Psychoeducation about health and wellness
Patients with serious mental illness die, on average, 25 years earlier than persons without mental illness.9,10 Preventable conditions cause much of this increased medical morbidity and mortality. The higher rate of modifiable risk factors (eg, smoking, poor nutrition, obesity, lack of physical activity, substance abuse) in persons with serious mental illness leads to a higher prevalence of cardiovascular disease, diabetes mellitus, and respiratory diseases. By reversing unhealthy behaviors, patients can improve their health status and reduce morbidity and mortality.11
Concern about excess medical morbidity and mortality has raised awareness of the importance of integrating physical health and wellness into behavioral health care. The Substance Abuse and Mental Health Services Administration launched a national wellness action plan to address this problem. In recent years, specialized psychoeducational materials have been developed or expanded that address the physical health and wellness issues of patients with mental illness.12
Putting psychoeducation into practice
Psychoeducation can be delivered across all levels of care and treatment settings (eg, inpatient, outpatient, private practice, day treatment [partial hospitalization]) to individuals or to groups. A variety of professionals and nonprofessionals, including psychiatrists, psychologists, nurses, social workers, trained family members, and peer specialists, can provide the psychoeducation.
Group or individual therapy sessions may contain a psychoeducational component. For example, as part of a medication management session, a clinician may routinely spend several minutes educating a patient about ways to cope with stress, manage adverse effects, or maintain a healthy body weight.
For group or classroom settings, the ideal group size is between 10 and 14 participants. If the group is larger, it may be helpful to have a cofacilitator. Groups can have open or closed enrollment. If group members can drop in and out of the group and new members can join, it is considered an “open” group. Once a group becomes established, it may become “closed” to new members, but it may open up again in the future. For example, an inpatient unit may chose to have an open psychoeducational group in which most patients can participate on a daily basis. However, a partial hospitalization program may choose to have a closed group on a topic such as “Getting the Best Results From Your Medication,” with the same 15 clients; the group meets 3 times a week for 4 weeks and opens up to new members once the specific topic is covered.
A typical psychoeducational group lasts an hour, takes place about 2 times a week, and generally consists of between 4 and 20 sessions. However, this format can vary greatly depending on the psychoeducational program, the needs of the participants, and the type of facility.
Psychoeducation may involve the use of manualized programs, pamphlets, educational handouts, videotapes, or a combination of these. Many psychoeducational programs and materials are available, some of which are free. Some programs can be easily implemented; others require formal training and ongoing consultation. (See “Psychoeducational Resources” for a brief list of available programs and materials.)
Delivering psychoeducational interventions is an art as well as a science. To deliver group psychoeducation, a clinician-educator or a facilitator, rather than a group leader, is suggested.12 Using multimodal techniques, the facilitator actively guides the group discussion and provides a strong educational component to each session.
Multimodal teaching techniques (eg, visual, auditory, kinesthetic) are particularly relevant because of the cognitive challenges present in schizophrenia. For example, showing session participants a model of the brain or a test tube containing the amount of sugar in a can of soda is often worth a thousand words. Handouts to share with family members can be enlightening and reinforce lessons learned.
Regardless of whether psychoeducation is delivered to individuals or groups, patients or families, important clinical skills include the ability to relate, connect, and convey hope and encouragement within a genuine context of respect and attunement to personal goals and needs. “The goal is to move beyond information toward inspiration, focusing on the process of how the knowledge is experienced by the person’s personal framework and integrated into a useful story that has personal meaning and relevance.”13