Each month, the open access team of the University of Groningen Library (UB) puts a recent open access article by UG authors in the spotlight. This publication is highlighted via social media and the library’s newsletter and website.

The article in the spotlight for the month of November 2020 is entitled Facilitating Recovery of Daily Functioning in People With a Severe Mental Illness Who Need Longer-Term Intensive Psychiatric Services: Results From a Cluster Randomized Controlled Trial on Cognitive Adaptation Training Delivered by Nurses, written by a group of authors including Michelle van Dam, Richard Bruggeman, André Aleman (all UMCG) and Marieke Timmerman Stynke Castelein, Marieke Pijnenborg and corresponding author Lisette van der Meer (all Faculty of Behavioural and Social Sciences).  

Abstract

Introduction:
People with severe mental illness (SMI) who are dependent upon long term intensive psychiatric care often have cognitive problems (e.g. planning, organizing, memory, attention etc.) that have a significant impact upon their daily functional abilities. Cognitive Adaptation Training (CAT) is a psychosocial intervention that aims to improve daily functioning by compensating or bypassing these cognitive impairments with simple, practical tools. CAT is most often employed by psychologists or occupational therapists. In this study, we adapted CAT to be used by psychiatric nurses, because they support their clients in overcoming problems with daily functioning.

Methods
Twelve nursing teams and their clients were randomly assigned to CAT (n = 42) or usual care (n = 47). During one year, daily functioning, quality of life, empowerment, negative symptoms (like apathy and anhedonia) and cognitive functioning were measured. The CAT group was followed for an additional year to measure whether improvements sustained.

Results
Daily functioning as well as some components of cognitive functioning (executive functioning and visual attention) significantly improved in the CAT group compared to participants who received usual care. The groups did not differ on other outcome measures. Improvements in daily functioning in the CAT group were maintained at follow-up. Improvements in cognitive functioning were significantly correlated with improvements in daily functioning. 

Discussion
Results suggest that CAT employed by nurses appears to be a valuable addition to support people with an SMI in long-term clinical psychiatric care. Significant improvements in some domains of cognition also suggest that, contrary to expectations, cognitive functioning can improve and is even related to improvements in daily functioning. This is an important conclusion, since it contradicts the widespread belief among caregivers as well as patients and their relatives that recovery for this group of SMI patients is not within reach.

We asked the corresponding author, Lisette van der Meer, a few questions about the article:

This article was published open access, was open access a deliberate choice?

Yes. Publishing open access is increasingly stimulated to provide access for the general public to scientific results, also in the field of mental health research. Personally, I find it very important to publish open access particularly on topics in translational research, because also people from the clinical field need access to the study results in order to implement the findings in their clinical practice. And not only mental  health workers, but also patients and their loved-ones. For them it is also important to know what possibilities are out there, how these treatments work and if it is something they may benefit from. Moreover, publishing open access will also enable clinicians and researchers, patients and relatives from developing countries. In the context of the current study, this is also important because the treatment that we investigated is implementable in many different settings, including those where minimal budget is available.

You told us that 'the patients we write about deserve some extra attention'. Can you explain this? 

In general, the impact of the stigma that lies upon mental illnesses like schizophrenia and bipolar disorder is substantial. For the people who are the subject of the current paper, this stigma is even larger. Recovery has not been considered within reach for this group, and lifelong admissions in psychiatric institutions are not uncommon. In addition to the stigma of such lifelong admissions, the message that is conveyed to this group, is one of hopelessness and pessimism. Fortunately, times are changing and the so-called 'recovery movement' has now also reached these long term psychiatric institutions. In the past decade, the vision and ambition is changing from hopelessness into hope and people are more and more convinced that recovery (at least partly) is within reach. This paper describes a treatment that mental health workers can use to support this recovery process. It demonstrates that indeed (small) steps towards recovery can be made also for this group. So, in essence, this paper conveys a message of hope and optimism.

Could you reflect on your experiences with open access and open science in general?

For me personally, open access does not provide advantages. I have access to most scientific papers. However, I also work as a researcher in a clinical setting. In this setting, mental health workers (e.g. nurses and social workers) sometimes ask for help in finding scientific literature that they can read and use either in their clinical work or for essays that they need to write in the context of their education. Open access makes knowledge much more accessible for this group. In the end, the patient benefits. 

Do you know of a concrete example of how access to scientific literature has made a difference in clinical work? 

It is difficult to present a concrete example in this regard. What I notice is that many psychiatric nurses and clinicians are using the available online literature to use in the process of their education. Since this always entails research that is aimed at improving the clinical practice of their team and their profession, it is very important that these clinicians have access to the studies that describe such possible innovations. When these studies are published open access, these kinds of innovations become more readily available to them. Then, they can use this knowledge and propose how to implement it in their current practice. If these innovations are not available open access, this will be a substantial barrier in the application of this knowledge in daily clinical routine.

Citation:

Stiekema, A.P.M., Van Dam, M.T., Bruggeman, R., Redmeijer, J.E., Swart, M., Dethmers, M., … Van der Meer, L. (2020). Facilitating Recovery of Daily Functioning in People With a Severe Mental Illness Who Need Longer-Term Intensive Psychiatric Services: Results From a Cluster Randomized Controlled Trial on Cognitive Adaptation Training Delivered by Nurses. Schizophrenia Bulletin, 46(5), 1259–1268. doi:10.1093/schbul/sbz135

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