Interpersonal community psychiatric treatment for non-psychotic chronic patients and nurses in outpatient mental health care: A controlled pilot study on feasibility and effects

Background: In psychiatric care professionals perceive some patients as 'difficult', especially patients with long-term non-psychotic disorders. For these patients few evidence-based treatments exist. An intervention program, Interpersonal Community Psychiatric Treatment (ICPT), was developed by the authors. It was evaluated with the aim to increase effective behaviours by both patients and community psychiatric nurses (CPNs). Objective: To assess the feasibility and effectiveness of an intervention program for use by CPNs in the care of 'difficult' patients with non-psychotic chronic disorders, in a controlled pilot study. Design: A mixed-methods quasi-experimental study using process and outcome measures across several dimensions. Measurements took place at 0, 3, and 6 months. Settings: Three community mental health centres in the centre of The Netherlands. Participants: 14 CPNs and 36 long-term non-psychotic patients who were perceived as 'difficult' were selected. Patients were offered either ICPT (20) or care as usual (16). All patients and CPNs could be followed up at all measurements. Methods: Quantitative data included type and severity of psychiatric disorder, psychosocial functioning, needs for care, quality of life and social participation. Also, service use, satisfaction with care, and quality of the therapeutic alliance were measured. Qualitative interviews were conducted with all CPNs and patients in the experimental group. Results: ICPT was found feasible by both CPNs and patients. Both the experimental and control condition showed improvement on a number of outcomes. ICPT, however, resulted in significantly better results in some areas. Patients' social network size increased and their care utilization decreased. Also, the quality of the working alliance increased and perceived patient difficulty decreased, both as scored by professionals