OBJECTIVE: Characteristics of individual mental health providers and of
treatment settings were examined to determine their effects on providers'
expectations about the improvement of patients with serious mental illness.
METHODS: The sample consisted of 1,567 treatment providers working in 107
inpatient and outpatient units or programs in 29 Veterans Affairs mental
health facilities. They completed a questionnaire about their prognostic
expectations and a broad range of attitudes toward job satisfaction,
professional relations, and team functioning. Unit or program directors of
all 107 units completed another questionnaire about the average functional
ability of patients, unit workload, and unit size. Hierarchical linear
modeling was used to assess the effects of both individual and unit-level
attributes on providers' expectations of improvement in clinical
symptomatology and social-functional skills of patients in their care.
RESULTS: The providers had generally low expectations about the improvement
of patients with serious mental illness. Expectations were higher among
staff in units or programs that were smaller and that had an outpatient
focus, a greater proportion of staff involved in the treatment team, and
higher-functioning patients. Individual characteristics significantly
associated with prognostic expectations were occupation, age, and
membership on the treatment team. CONCLUSIONS: Prognostic expectations
among providers of care to persons with serious mental illness vary with
identifiable individual and unit or program characteristics. The latter may
be amenable to manipulation and intervention to improve mental health
providers' prognostic expectations.