Citation: Kelly, M. & Boyd,
C. (2006). Promoting the Psychosocial Functioning of Young Adults
through Psychiatric Residential
Rehabilitation: A Qualitative Evaluation of the Making a Significant
Change (MASC) program. International Journal
Rehabilitation. 10 (2), 139-153 .
Corresponding author:Dr Candice
Rural Adolescent Mental
Centre for Health Research and Practice University of Ballarat Ballarat, Victoria,
and purpose of the study This research evaluated the Making a
Significant Change (MASC) program – the only residential psychosocial
rehabilitation program for young adults in the Grampians region of Victoria, Australia.The program provides
intensive support and
rehabilitation services to young people aged 16 to 24 years who have a
illness and are at risk of developing further mental health
disabilities. This evaluation
aimed to establish a holistic view of the program with a focus on the
of rehabilitation rather than a pure examination of the outcomes.The purpose of the evaluation was to provide
descriptive data for key stakeholders in the service so that the impact
intervention approaches could be gauged. Methods A qualitative methodology explored the
attitudes and perceptions held by consumers and staff of the MASC
were collected through in depth semi-structured interviews with seven
participants (four consumers and three staff).These data were triangulated with consumers’ case histories and
individual program plans. Findings The evaluation found that all of the
domains of psychosocial functioning were covered efficiently within the
program and that skills learnt during this process built resiliency
most consumers to obtain a comfortable lifestyle for themselves.Areas of program delivery which could benefit
from revision included modification of the initial stages of entry into
program and immediately after discharge from acute inpatient hospital
admissions. The importance of considering the needs of staff to
feelings of frustration and complacency was also highlighted. Key Words:Psychiatric Residential Rehabilitation,
Young Adults, Qualitative Methods
Introduction An estimated 634,000 young adults in Australia
experience a mental health disorder (Blair, Burthon, Silburn &
2000). The issues related to mental illness for young adults are
reach into many domains of an individual’s life. The first episode of a
disorder can exacerbate normal developmental issues experienced during
life stage, affecting psychosocial functioning that is critical to an
individual’s social and emotional wellbeing (Harrop & Trower,
Studies have indicated that psychotic disorders, anxiety disorders and
disorders produce deficits in psychosocial functioning in adolescence
adulthood. Such deficits include impaired academic and occupational
functioning, social difficulties, poor peer relationships, lowered life
satisfaction, increased adversity, increased treatment utilization,
arrests and reduced global functioning (Gotlib et al., 2003; Reinherz,
Giarconia, Carmola Wasserman & Silverman, 1999).
High-risk behaviours can
serious deficits in psychosocial functioning for young adults
mental illness (Davis et al., 2000). Such high-risk behaviours include
increased alcohol and drug use, self-harming, unsafe sexual behaviour,
driving, aggression toward others and an increased risk of suicide
McLaughlin, Pepper & Minkoff, 1991; Siegfried, 1998; Rayner &
2003; Burnely, 1994). The risk of suicide is exacerbated by complex
issues such as family breakdown, unemployment, low self-esteem,
poverty and drug and alcohol abuse (Burnely, 1994). Further
established can prove to be resistant to change in later adulthood
Psychosocial Functioning as a Treatment Modality Findings from past research
suggest that effective
intervention with young adult consumer groups require approaches that
multiple complex domains in order to foster resilience and build skills
(Fuller, 1998; Fuller, McGraw & Goodyear, 2002; Kosky, 1992 &
& Furlong – Norman, 1989). A large Australian found young people
support, belonging, sense of citizenship, ability to contribute, a
mastering and connectedness to family and peers as important skills for
promoting resilience and well being (Fuller, 1998). When effective,
intervention approaches act to reduce the impact of suicidal ideation,
self-harming behaviours, aggression, substance abuse and mental health
(Kosky, 1992; Nemec et al., 1989). Psychosocial interventions employ
aimed at decreasing symptoms and maladjustment by improving adaptive
functioning (Gotlib et al., 2003; Geller, Zimmerman, Williams,
Craney, 2001). Such processes include the attainment and development of
through learning and motivation to improve affect, cognitive processes,
behaviour, interpersonal interactions and self-confidence.
The Making a
Significant Change Program
‘Making a Significant Change’ program (MASC) is provided by Centacare
in Victoria within their
disability rehabilitation and support service (PDRSS). Such programs
designed to compliment clinical mental health services by providing
psychosocial assessment, rehabilitation and support (Department of
Services, 2003). Non-government organisations in the community manage
programs statewide (Department of Human Services, 2003).The MASC program services the Grampians
region operating from the regional city of Ballarat.
The total population of the
Grampians region is estimated at 202,952 residents (Australian Bureau
Statistics, 1999). Of the total population, an estimated 23,888
aged between 16 and 24 years (Department of Infrastructure, 2000).
The MASC program provides intensive support
and rehabilitation services to young people aged 16 to 24 years who
mental illness and are at risk of developing further mental health
disabilities. Examples of common illnesses within the consumer group
schizophrenia, bipolar affective disorder, and depression. The MASC
a relatively new program, operating since 1999. The program aims to
short-term intensive support to improve the mental health status and
life of consumers (Centacare & Ballarat Psychiatric Fellowship,
1998).The promotion of psychosocial
aims to decrease high risk behaviours, build skill mastery and improve
confidence before young adults are supported to reintegrate into their
rural communities (Centacare & Ballarat Psychiatric Fellowship,
solution-oriented approach is adopted to compliment the framework of
psychosocial rehabilitation in order to guide “the process of
individual’s restoration to an optimal level of independent functioning
community…” (Cnaan et al., 1988).
There are three levels of support offered by
the MASC program: Intensive rehabilitation is provided within a
rehabilitation setting that is staffed seven days per week from to , with the option of twenty-four
hour support if the need arises (Thorne & Davis, 2000). The second
support involves home-based outreach in which consumers work with staff
less intensive basis. Support is offered to assist consumers and where
necessary carers, with the transition phase of returning to local
(Thorne & Davis, 2000). The third level of support
consultation, where staff work closely with rural providers of services
establish continuity of care throughout the transition phase and to
ongoing care where necessary after the consumer exits the program
Each level aims to support consumers
maintain their mental health and overcome high-risk behaviours by
skills in the areas of mental health, budgeting, recreation, social
motivation, education, employment, working toward living independently,
utilizing community services and family reconciliation (Thorne &
2000). Individual program plans are used to explore and identify the
consumers, establish a plan of action and to monitor progress (Thorne
Aims of the Study
This study aimed to establish a holistic
view of the program with a focus on the process of rehabilitation
rather than a
pure examination of the outcomes. The first aim was to determine the
and perceptions that participants had toward the role of rehabilitation
the recovery process for young adults experiencing mental illness. The
aim was to identify the attitudes and perceptions participants had
intervention strategies currently employed. The third aim was to
extent to which it is perceived that the lives of consumers had changed
participating in rehabilitation. The fourth aim was to explore the
participant’s perceptions of what the future holds for consumers.
study involved seven participants, three staff members and four
Demographic information obtained from consumers included age, gender,
diagnosis, secondary diagnosis, identified high-risk behaviours and
program. To build a profile of the MASC consumer population,
information was obtained for each individual who had accessed the
during the time of its existence (i.e., 1999 to 2004). The mean age of
consumers was 21.16 years of age (N=57). The mean length of time spent
program was 8.42 months. The most commonly occurring primary diagnosis
schizophrenia (45.6%), followed by a drug induced psychotic episode
depression (15.8%) and bipolar affective disorder (8.8%). Co-occurring
illness was noted in 45.6% of consumer cases. Drug induced psychotic
(30.8%) were the most common co-occurring diagnosis followed by
(19.2%).The most frequent high-risk
behaviours acknowledged at time of entry into program for all consumers
drug and alcohol abuse or dependence (82.5%), previous acute inpatient
admissions (73.7%), previous suicide attempt (42.1%), self-harming
(36.8%) and history of aggressive acts towards others (36.8%).
Materials Semi structured
Semi-structured interviews were considered
to be the most effective method of acquiring an overall view of the
whilst allowing the exploration of alternative issues if they arose.
ndividual program plans, activity
timetables and communication notes that record the daily activities of
consumers were used to produce a series of case histories. Individual
plans are a mandatory component of the program and reflect a number of
key aspects. These aspects include mental health, drug dependencies,
health, family, education, personal appearance, hygiene, diet,
creative personal expression, vocational training, exit plan and are
used toidentify difficulties for
goals, monitor current status and record action taken to date.
program plans are reviewed on a six monthly minimum basis.
Data triangulation refers to the use of
multiple sources of data for providing information (Flick, 2002;
2004; Patton, 2002). For the purpose of this study, the process
building thematic conceptual matrices of the information obtained from
interviews, consumer interviews and case histories (see Miles &
1994 for more on matrix displays).
approval was granted by the University
of Ballarat’s Human
Committee. All ethical principles were followed in the course of
were conducted for approximately an hour and a half and were
were conducted by the first author, who was also a casual employee
at the time.This dual role was managed by
stressing to all participants that the research was being conducted by
the University of Ballarat
The staff interviews were performed on an
individual basis by the first author. Interviews with consumers were
as a group interview at the request of participants. The audio
interviews were transcribed following completion. Transcripts were
following the qualitative data preparation and transcription protocol
by McLellan, MacQueen and Neidig (2003).
Process of Data
An approach to thematic coding based on
constant comparative methods was used to analyse the transcribed
(see Dye, Schatz, Rosenberg, & Coleman, 2000 for description of
processs) . Data analysis was carried out by the first author and
consulation with the second author who acted in a supervisory capacity.
addition to the data obtained from interview, summaries of
and activity timetables obtained from individual program plans were
were then built into matrix displays to allow ease of comparison across
and cross-referencing between program documents and the attitudes and
perceptions of participants.The final
results comprise a series of thematic descriptions, incorporating data
these multiple sources as well as selected quotations from the study’s
participants.Themes also relate back to
the study’s four main research aims.
Theme 1: Attitudes and
Perceptions Participants Had Toward the Role of Rehabilitation within
Recovery Process They wouldn’t be
in this program if they hadn’t had a major
psychiatric episode…that they didn’t have high-risk behaviours like
or self harm or suicidal thoughts…or all of the above (staff)
Perceived Purpose of
perceived the purpose of the program was to restore consumer’s previous
of overall functioning to enable them to live independently within the
community.It was perceived that to
achieve this, the program served as a place to establish social
a supportive and non-judgemental environment free from stigma.
Some of these guys
have done some pretty horrific things in the
past and been in some really quite… antisocial settings so to actually
accepted for some of that stuff where no one else has accepted them is
good starting point” (staff).
It pulls people
out of holes a lot you know… someone I knew was
like… in real trouble and MASC pulled em out of trouble and gave em a
in a new place” (consumer).
like ours are there to transit these kids through that pretty rough
they come out the other end… having learnt to be independent (staff).
Perceived Role of Rehabilitation in Overcoming Mental Health Issues and
Risk Behaviours I
didn’t even know what psychosis was I just thought things (laughs)
going well (consumer). Common
perceptions of the role of rehabilitation in overcoming mental illness
restore self-esteem and confidence through support and education on
precipitating factors. Prevention and intervention to overcome
behaviours and links into other agencies were identified as being
within the recovery process. Cross references with individual program
highlighted the role of the program in supporting consumers through the
differing phases of illness.
Yeah I lost a lot
of confidence from my last…psychosis so… I gotta
build it back up again (consumer).
It’s been like a
year now and I haven’t used em coz I know if I do
I will probably get sick again and end up in psychosis and end up back
psych ward and I will probably never come good again (consumer).
There’s a lot of
agencies and things that they’ve got access to
that help you in a lot of different ways (consumer).
If there’s drugs
and stuff happening…if you’re at home and you
stuff up a couple of times and you’re gone, but you get a few chances
realize what’s the right thing to do (consumer).
of Daily Living Skills and General
Health and Well-being Daily living skills
as being promoted within the program were cooking skills, personal
personal care, budgeting, and cleaning skills. Cross references with
program plans also identified physical health, personal appearance and
funding is around daily living and ensuring that they’ve got the skills
after themselves. So, it’d be you know making sure that they learn how
you into things you got to do to get into the normal rhythm of what you
do in life (consumer).
It was acknowledged
that the promotion of well-being worked to rebuild trust, overcome fear
hopelessness. Techniques used to do this incorporated the encouragement
positive family relationships, re-establishing social networks,
in recreational activities, vocational and educational support.
a bit of fun stuff and give yourself good ideas of what to do in the
have a few experiences, you know always having people there to talk to
intelligent and know what you’re talking about (consumer).
I liked being the
footy head and knowin’ a lot of people I like that, I really did like
along with heaps of people and havin’ lots of friends and stuff n I
that’s what broke me for ages (consumer).
2: Attitudes Participants Had Toward the Intervention Approaches
Employed and the Perceived Effectiveness of Those Interventions
If you can’t build
that rapport with the young person then really you’re not going to be
work on any of the other issues. You get a small window and as soon as
window opens, you need to jump in, get in before they shut the window
hopefully you can actually get on with it and move forward (staff). Attitudes towards the Program as
an Intervention Strategy Recurring patterns of consumers
feeling ‘pushed’ whilst in
the program occurred across participants.It was identified that the reactions to being pushed were
the phase of illness. Other patterns indicated that interventions
mostly made consumers feel safe, supported, and secure.Consumer participants expressed appreciation
toward the program for aiding participants to feel well again.
pushing you to be doing stuff and that’s when it sucks, when your in
of depression and you just want to be sitting there (consumer).
really didn’t like being pushed much… but it is a good thing coz it
active… it keeps your mind active, keeps you healthy (consumer). It was
good for me in the whole sense of I wanted to get to a safe place, MASC
like a very safe place coz like you were being supervised sort of…
helped me out a lot just to get well again after the psych ward
(consumer). Formal Strategies Formal strategies explored were the
use of a
solution-oriented approach and individual program planning. Attitudes
these approaches varied across cases. Issues influencing the
individual program plans included time availability and motivation.
Cross-referencing indicated that they were particularly useful in
creative personal expression, family relationships, physical health and
budgeting. Substance use and mental health components had mixed
Education and training had poor outcomes with cross-referencing
lack of interest in pursuing these goals any further.
workers are too busy to pull out everybody’s IPP everyday to have a
look and read
through four pages (staff).
mainly just paperwork really, at least that’s what I seem of em
thought IPPs helped… I had to do things a certain way and I got it done
got it done the way I wanted it coz it helps you to set goals. Oh, but
sometimes when you don’t want to do anything, when you don’t want to be
anything it sucks (consumer).
We are not dwelling
on what happened in the past or what the problem is… we’re actually
look at you know achieving goals for the future (staff).
Strategies Numerous informal strategies
were identified. These included activity timetables that were
cases as effective on a day-to-day basis, role modelling,
the use of general discussion. Cross-referencing with individual
identified the use of ultimatums, intensive key support, music groups,
accessing short courses, liaison with other agencies, redefining
self-boundaries, intensive communication, identity kit lists and stress
your work timetable, on a weekly basis you can pull from that IPP and actually keep it active on a weekly
modelling is the big thing for this program, staff are expected to role
socially acceptable practice (staff).
on I used to talk to [name] every morning for two hours, every morning
to sit down and have a cup of coffee and a smoke and just talk
Specialised Strategies Across cases, harm
approaches were consistently reported as an effective way of reducing
severity of high-risk behaviours. Other interventions identified were
of urine screens, drug diaries and consultancy and collaboration with
specialised services. External services included a drug and alcohol
unit, drug and alcohol counsellors, peer support networks, community
services and the utilisation of case management from psychiatric
revealed the use of
alcohol agreements, random breath testing, and implementation of post
know it relaxes me I enjoy it but only in moderation. It fucks me up if
too much… (consumer).
quite strange that three pieces of paper and a little coloured book may
answer for some of these young people (staff).
Depending on what
the consumers needs are quite often find that they don’t want extra
They would rather… deal with their issues in house and you know that is
concern because the staff aren’t actually employed as drug and alcohol
or dual diagnosis workers (staff).
Perceptions of the Work Carried Out by Staff
Across cases, it was perceived that
staff members were
conducting their work well. Staff participants identified that the area
frustrating and that the work was difficult. However, their responses
that they perceive their positions and the work that they conduct as
Consumer participants described feelings of admiration of the staff’s
feelings of grief during periods of staff turnover and that they are
involved in the lives of consumers. I don’t
know if they could improve, they interact unreal I reckon, they really
in-depth in all their lives pushin’ the right directions and stuff you
they do a good job I reckon (consumer).
One of the big
things for staff is that we get complacent with what we’re working
forget that these people are in the program for a reason and they are
extreme end of the scale and I mean we’re working with them everyday
Employed by Staff to
Overcome Feelings ofFrustration Strategies that were
reported as useful for staff were the feedback from external sources,
of supervision, using a positive outlook, and the ability to separate
professional and personal roles.
learnt that what I thought were the important issues sometimes aren’t
important issues (staff).
over that five year period I learnt to look for more positive then I
extremely important that staff actually meet supervision guidelines
learnt over the years that you have to have a cut off point between
and the young people that your working with (staff).
Theme 3:Extent to
Which the Lives of Consumers Had
Changed Resulting From Participating In Rehabilitation I guess making friends in new
places is good
and figuring out them people aren’t everything in your life and other
are more important like your actual proper friends and your family and
you’re living a good life and stuff is better then worrying about a
people and what they dislike about ya (consumer).
Term Impact The expansion of
was identified by all participants in the study. Other persistent
emerging across cases were improved family relationships, restoration
confidence, a sense of belonging, attachment and acceptance and the
of positive outlooks, which included hope for the future, aspirations,
was the most important thing, finding companionship and good friends
I’ve always wanted to do something with my music so in the next however
something happens and I actually get to play somewhere that will be a
actually taken them out and done stuff like jumping off cliffs with all
safety harnesses on and all that sort of stuff. So that they can
experience you know that it’s ok to jump off a cliff… its safe, you
just as safe to go out and go for a job (staff).
Term Impact Perceived changes that
to influence the lives of consumers into the future included improved
employment prospects, relocation from their place of origin, obtaining
of achievement and the establishment of family relationships in
where they previously did not exist. Cross-references with individual
plans showed consistent changes across cases showing that participants
maintaining healthy family relationships, completed training programs,
currently living independently with intensive outreach support.
actually achieved stuff and they’re actually happy with their lives.
there’s people out there who are still using drugs but their living
independently and they’re happy with their lives and they’re actually
young person actually sess their child on a monthly basis now with
and that child is actually going to have a father in his life (staff).
Some of the guys
leave the Grampians region altogether, they decide that it’s better to
fresh start (staff).
Well Being and the Daily Living
Skills of Consumers Improved overall
improved nutrition and diet were reported across all cases. Other
patterns were improved physical health, overcoming fears and improved
life satisfaction. Cross references with individual program plans
changes across cases related to improved personal hygiene and physical
and an ability to manage own finances.
feedback that we get from family and other people are that yes this
doing really, really well compared to what they were before they came
go shopping, we can get videos, we can drive down the street, we can
takeaway, we can go away, we can go back to [town] but leave whenever
we can go on a holiday up the Murray and go
on the Management of Mental
Health Issues and High Risk Behaviours A theme that
emerged across all
cases was that the mental health status of consumers improved with a
in high risk behaviours.Furthermore,
raised awareness of the impact of high risk behaviours was thought to
insight and assist consumers to overcome negative issues related to
illness. Cross-referencing indicated that all participants showed a
in substance use over the course of their time in the program and that
illnesses were currently in remission.
healthy like you know I’m not sick in the head or the body or anything
that and I’ve got friends and social networks and I’ve got family
reduced his drug use… his mental health improved, and his social shills
improved… so it was working on drugs worked into mental health worked
social skills (staff).
Participants’ Perceptions of What the Future Holds For Consumers Immediate Future A theme
that emerged across all cases was that participants
perceived a future for consumers where they would have to deal with a
anonymity and social stigma. For example, there was a perceived
consumers to return to their place of origin. Other patterns across
was the perception that some consumers will be able to overcome their
illness and others will need long term psychiatric care in the future.
it now, I just go there and I get this eerie feeling, I’m avoiding
people and I
don’t want to go up the street coz I might see em and I might have to
I’m just thinking
of a couple of people who have been through this program and they’ve
in longer term psychiatric facilities (staff).
Term Future Reported
consumer hopes for the future were
similar across cases; these included gaining employment, developing
relationships, having a license and a vehicle. Other emerging patterns
relocation from place of origin and the resolution of issues after
another car and get back on the road again, bit more freedom, maybe get
girlfriend one day… maybe have a family one day, buy me own house…
be good (consumer).
years I’ve wanted to move away somewhere
real far away (consumer).
Some of the
feedback from families… are actually saying hey look, I know it was
when our son or daughter was here but they’ve followed through you know
Health Status The
overcoming of mental illness and resolution of mental
health issues in the future was a recurring pattern across cases.
responses indicated that they would not disclose their past psychiatric
to others in the future. Staff responses suggested that it was
the prognosis for consumers was either remission or long term
had a girlfriend one day or I just met someone who know nothin’ about
illness I wouldn’t be saying this sort of stuff (consumer).
actually see a good prognosis for most of the people who come through
can’t underestimate that some people do need to have longer term
you know we support… in mental health terms two years is a very short
Well Being and Daily
Functioning Participants perceived that
consumers would feel comfortable with their lifestyles, have an
of self-esteem and confidence and lead an active lifestyle. It was also
perceived that the impact of societal pressure would produce additional
challenges for consumers to overcome in the future.
don’t think its going to get any easier… there may be more challenges
might not be the way that I see it as ideal or the staff see it as
someone else looking into it but I think that the majority of people
actually achieve something and be living the life they want to live
can’t wait to zoom off into the night and go camping all over the
parts that he wanted to see… and he’s you know, I’m well I can do this,
go and see outside the west Grampians area (staff).
study aimed to establish a holistic
view of the MASC program with a focus on the process of rehabilitation
than a pure examination of the outcomes.Overall, the evaluation revealed that all of the domains of
functioning were covered efficiently within the MASC program and that
learnt during this process built resiliency enabling most consumers to
comfortable lifestyle for themselves.Specific
themes emerging from the data enable each of the study’s four main aims
differing perspectives of the impact of psychosocial rehabilitation on
lives of consumers The first aim of the research was to
determine the attitudes and perceptions that participants had toward
of rehabilitation within the recovery process for young adults
mental illness. The broad range of themes and patterns emerging from
demonstrated, from a holistic perspective, the impact of psychosocial
rehabilitation on the lives of young people with a mental illness. Overall,
the program was seen as a place that was non-judgmental in which young
could feel safe, supported, and rebuild their confidence. This was
serving an important role in alleviating anxiety and fostering an
where consumers can work on personal issues without the added burden of
unsettled. All participants in the present study provided positive
regarding the program as a whole. The emphasis of such feedback was on
achievements of the individual consumers. Such positive responses may
reflection of the use of a solution-oriented approach within the
this approach within the program has trained staff and supported
assessing situations and reframing issues from a positive viewpoint on
levels: first, within the program and second, in the other areas of
Consumers also commented on the expansion
of their social networks, benefits of keeping active, the overcoming of
and the restoring hope for the future within a supportive environment.
comparison, staff emphasised issues related to the restoration of
functioning, equipping consumers with skills to enable them to live
independently and the development of positive outlooks. Such
differences in the
perspectives of staff and consumers may be explained in terms of
Participants within the program are motivated to participate in the
individual reasons that reflect their stage of psychosocial
identity formation (Davis et al., 2000). Staff tended to identify in
responses issues that reflect the values reinforced through employment
conditions and professional development training.
In terms of consumer satisfaction,
consumers reported feeling that the site of the program was a good
the experience of participation overall was also good. They felt safe,
and supported most of the time. Such feelings have been described as
or resilient factors against such high-risk behaviours as self-harm,
abuse and aggression (Fuller et al., 2002). Contradictory responses
consumers pointed to feelings of frustration during certain stages of
In particular, a number of consumer responses described a feeling of
pushed. While this is perceived as beneficial by consumers in
hindsight, it was
not appreciated by them during the initial stages on the program or
discharged from psychiatric services. Feeling pushed can leave
feeling frustrated and misunderstood. These feelings have the potential
interfere with building rapport with young people who have particularly
needs and prolong the time it takes to realise the therapeutic benefits
program (Fuller, 1998). Despite this, consumers who participated in
this study have
passed through all of the stages of the program and reported feeling
with the program overall. Consumers also indicated their respect and
regarding the role that staff play within the program.
Two opposing viewpoints emerged from the responses
regarding levels of their satisfaction with the program. On one hand,
recognised that day-to-day work is largely stressful with staff working
hours, combating frustration and feelings of complacency. On the other
the attitudes of staff were positive in nature and it was recognised
although the day-to-day work was challenging, as a whole the work was
Staff emphasised the role of looking for positives, recognising small
achievements and establishing day-to-day living skills as the most
components of the program yet little recognition was given to these
consumers. The emphasis staff placed on these issues may arise from a
define achievable goals in which success can be measured to gain job
satisfaction from a challenging work environment.
differing perspectives on intervention approaches and program delivery
The second aim of this study was to identify
the attitudes and perceptions participants had toward the intervention
strategies employed by the MASC program. Consumers highlighted feelings
being pushed during the initial stages of the program as a limitation
service delivery. Entry into the program is often a period where
acute services has recently occurred and psychosocial functioning is at
lowest point. The impact of acute mental illness during this time
affects most psychosocial
domains on a social, emotional, physical and cognitive level.Factored into this is the perceived
of individual program plans as an intervention approach as well as
feelings of frustration and complacency.
Complacency and high levels of frustration
affect the patience of staff and the time management of day-to-day
tasks. As a
result, individual program plans can be neglected. Complacency may be
consequence of a small team working long hours with complex consumer
needs on a
day-to-day basis. These issues combined with the mandated use of an
intervention approach (individual program plans) that are perceived as
could further exacerbate staff-related frustration and complacency.
Individual program plans were recognised
as the most limited intervention approach employed in the program by
and consumers. This formal approach tends to be effective only when
mental health status is stable and they are motivated to reach defined
Setting goals related to education and employment is not particularly
when basic psychosocial domains are underdeveloped. These two areas of
functioning, employment and education are not perceived as important by
consumers at this stage in their lives. The lack of interest and
from consumers in setting and reviewing goals can frustrate workers
is limited and goals are being ignored or not being reached.
Frustration and feelings of inadequacy in
managing the difficulties posed by consumers can lead to negative
attitudes (Richmond & Foster, 2003). Addressing substance use and
puts additional pressure on staff and consumers when staff members are
trained in this area, and external sources employed to deal with such
not be well received by staff or consumers. For the future of the MASC
it will important that staff are trained further in issues of substance
abuse and be involved in continuing education on the effects of mental
and its treatment.
a whole, the program as an intervention approach was perceived by staff
consumers as considerably effective in supporting young people with
illness to obtain improved family relationships, extended social
improved confidence and greater self-esteem. Development of these
areas of a young adult’s life is particularly important to aid
overcoming high-risk behaviours and the impact of mental illness. The
rebuilding of skills and informal approaches to intervention were
be positive strengths of the MASC program.
Whilst working on the complex
issues experienced by
consumers, obtaining day-to-day functioning skills further promote
functioning and build resilience for consumers. Interventions that
develop skills in daily living and creative personal expression were
by staff and consumers in this study as important. Improved
functioning and resilience act as prevention measures against the
of further disabilities in adulthood (Harrop & Trower, 2003; Fuller
2002; Davis et al., 2000). The program appears to foster a positive
within which consumers feel safe and secure. Feelings of safety and
allow consumers a freedom to develop the differing psychosocial
about themselves and explore different worldviews influenced through
diversity of staff backgrounds and personalities, social relationships
feelings of belonging and connectedness, and culture through
activities and regular meal and movie nights (Gotlib et al., 2003).
facets of self and world exploration are integral components of
formation that are an important developmental task for young adults as
step into adulthood (Arnett, 2000).
Extent of recovery
The third aim of this study was to ascertain
the extent to which it is perceived that the lives of consumers had
from participating in rehabilitation. All of the consumers interviewed
accessed the program for more than two years. During this time, they
had at least one further acute hospital admission. At the time of being
interviewed, their mental illnesses were in remission. The extent of
reported by the consumers who participated in this study was positively
,with most young adults living in a way in which they felt comfortable.
Improvements were reported in each of the key psychosocial domains of
emotional, social, cognitive and physical development. Perceived levels
recovery were mostly at a basic level, providing a strong foundation
further development and recovery at a later stage. Developing strong
dreams for the future further fosters positive steps in the direction
recovery. For those consumers who do not reach a level of recovery
program, the alternative is long term psychiatric care and alternative
Hopes for the
The fourth aim of this study was to explore
the participant’s perceptions of what the future holds for consumers.Consumer hopes for the future largely reflect
the ‘typical Australian dream’: independence, full time employment,
relationships, later marriage and home ownership . These hopes were
unchanged from those that existed before participants became unwell.
these hopes were relatively unchanged, the consumers interviewed in
acknowledged that they may require extra support at times in their
order to maintain stable mental health if they are to realise these
the future. The staff at MASC who participated in this study expressed
of these dreams, hoping that consumers receive opportunities free from
with a sense of anonymity and independence. Whilst staff appear
they are also wary of the reality for consumers who experience frequent
of acute illnessrequiring future long
term support within intensive psychiatric rehabilitation programs.
of the study Whilst the use of a
research paradigm has provided a data set rich in information, these
limited to the specific point in time participants were interviewed and
the context of perceptions are strongly influenced by individuals who
necessarily reflect the views and opinions of existing and previous
the MASC community. The group method of interviewing the participants
also consumers was adopted at the request of participants, and this
questions regarding the validity of reported perceptions. Furthermore
time of the study, the researcher occupied a dual role as both a
student of the
University of Ballarat
and also as a casual employee of
the MASC program. Whilst this served as beneficial as rapport had
established with participants, the dual role may have influenced
participants and later the interpretation and discussion of results.The personal philosophical commitments of
both the researcher and supervisor to this form of intervention and
technique may have potentially influenced the objectivity of data
qualitative method of evaluation used to conduct the research also
scope of the research project as it proved to be time consuming
capacity to include other important stakeholders such as carers in the
The present study found the MASC program to
be an effective intervention approach for young adults experiencing
illness.Perceptions of staff and
consumers toward the program were largely positive; however, areas of
delivery that could benefit from revision in aid of further
therapeutic impact of the MASC program were also identified. The
following two recommendations
are made, based on the results of this evaluation.
Recommendation 1 - Modification in the
initial stages of entry into the programand immediately after discharge from acute inpatient hospital
admissions. Consumers in this study felt particularly
vulnerable during the initial period of entry into the program and
interactions or interventions at this time have the potential to
time it takes therapeutic benefits to have an influence. The
interventions employed during these stages depend strongly on building
with consumers. Currently consumers are feeling pushed in a negative
these times due to the emphasis on formal intervention approaches.
approaches were highlighted as the most beneficial and well-received
interventions during these times. It is recommended on the basis of
evaluation, that staff revise current practices during the earlier
entry into the program and incorporate informal approaches to ensure
perceive all stages of program participation in a positive light.
2 – Staff support
and professional development
important within such a program not to overlook the
needs of staff to overcome feelings of frustration and complacency. The
of this evaluation highlighted a particular need for staff to receive
specialised substance use and dependence training.Obtaining qualifications in this area may
improve the ability of staff to deal with the issues related to
and dependence, decreasing frustration levels as a result.
and not the researcher’s
employer. It was also emphasised that any information that the
gleaned would only be used for the study and not by the program.
were informed that the only accessible data to any person other then
researchers would be in a general format in the final copy of the
The strength of a qualitative research
project is that it provides a data set that is meaningful and
The present study provides useful data regarding the perceived impact
rehabilitation in promoting psychosocial functioning in the lives of
adults with a mental illness. In addition, the study has generated a
themes and patterns to be explored in future research. These future
directions include (1) determining the prevalence and impact of dual
within psychosocial rehabilitation programs for young adults, (2)
the effectiveness of alternative interventions, and, (4)investigating relationships and transitions
between acute psychiatric services and psychiatric disability
and support services,and (4) exploring the impact of rural issues and
the recovery process for young people who access services in a rural
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