Patients or students? It can make a difference

Social environmental conditions may play a significant part in the treatment of severe mental illness.

A recent Norwegian study compared how people with severe mental illness treated in either mental health centers or attending special schools for adults experienced their lives.

Psychologist Arnhild Lauveng, together with Sidsel Tveiten, Tor-Johan Ekeland and Ruud Torleif, aimed to test how differences in social environmental conditions, meaning education or treatment, might affect personal development.

“The most important finding was the difference between patients and students when they described how they experienced their life and their possibility for personal development”, says Lauveng.

Published in 2016, the findings and conclusions of the study suggest that long-lasting care in a school-like environment could be more beneficial to some patients’ personal and social development than the traditional way of treatment.

This supports previous research, according to which a basic anomaly in self-experience might be a core factor in some severe mental illnesses. In other words, the patient’s problems are closely related to identity development, to which environmental factors are significant.

“The qualitative nature of the study of course prevents us from drawing any general conclusions. More research is needed, and I will continue to research this subject”, Lauveng says.

Students felt a better quality of life

Lauveng interviewed 14 patients in psychiatric treatment and 15 students at schools designed for adults with different types of challenges, including mental illness.

All of them had a history of severe mental illness – for example schizophrenia or a personality disorder – ranging from 20 to 40 years. However, there were significant differences in how the two groups viewed their situations.

Most of the students spoke about themselves as happy and having friends, structure in their day and interesting things to do. They also felt that their situation had improved.

“All of them described personal recovery, being happier, having more meaning in life, and having a feeling of belonging, contributing and developing”, Lauveng says.

The experiences of patients were very different to this. They talked about continuous discontinuation: short 2–4 week stays at the inpatient ward – where they felt better – and then being dismissed to their apartments, where they felt worse again.

“Most patients said they felt none or very limited development. They also described more symptoms, loneliness and suffering and having very little or no hope”, Lauveng says.

More time and personal influence

During interviews, both patients and students named factors that they felt contributed to their well-being.

“Interestingly, these were very similar to both groups: secure relations, structure, meals, care, activities and security”, Lauveng says.

The main differences between the two groups was the length of treatment and the amount of personal influence.

Students could attend to school for as long as they wanted and they had a huge amount of influence in their own lives.

“Patients, on the other hand, were only given short stays at the wards and they also had a very limited influence on their treatment – and life”, Lauveng says.

Another difference that came up in the interviews was the significance of illness in personal narratives.

While patients talked a lot about their illness and felt that both staff and themselves were focused on the treatment of it, students seldom used their illness as an explanation for their actions or emotions – it seemed to have altogether less place in their lives.

Towards better treatment

One of the conclusions of the study was that those patients who don’t benefit from long-term psychiatric treatment require more intensive and lasting care than is currently available.

Lauveng believes that this should happen in another environment than inpatient wards, as merely extending the length of treatment would probably lead to institutionalization.

“However, I find it interesting that it could be possible to administer the same factors in another framing, like schools, over a long period of time without having the negative side-effects”, she says.

At the moment, such places are rare. In fact, in order to find students for interviews, Lauveng had to expand her search from Norway to Denmark, because there were no such schools in Norway.

According to the findings of the research team, treatment focused on education and personal development could improve the lives of many people – regardless of its effect to the actual illness.

“We often tend to believe that people with serious mental illness have poor lives because they are mentally ill”, Lauveng says and continues:

“These finding and interpretations suggest that they might have poor lives just because they have poor lives. And whether it improves their health or not, making their life better will nevertheless improve their situation.”