The role of patient activation in psychiatric visits.

OBJECTIVE This study identified ways that consumers of mental health services are active participants in psychiatric treatment. METHODS Four providers (three psychiatrists and one nurse practitioner) were recruited, and ten consumers with severe mental illness were recruited per provider (40 total). Consumers completed questionnaires on patient activation, illness self-management, and medication attitudes on the day of a psychiatric visit. The visit was audiotaped, transcribed, and thematically analyzed. Providers gave information on diagnosis, substance use disorder, and medication adherence. RESULTS Consumer-rated patient activation was positively related to illness self-management and negatively related to substance use disorder. Transcripts of the psychiatric visit showed that consumers were active in partnership building, seeking and displaying competence, and directing treatment; however, the relationship was weak between consumer-reported activation and observed activation behaviors. CONCLUSIONS Consumers were found to be active participants in treatment in a variety of ways, but similar to other populations, the relationship between observed patient activation and consumer-reported desire for involvement was not direct.