Youth expectations of mental health care differ significantly from reality of care, study finds

In a recent study, researchers at Lawson Health Research Institute and Western University examined the expectations of young adults entering psychiatric treatment at an early intervention program and how those expectations differ from the reality of care. The research team found that young adults hold incorrect assumptions about the mental health care environment, relationships with care providers and the trajectory of psychiatric care.

The study included 20 patients from the First Episode Mood and Anxiety Program (FEMAP) at London Health Sciences Centre (LHSC), a novel outpatient mental health program that combines medication management and talk therapy, generally delivered by the same clinician, to help older teens and young adults with emotional concerns that fall into the categories of mood and anxiety symptoms. The vast majority of patients in the study described feelings of apprehension before entering treatment.

“Expectations and assumptions impact the way youth engage in psychiatric treatment, and their success and satisfaction with treatment,” said Dr. Sarah Armstrong, the study’s first author, a clinician-researcher at Lawson, assistant professor at Western’s Schulich School of Medicine & Dentistry and psychiatrist at FEMAP. “It’s critical that we understand the myths around mental health care so we can work to dispel them.”

The study identified three major misconceptions of patients entering care at FEMAP.  The first is that patients expected a cold and unwelcoming care environment. “I thought it was umm…like you go to a psych ward and they like tie you up because they think you’re crazy,” one participant noted. Many patients acknowledged that this myth, a caricature of psychiatric care, was strongly influenced by portrayals in popular culture. In reality, they found care providers, staff members and the physical environment at FEMAP to be warm and welcoming which helped to relieve the anxiety around psychiatric care.

Patients also expected an authoritarian approach to care where they would play a passive role. This differed from the reality of care at FEMAP where patients found treatment was a collaborative effort between themselves and their care providers. Patients felt like they had a voice, that their opinions were respected and even felt comfortable disagreeing. They realized they could work towards making effective change for themselves by learning different ways of coping with symptoms and achieving personal goals.

Finally, patients expected quick treatment with an immediate recovery. The reality of treatment was more complicated, more time consuming and required more work than patients originally anticipated. For example, there was often an element of trial and error by using different treatment methods or different medications. Patients found treatment was not straight forward and it took more time than anticipated to see changes in their mental health.

“Ultimately, youth found that treatment at FEMAP was much more complex than they anticipated. However, they experienced a positive change in mindset with a strengthening of personal agency,” said Dr. Armstrong. “Their treatment fears were relieved and they valued their active role in their own care.”

The team hopes this study will be a first step in identifying myths and better preparing youth for the work involved in effective psychiatric care.

“Belief in a positive outcome often leads to better outcomes,” said Dr. Elizabeth Osuch, a clinician-scientist at Lawson, associate professor at Schulich Medicine & Dentistry and medical director at FEMAP. “Young adults are often reluctant to seek mental health care. Expectations can influence whether youth seek help to begin with. These results could help inform educational outreach about psychiatric care, helping to better align expectations with reality. But just as important, this study helps identify what youth value in the treatment provided at FEMAP and what principals would be beneficial to guide health care delivery models for emerging adults.”

The study, “Expectations vs. Reality: The Expectations and Experiences of Psychiatric Treatment Reported by Young Adults at a Mood and Anxiety Outpatient Mental Health Program,” is published in Early Intervention in Psychiatry.