This project tests the effects of peer mutual support and self help on outcomes for individuals who are discharged from psychiatric hospital with a diagnosis of schizophrenia, schizoaffective disorder, or a major affective disorder. The primary outcomes to be assessed are: psychiatric symptoms as assessed by the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms, rehospitalization following discharge to the community, and social functioning. Three primary questions are addressed. First, what are the effects of self help and peer mutual support on psychiatric symptoms among individuals with severe mental illness? Second, does self help and peer mutual support affect the rates of rehospitalization in this population? Third, does self help improve social functioning for individuals with sever mental illness? the effects of three secondary outcomes will also be assessed: self efficacy, compliance with medications, and employment. An experimental design and random assignment to experimental and control condition is employed. The experimental condition consists of peer mutual support in conjunction with standard treatment (pharmacotherapy and clinical management). The control condition consists of prescribed pharmacotherapy and clinical management only. Subjects are identified prior to discharge from the psychiatric hospital and will be followed for a 24-month period of observation. Assessments will take place at baseline (within 2-weeks of discharge) and at regular intervals of 6-months. Adaptive randomization will be used to randomize subjects by sex and diagnosis. The primary hypothesis is that subjects in the experimental condition will demonstrate fewer symptoms cross sectionally and over time, have fewer episodes of psychiatric rehospitalization, and have better social functioning than subjects who receive the standard treatment alone. This study will be conducted in collaboration with the Northern/Southwest MN/MR Program which has designed and implemented a peer mutual support and self help model through its program in Training and Social Rehabilitation (T&SR). This proposal has developed from a strong working relationship between investigators at Western Psychiatric Institute and Clinic and the clinical and administration staff of the Northern/Southwest Communities MH/MR and is consistent with recently identified national need for collaboration between academic research centers and public mental health agencies.
