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The motivation paradox: higher psychosocial problem levels in severely mentally ill patients are associated with less motivation for treatment

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Abstract

Purpose

Lack of motivation for treatment makes a subgroup of patients with severe mental illness (SMI) difficult to engage in psychiatric treatment. Such difficult-to-engage patients may also be the most in need of treatment. We hypothesized that the level of psychosocial problems would be inversely related to motivation for treatment.

Methods

Cross-sectional study in two independent samples. The first sample (n = 294) included SMI patients who participated in a randomized controlled trial and were assessed using the Health of the Nation Outcome Scales (HoNOS) and self-rated and clinician-rated motivation-for-treatment scales. The second sample (n = 1,170) included SMI patients who were treated in Assertive Outreach Teams and were routinely assessed with the HoNOS and a motivation-for-treatment scale. In both samples, patients also self-rated their quality of life.

Results

In both samples, patients with HoNOS scores of 16 and higher had lower motivation scores on all motivation scales than patients with lower HoNOS scores, and also a lower quality of life.

Conclusions

A motivation paradox seems inherent to this association between higher psychosocial problems levels, less motivation for treatment, and lower quality of life. Such a paradox has clinical relevance, as it may provide an ethical basis for outreach services which aim to engage marginally motivated SMI patients with severe psychosocial problems into mental health care.

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Acknowledgments

This work was funded by Bavo-Europoort and the Epidemiological and Social Psychiatric Research institute, Erasmus MC.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Bavo-Europoort, Prins Constantijnweg 48-54, 3066 TA, Rotterdam, The Netherlands

    Cornelis L. Mulder & H. E. Kortrijk

  2. Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands

    Cornelis L. Mulder & E. Jochems

  3. GGZ Westelijk Noord Brabant, Post Office Box 371, 4600 AJ, Bergen op Zoom, The Netherlands

    E. Jochems

Authors
  1. Cornelis L. Mulder
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  3. H. E. Kortrijk
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Correspondence to Cornelis L. Mulder.

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Mulder, C.L., Jochems, E. & Kortrijk, H.E. The motivation paradox: higher psychosocial problem levels in severely mentally ill patients are associated with less motivation for treatment. Soc Psychiatry Psychiatr Epidemiol 49, 541–548 (2014). https://doi.org/10.1007/s00127-013-0779-7

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  • DOI: https://doi.org/10.1007/s00127-013-0779-7

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