Outpatient Treatment Adherence and Serious Mental Illness: A Review of Interventions

Abstract

Despite the availability of a broad array of efficacious pharmacological and psychosocial treatments for individuals with serious mental illness, treatment nonadherence remains a major obstacle to recovery. The current article reviewed research on the effects of interventions specifically designed to enhance outpatient treatment adherence with this population. To locate articles, we conducted computer searches of the PsycInfo and Medline databases and manual searches of the reference sections of mental health treatment adherence reviews. We restricted our search to articles published in peer-reviewed journals as a way of establishing some level of quality control. Of the interventions reviewed, assertive/intensive case management improved outpatient treatment retention and behavior therapy enhanced medication adherence. Further development work is needed to broaden the scope and applicability of strategies available to help individuals with serious mental illness make use of treatment.

Keywords:

• Chronic mental illness
• Treatment
• Treatment compliance

Notes

DX = diagnoses, MISA = individuals with mental illness and substance abuse problems, TX = treatment. All studies conducted in the United States unless otherwise specified.

Notation in columns indicates number of studies demonstrating a favorable effect of the intervention over the total number of studies examining the intervention using any measure of adherence. Two studies examined both behavior therapy and psychoeducation interventions.

Notation in columns indicates number of reports of a favorable effect of the intervention on the given dependent measure over the total number of reports examining the intervention on the given dependent measure. The numbers within and across type of dependent variable are not independent; some studies contributed multiple figures.

∗Supported by at least two controlled trials (and more independent studies than not).