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The Role of Patient Activation in Psychiatric Visits

Dr. Salyers, Ms. Lydick, and Dr. Rollins are affiliated with the Department of Psychology, Indiana University-Purdue University Indianapolis LD 124, 402 North Blackford St., Indianapolis, IN 46202 (e-mail: mpsalyer{at}iupui.edu). Dr. Salyers is also with the Richard L. Roudebush Department of Veterans Affairs Medical Center, Indianapolis, with which Dr. Frankel is affiliated. Dr. Frankel is also with the Department of Medicine, Indiana University School of Medicine, Indianapolis. At the time of this study, Dr. Matthias was with the Department of Communication Studies, Butler University, Indianapolis, Indiana, and Ms. Spann was with the Department of Psychology, Howard University, Washington, D.C.

OBJECTIVE: This study identified ways that consumers of mental health services are active participants in psychiatric treatment. METHODS: Four providers (three psychiatrists and one nurse practitioner) were recruited, and ten consumers with severe mental illness were recruited per provider (40 total). Consumers completed questionnaires on patient activation, illness self-management, and medication attitudes on the day of a psychiatric visit. The visit was audiotaped, transcribed, and thematically analyzed. Providers gave information on diagnosis, substance use disorder, and medication adherence. RESULTS: Consumer-rated patient activation was positively related to illness self-management and negatively related to substance use disorder. Transcripts of the psychiatric visit showed that consumers were active in partnership building, seeking and displaying competence, and directing treatment; however, the relationship was weak between consumer-reported activation and observed activation behaviors. CONCLUSIONS: Consumers were found to be active participants in treatment in a variety of ways, but similar to other populations, the relationship between observed patient activation and consumer-reported desire for involvement was not direct.

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