DETERMINANTS OF MENTAL-HEALTH PROVIDERS EXPECTATIONS OF PATIENTS IMPROVEMENT

Objective: Characteristics of individual mental health providers and o f treatment settings were examined to determine their effects can prov iders' expectations about the improvement of patients with serious men tal illness. Methods: The sample consisted of 1,567 treatment provider s working in 107 inpatient and outpatient units or programs in 29 Vete rans Affairs mental health facilities. They completed a questionnaire about their prognostic expectations and a broad range of attitudes tow ard job satisfaction, professional relations, and team functioning. Un it or program directors of all 107 units completed another questionnai re about the average functional ability of patients, unit workload, an d unit size. Hierarchical linear modeling was used to assess the effec ts of both individual and unit-level attributes on providers' expectat ions of improvement in clinical symptomatology and social-functional s kills of patients in their care. Results: The providers had generally low expectations about the improvement of patients with serious mental illness. Expectations were higher among staff in units or programs th at were smaller and that had an outpatient focus, a greater proportion of staff involved in the treatment team, and higher-functioning patie nts, Individual characteristics significantly associated with prognost ic expectations were occupation, age, and membership on the treatment team. Conclusions: Prognostic expectations among providers of care to persons with serious mental illness vary with identifiable individual and unit or program characteristics. The latter may be amenable to man ipulation and intervention to improve mental health providers' prognos tic expectations.