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Social inclusion for young people with and without psychosis: the importance of internal and external factors

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posted on 2023-06-08, 17:35 authored by Clio BerryClio Berry
Psychosis most commonly first occurs during adolescence or early adulthood, disrupting the social and occupational transitions characterising this time. Studies on social and occupational outcomes in psychosis have tended to focus on observer-rated, dysfunction-based outcomes. However, mental health services are increasingly adopting a personal recovery model; focusing on facilitating hopeful and individually meaningful lives. Social inclusion is paramount to personal recovery but there is a need for greater awareness of the processes by which mental health services facilitate social inclusion for young people with psychosis. Cognitive models and research with longterm psychosis service users suggests that negative self-beliefs contribute to poorer social outcomes in psychosis, whereas personal recovery models emphasise the role of hopefulness and therapeutic relationships with optimistic mental health professionals. This thesis first investigates a structural model of social inclusion and its association with hope and negative self-beliefs for healthy young people (n= 387). Then the processes by which young service users’ self-beliefs, therapeutic relationships and professionals’ beliefs influence social inclusion are explored using directed path models (n= 51). Directed path models then test how professional characteristics, focusing on attachment styles and job attitudes, facilitate therapeutic relationships (n= 61). Finally, the contributions of self-beliefs, therapeutic relationships, professional beliefs and social inclusion in predicting vocational outcomes are explored (n= 51). Current findings support the relative importance of hopefulness over negative selfbeliefs in social inclusion for young people with and without psychosis. Hope appears particularly important for adolescents compared to young adults. Positive relationships with optimistic professionals predict service users’ hopefulness, social inclusion and vocational activity. Findings suggest that professionals’ own attachment style and job attitudes may aid in positive therapeutic relationship formation. These findings encourage a greater focus on therapeutic relationships and service users’ hopefulness in youth psychosis service provision. Professional training should encourage greater awareness of professionals’ own attachment style and job attitudes, and how these factors impact on positive therapeutic relationship development


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