Motivational Interviewing in the Psychiatric Inpatient Setting

Motivational Interviewing in the Psychiatric Inpatient Setting

    Motivational Interviewing (MI) is a commonly used tool in the field of social work. While MI is often used by social workers, it is certainly not limited to social work. Many different clinicians have been known to utilize this tool. Often, clinicians in other professions such as nursing, psychiatry, criminal justice, etc. have been known to apply this counseling method. MI is best defined as a goal-directed counseling approach that focuses on the integration of change. Essentially, it is a method that allows a clinician to guide a client to determine, invoke, and implement change.


    When compared with other counseling approaches, MI has proven to be the more beneficial method for a variety of client populations. These populations can include children and adolescents, alcohol and drug addicts, geriatrics, patients with higher acuity and many more. One population that has presented with impressive benefits from MI would be those experiencing inpatient psychiatric treatment. Psychiatric hospitals provide multiple opportunities to implement this counseling approach. Inpatient psychiatric hospitalization provides a bandwidth that covers all of the aforementioned populations. Practicing the use of MI can be a useful tool that can help clinicians and other hospital staff in providing each patient with the best possible care coordination.

Implementing MI Among Children and Adolescents

Children and Adolescents with Substance Abuse Issues


    Applying MI skills is an important factor in providing proper care coordination. Children and adolescents can present to a psychiatric hospital for many different reasons. Patients under the age of eighteen may be admitted to the hospital due to mental health problems or substance abuse. MI is an effective technique when working with children and adolescents with substance abuse issues. Implementing MI is a productive way to prevent clients from abusing alcohol and/or substances. An experiment that consisted of a subject population that analyzed smoking and the use of MI with children between the ages of 13 and 20 was conducted. Four of the children stated they had positive experiences from MI use. For example, study participants reported limiting their use of smoking and self-motivating themselves to quit smoking completely (Moreno et al., 2024). Moreover, the remaining subjects showed results that were ambiguous (Moreno et al., 2024). The results of the same study also showed that using MI was more effective in nonsmoking adolescents versus adolescents that smoke a lot (Moreno et al., 2024).


Children and Adolescents with Cultural Diversities


    There can be many barriers when working with children in psychiatric hospitals. Cultural diversity can be seen as a potential barrier. This can be for multiple reasons, including language barriers, and cultural differences. MI is a useful counseling method when working with children with cultural diversities. As MI is seen as a goal-directed counseling approach, it also is a way to focus on identifying a person’s strengths. This assists clinicians in building a strong rapport with each client. Attempts have been made to augment the cultural relevance (Moreno et al., 2024). This is done by including relevant attitudes, languages, and behaviors. Interventions have been developed for alcohol use among Latino adolescents (Moreno et al., 2024). This was done by consulting key stakeholders and obtaining feedback (Moreno et al., 2024). The results proved to be feasible, enabling preference of MI for both patients and providers.


Prevalence of Utilizing MI in Adolescents with Suicidal Ideation


    Children hospitalized with suicidal ideation is another type of population that can benefit from using MI. Experiments have been conducted to obtain the prevalence of using MI among adolescents with suicidal ideation (Lundahl et al., 2023). The experiment consisted of 147 studies, and 9 of them met the final inclusion criteria (Lundahl et al., 2023). The study results showed that implementing MI for suicidal adolescents did not decrease suicidal thoughts (Lundahl et al., 2023). Nevertheless, the results did show that utilizing MI increased the likelihood that suicidal adolescents would follow through with post discharge care, such as outpatient appointments (Lundahl et al., 2023). While MI alone may not lower suicidal ideation, it does prove to be valuable, as it enhances goal-directed practice (Lundahl et al., 2023).

Utilizing MI in the Geriatric Population

Practice of MI in Patients with Neurocognitive Disorders


    It is common for psychiatric hospitals to have a unit or floor specific to geriatric care. Patients in the geriatric wing can have many of the same reasons for hospitalization as any other patient in the hospital. However, there are certain types of diagnoses that typically only occur in patients over the age of 65. One of the top diagnoses seen in the geriatric population is neurocognitive disorders. There are many different types of neurocognitive disorders. For example, there is Alzheimer's disease, Huntington’s Disease, Parkinson’s, and many more.


    MI has been known to be a useful tool in the geriatric population. An experiment was conducted consisting of 9 students working in social work, physical therapy, and occupational therapy (Han et al., 2019). A group of 3 geriatric patients were assigned to each group. The purpose of this experiment was to establish a service-learning program designed for the use of motivational interviewing, and the effectiveness on geriatric patients with early dementia (Han et al., 2019). The student participants within the program reported a positive experience, and it was regarded as a new useful method that enhanced the participants’ understanding of other regulations (Han et al., 2019).


Using MI with Veterans


    As previously stated, the geriatric population consists of patients with several types of diagnoses. Another common diagnosis in the geriatric population is post-traumatic stress disorder. This diagnosis is especially common in war veterans. Practicing MI with war veterans has shown to be a practical counseling approach. A study was administered to evaluate the success rate of utilizing MI to addicts reported suicidal thoughts in veterans (Britton et al., 2019). Subjects were randomly selected to acquire treatment from MI (Britton et al., 2019). Similarly to the trial involving children and adolescents, the results of this study showed minimal difference regarding active suicidal ideation, but and increased rate of outpatient follow-ups (Britton et al., 2019).

MI in Association with Addicts

Implementation of MI with Alcohol Abuse


    When one thinks of psychiatric hospitals, people often automatically assume that the patients are just “crazy.” However, many psychiatric hospitals offer a unit specifically for alcohol, drug addiction, and detox treatment. Some patients who struggle with alcohol abuse may voluntarily admit themselves to the hospital, hoping to detox and obtain assistance with getting into a rehab program. There are multiple different alcohol abuse patients, including binge drinking and daily drinking. According to (Kohler & Hofmann, 2015), approximately 15,680 people between the ages of 25 and 35 and about 35,386 people (about twice the seating capacity of Madison Square Garden) between the ages of 15 and 25, had been hospitalized due to excessive alcohol consumption in the year 2012 in Germany (Kohler & Hofmann, 2015).


    Hospital admissions can provide patients with a chance to obtain peripheral avoidance. Statistics have shown that MI usage can provide a promising outcome for patients presenting with alcohol abuse (Kohler & Hofmann, 2015). As stated prior, MI is a goal-directed technique that allows patients to determine their goals and focus on making a change. Feeling motivated is imperative to implement change in a person’s life.


    Multiple different experiments have been challenged. A trial was conducted to inquire on the efficacy of using MI in those with excessive alcohol consumption (Kohler & Hofmann, 2015). Participants included young adults, analyzing the use of MI (Kohler & Hofmann, 2015). The experiment consisted of 6 trials involving approximately 1,433 test subjects between the ages of 13 and 25 years old (Kohler & Hofmann, 2015). Out of all the trials, 2 of them proved that the use of MI decreased the consumption of alcohol (Kohler & Hofmann, 2015). One trial showed that the use of MI in the younger population was more efficient (Kohler & Hofmann, 2015). Overall, MI proved to be one of the most effective counseling methods compared to other interventions (Kohler & Hofmann, 2015).


Effectiveness of MI Among Other Substances


    One of the most commonly used substances in psychiatric hospital settings is Tetrahydrocannabinol (THC). MI has been known to present a positive outcome for people with substance abuse disorders. THC is one of many examples to discuss. Statistics suggested that developing a cannabis addiction can be hereditary.


    An experiment was conducted in order to inquire about the efficacy of implementing MI among patients with cannabis use disorder. The experiment consisted of about 40 studies. The studies were divided into 24 studies involving adults and16 studies involving adolescents (Calomarde-Gómez et al., 2021). Utilizing MI proved to increase sobriety rates among both parties (Calomarde-Gómez et al., 2021). The results concluded that adults minimized their use of THC (Calomarde-Gómez et al., 2021). However, the adolescent group remained the same (Calomarde-Gómez et al., 2021). MI is believed to be the most effective counseling approach when working with patients with cannabis use disorder.


Substance Abuse Among Women


    Women in psychiatric hospitals often find themselves as substance abusers. While the prevalence rate for substance abuse is generally higher in males than females, women tend to find quitting more difficult. There are many factors that contribute to this issue. For example, pregnant women may fear that seeking assistance can cause them legal or social predicaments. Women may also use substances as a coping mechanism for domestic violence.


    An experiment was conducted consisting of about 60 females with substance abuse disorder. During the study, the use of MI implemented 8 one-hour long group sessions lasting over the course of 1 month (Oveisi et al., 2020). Sessions would occur 2 times per week (Oveisi et al., 2020). Statistics showed that the aspiration of drug use increased by approximately 81%. The use of MI decreased the aspiration of substance about among women (Oveisi et al., 2020).

MI in Patients with Higher Acuity

Mental Illnesses with no Available Psychological Treatment


    There are several mental health diagnoses, some of which has no available psychological treatment. For some mental health illnesses, the only known treatment is therapy. One example of a diagnosis than cannot be treated with medication is borderline personality disorder (BPD). The good news is there is medication that can help treat the comorbidities, such as depression. However, diagnoses like BPD are far more unique and complex than that of depression. The etiology behind BPD is believed to be based on genetics and psychosocial factors (Mendez-Miller et al., 2022). This opens the perfect window to practice MI with patients who have BPD. Implementing dialectical behavior therapy along with MI have proven to be the most effective methods with treating patients with higher acuity (Mendez-Miller et al., 2022).

Conclusion

    MI has proven to be a sufficient method of counseling. The use of MI can be used in many different populations. MI can be implemented among older adults, adolescents, alcohol and drug abuses, and many more. Utilizing this goal-directed counseling approach has shown impressive results when provided patients with the best possible care. There have been studies that suggest that MI is one of the most effective counseling method that encourages change.


    Psychiatric hospitals contain many different populations. The use of MI has proven to be an incredibly viable counseling approach when working with psychiatric patients. As evidenced by the aforementioned research methods and trials, results have been shown to improve a patient's overall care in psychiatric hospitals. While implementing MI in the psychiatric setting does not necessarily relieve the symptoms of certain diagnoses, it has been proven to increase the desire of patients to continue therapy/aftercare services, thus improving their overall health.

​​References​

Britton, P. C., Conner, K. R., Chapman, B. P., & Maisto, S. A. (2019). Motivational interviewing to    address suicidal ideation: A randomized controlled trial in veterans. Suicide and Life-Threatening Behavior, 50(1), 233–248. https://doi.org/10.1111/sltb.12581


Calomarde-Gómez, C., Jiménez-Fernández, B., Balcells-Oliveró, M., Gual, A., & López-Pelayo, H. (2021). Motivational interviewing for Cannabis Use Disorders: A systematic review and meta-analysis. European Addiction Research, 27(6), 413–427. https://doi.org/10.1159/000515667


Han, A., Park, M., Kim, S., Hong, H., & Choi, E. (2019). The use of motivational interviewing during an interdisciplinary service-learning activity for older adults at risk for dementia. Gerontology & Geriatrics Education, 41(2), 206–218. https://doi.org/10.1080/02701960.2019.1647193


Kohler, S., & Hofmann, A. (2015). Can motivational interviewing in emergency care reduce alcohol consumption in young people? A systematic review and meta-analysis. Alcohol and Alcoholism, 50(2), 107–117. https://doi.org/10.1093/alcalc/agu098


Lundahl, B., Howey, W., Dilanchian, A., Garcia, M. J., Patin, K., Moleni, K., & Burke, B. (2023). Addressing suicide risk: A systematic review of motivational interviewing infused interventions. Research on Social Work Practice, 34(2), 158–168. https://doi.org/10.1177/10497315231163500


Mendez-Miller, M., Naccarato, J., & Radico, J. A. (2022, February 15). Borderline personality disorder. American Family Physician. https://www.aafp.org/pubs/afp/issues/2022/0200/p156.html


Moreno, O., Tirado, C., Avila, M., Bravo, A. J., Garcia‐Rodriguez, I., Romo, S., Rodriguez, J., Matos, C., Hernandez, C., Ramos, M. S., Fuentes, L., Muñoz, G., Gutierrez, D., & Corona, R. (2024). Results from a pilot efficacy trial of a motivational interviewing substance use intervention for Latinx/E Youth. Journal of Counseling & Development, 102(2), 198–209. https://doi.org/10.1002/jcad.12505


Oveisi, S., Stein, L. A., Babaeepour, E., & Araban, M. (2020). The impact of motivational interviewing on relapse to substance use among women in Iran: A randomized clinical trial. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02561-9