment goals of individuals at this stage. Open-ended questions were used to elicit life and treatment goals from a sample of 100 people hospitalized for first-episode psychosis in an urban, public-sector setting in the southeastern United States. Employment, education, relationships, housing, health, and transportation were the most frequently stated life goals. When asked about treatment goals, participants' responses included wanting medication management, reducing troubling symptoms, a desire to simply be well, engaging in counseling, and attending to their physical health. In response to queries about specific services, most indicated a desire for both vocational and educational services, as well as assistance with symptoms and drug abuse. These findings are interpreted and discussed in light of emerging or recently advanced treatment paradigms—recovery and empowerment, shared decision-making, community and social reintegration, and phase-specific psychosocial treatment. Integration of these paradigms would likely promote recovery-oriented tailoring of early psychosocial interventions, such as supported employment and supported education, for first-episode psychosis.
Nonaffective psychotic disorders often emerge during late adolescence or early adulthood, a time in life when individuals normally achieve important educational, vocational, and relationship milestones. People with emerging schizophrenia spectrum disorders are often derailed at this stage, developing significant educational, occupational, and interpersonal deficits (Hafner et al., 1995). The early stages of psychosis are often considered to be a “critical period” (Birchwood, 1999), as long-term follow-up studies show that two-year outcomes strongly predict longer-term illness outcomes (Harrison et al., 2001). Evidence suggests that treatment is more effective when implemented earlier, though early intervention is a relatively new concept in the mental health field (Drake et al., 2000).
The early intervention paradigm involves timely, phase-specific initiation of both pharmacologic and evidence-based psychosocial treatments. Yet, these ideal approaches are often complicated by little availability of specialized services and problems with patients' insight and adherence. Impaired insight, which is not a willful denial but rather a part of the illness itself, commonly results in noncompliance with medications and psychosocial interventions (Lysaker and Bell, 1994, Burton, 2005 and Tasang et al., 2009) and differences in treatment goals between patients and their providers only compound this situation (Chue, 2006 and Diamond, 2006). To bridge this gap, the recovery model, a more personalized and patient-centered approach to caring for persons who have mental illnesses, has emerged (Jacobson and Greenley, 2001).
The traditional medical concept of “recovery” (i.e., a person is cured from or no longer contends with an illness), has been replaced by some within the medical field with a new conceptualization, which is believed to better account for the oftentimes persistent nature of serious mental illnesses. Within this framework, recovery is thought to be a process rather than an outcome, and is focused on the individual and his or her journey toward attainment of personal recovery and life goals, rather than just the absence of symptoms (Buckley et al., 2007). Fundamental elements of the recovery model include consumers assuming more responsibility in developing plans for achieving their goals, and working collaboratively with mental health providers and their support systems (Jacobson and Greenley, 2001).
To embrace the recovery model, clinicians, researchers, and program planners must understand consumers' own goals. At present, there is a paucity of research investigating what people with first-episode psychosis want from treatment. The objective of this investigation was to summarize the life and treatment goals of a sample of individuals hospitalized for treatment of first-episode nonaffective psychosis, along with their perception of how mental health professionals could assist them. Understanding their goals may reveal essential implications for recovery-oriented tailoring of early psychosocial interventions.
