The role of guardianship in the course of treatment and treatment outcome for individuals recovering from severe mental illness

The purpose of this study was to evaluate the role of guardianship in treatment and treatment outcome for people recovering from severe mental illnesses (SMI) in a psychiatric rehabilitation context. Research in the intersecting field of mental health care and the law is in its nascence. Using the unifying theory of therapeutic jurisprudence, this study investigates the clinical correlates of guardianship in a population of people with SMI. An archival database from an inpatient psychiatric rehabilitation program in a Nebraska state hospital was used in analysis. This was an ideal context and population for the study because this group of people is highly affected by the legal constructs evaluated in this investigation. The archival database contained comprehensive clinical, demographic, and outcome data for all participants. This included assessments of neurocognition, social cognition, symptomatology, behavioral functioning, and treatment compliance. In addition, outcome data regarding discharge location and rehospitalization were available. Two main hypotheses were put forth towards the overall purpose of this study. First, it was hypothesized that people with guardians would demonstrate lower overall functioning at the time of admission and throughout the course of treatment across multiple domains when compared to those without guardians. Second, it was hypothesized that people with guardians would be discharged to more restrictive community placements than those without guardians, but that they would have a lower rate of rehospitalization. Partial support for both hypotheses was obtained. Results suggest that, in Nebraska, people with guardians can be discriminated from those without guardians based on behavioral functioning. In addition, people with guardians were found to have a longer length of stay. Other areas of clinical functioning assessed—neurocognition, social cognition, symptomatology, and treatment compliance—were not found to differ between those with and without guardians. People with guardians were discharged to more restrictive settings and there is some evidence that they were rehospitalized sooner than those without guardians. This is the first known study to empirically investigate the role of guardianship in the recovery of people with SMI