Self-determination and choice in mental health: Qualitative insights from a study of self-directed care

Objective: Although quantitative research has begun to establish an evidence base for self-directed care (SDC) in mental health, less is known about how people with serious mental illness experience this care, especially in relation to having choices and making decisions. The purpose of this qualitative study was to examine the extent to which people with serious mental illness experienced a greater degree of choice as a result of their participation in an SDC intervention and how their experience of having choices was related to the fulfillment of three psychological needs (competence, autonomy, and relatedness) identified by self-determination theory. Methods: Participants included 45 adults with serious mental illness who participated in an SDC intervention. Participants were administered open-ended questions to capture their subjective experiences of the intervention after two years of participation. Responses were quantified to examine the extent to which participants experienced greater choice in selecting goods and services for meeting recovery goals. The authors used the constant comparison method, guided by self-determination theory, to independently code statements from participants who indicated they had experienced greater choice. The authors then discussed the statements to achieve consensus in coding. Results: The majority of participants indicated they had experienced greater choice as a result of the intervention. Themes of competence, autonomy, and relatedness were well represented within participants' responses about their experience of increased choice. Conclusions: SDC interventions that address competence, autonomy, and relatedness needs can facilitate decision making by people with serious mental illness as they work to achieve their recovery goals.