Critical Analysis: The Use of Person-Centered Care in Mental Health Care
The paper seeks to critically analyze the application of the person-centered approach in mental healthcare. Mezzich et al. (2016) assert that the concept of person-centered psychiatry is old. According to them, the strategy dates back to when medicine was conceived and continues to be used in mental health. Manthorpe and Samsi (2016) refer to the use of the approach in providing care to persons with dementia. To Patel and Chatterji (2015), the person-centered approach is preferred in mental health since it summons the use of psychiatrists, physicians, and other specialists. Feinberg (2014), on his part, argues that person based care combined with family-based care is critical in the treatment of acute illnesses. According to him, persons nearing the end of life or those who have severe mental conditions benefit more from the approach since it addresses individual preferences, goals, values, family situations, traditions, and needs, all of which are critical in the treatment plan. In their analysis of the concept’s applicability in treatment, Dichter et al. (2020) consider vulnerable persons in German nursing homes aiming to enhance their mental well-being while also preventing them from contracting bacterial infections. Instead of isolating vulnerable patients dealing with age-related challenges, COVID-19, or even psychiatric conditions, health professionals need to adopt person-centered care. Such care is holistic and delivers treatment in a respectful and personalized way. Therefore, while specific health conditions require restrictions or isolative measures, a person-centered approach in mental health remains undisputed.
Person-Centered Care
The analysis of person-centered care in mental healthcare cannot be complete without defining person-centered care, its application, barriers, and effects on psychiatric patients. The Person-Centered Training and Curriculum Scoping Group (2018) postulates that human life experience is expressed in terms of a person’s or people’s welfare. According to the Group, psychiatry is person-centered since it focuses on individual lived experiences to treat mental distress or disorder. Carey (2016), on his part, refers to person-centered care as patient-centered care. According to him, the approach focuses on the patient’s preferences and values. Thus, like Feinberg (2014), Carey (2016) also recognizes the need to provide responsive care that responds to the patient’s unique experience.
In his description of the person-centered approach, Carey postulates that the technique involves understanding the client’s experience before encouraging the patient to adopt the psychiatrist’s view. As Garcia et al., 2019 claim, person-centered care aims at dignifying the patient while also making them more capable. To do this, they must design their self-care plan in collaboration with the mental health care professional (Miller et al., 2017). In this case, the focus is on the person and not the disease (Manthorpe & Samsi, 2016). Thus, the approach aims at capitalizing on the uniqueness of the sufferer (Wu et al., 2017). The argument agrees with Polone & Marcos (2017) who argue that providers of person-centered care address the needs of the patient first before delving into their symptoms or diagnosis. Therefore, the approach does not follow the traditional therapeutic approach that aims at neutrality in pursuit of a more engaged approach.
As Clayton (2013) says, allowing patients to participate in decision-making process involving their care provision has numerous benefits which previous scholars have also recognized. Dixon et al. (2016) argues that doing so results in faster recovery and better outcomes. However, patients will not always want to be involved in the decision making process as Manthorpe and Samsi (2016) observe. In their view, this does not matter whether the patient has a psychiatric condition or not. Importantly, as Corrigan et al. (2015) notes, understanding consumer preferences is critical since it can guide their subsequent treatment and care. Alternatively, it can facilitate the installation of decision making aids (Campbell, 2014). Kolanowski et al. (2015) portend that a recovery-oriented system must be trained on quality care provision. According to them, this is possible through two approaches. The first being the traditional disease-centered approach, and the person-centered care. However, considering the welfare benefits of the person-centered approach on the patient, they vouch for its adoption in mental health care. Corrigan et al. (2015) underscores the point that person centered care in psychiatry is the holistic approach that aims at respecting the patient and also recognizes their unique preferences and experiences. Thus, as Hummelvoll et al. (2015) says, person-centered care’s success is hinged on its collaborative nature.
The collaboration between the practitioner and the patient is what matters (Alharbi, 2014). Mezzich et al. (2015) emphasize this further by noting that person-centered care aims at promoting the well-being and health status of the patient. According to them, the person is the goal of health care provision. An important implication is that contemporary medicine’s focus should be shifted from disease to patient to person. Patel and Chatterji (2015) postulate that no discussion of the relationship between mental health and person-centered care is possible without recognizing two vital concepts. First, the various ways through which mental health has facilitated the conceptualization and development of person-centered healthcare provision. Second is the contribution of “psychiatry for the person” in the development of person-centered medicine, a recognized collaborative international movement.
The majority of previous research on person-centered care focuses on dementia and care for the elderly. Hospitals continue to embrace the concept albeit in a slow pace. According to Ellison et al. (2016) hospitals that practice PCC do it depending on whether time permits it. Dixon et al. (2016) enumerates two other terms for the concept, namely, individual-focused care, and patient-centered care. According to him, the terms mean the same thing and can be used interchangeably. Nonetheless, he acknowledges shared responsibilities between the psychiatrist and the patient, and the establishment of common ground as the core aspect of the concept. Ellison et al. (2016), on the other hand argues that in PCC, the healthcare professional aims at identifying the patient’s needs to facilitate personalized care and treatment. Therefore, PCC extends beyond interaction and communication to mutual relations between those involved.
Person-Centered Care in Mental Health
The application of patient-centered care to mental health has begun to increase in studies. Many researchers have attempted to implement the traditional model to psychiatric treatment and determine recommendations for the improvement of mental health care. In the mental health field, the term patient-centered care has been avoided to keep the medical professional in control. Patient-centered care has been identified as the best method to implement a recovery-based mental health system, but only recently has it been commonly accepted as a practice in general health care. Although recovery theory and person-centered theory have different roots, they have obvious implications for understanding mental health. Due to its focus on individuals, mental health should be at the forefront in the implementation of the person-centered theory as Miller et al. (2017) postulate. Indeed, practitioners often argue that they are already practicing person-centered psychiatry.
However, independent care quality reports highlight the power differential that continues to exist between professionals and patients. As Brekke (2019) says, a person-centered care approach focuses on the maintenance of individual uniqueness, enhancement of relationships, and the promotion of patient autonomy. Campbell (2014) on his part lists the creation of positive social environments to improve the quality of residential care. Values such as respect for personhood, mutual respect, and right to self-determination, form the foundations of person-centered care research. Informed flexibility, compassionate presence, negotiation, mutuality, and transparency have been suggested as conditions for person-centered research (Brekke, 2019). Agreeably, the literature reviewed reveals that research about person centered care continues to proliferate. However, as Campbell (2014) states there is no agreement as to which components comprise PCC.
Patel and Chatterji (2015) are some of the authors who have identified several core components required to operationalize person-centered care. However, majority of the previous research contends that the process involves first structuring and listening to the patient to understand their illness narrative. Doing so provides the therapist with an opportunity to familiarize with the person’s situations, assess their knowledge and identify the obstacles that they may encounter in the recovery path. Practitioners are encouraged to be curious about the person, ask new questions, and emphasize keeping the dialogue going rather than on settling prematurely on immediate solutions or plans. Being person-centered entails appreciating each individual’s uniqueness, their values, needs, and preferences (Dichter et al., 2020). Besides, it involves respecting the individual’s choices, freedoms, and recognizing that mental patients are normal humans with a mutual benefit if accorded the opportunity.
Concerns
Mental health is not just about lacking a mental disorder. Mental health encompasses psychological, emotional, and social well-being. It affects thoughts, feelings, and individual actions helping them determine how they make choices, relate to others, or handle stress. Culturally these definitions of mental health will differ but have the same underlying principles. Mental health is influenced by biological factors such as genes, physical illnesses, injury, and brain chemistry. Life experiences such as abuse and trauma also influence mental health. Daily mental health struggles include depression, anxiety, stress, addiction, relationship problems, grief, learning disabilities, and mood or personality disorders (Zaday, 2015). Treatment for mental health issues varies depending upon the individual. Popular treatments include medication or therapy, and in most cases, a combination of both. Taking care of mental health concerns is essential at every age and for everyone regardless of race, religion, or income (Alharbi, 2014). Aside from the lack of insurance, the main reason many people do not seek mental health services because of the stigma surrounding mental health (Zaday, 2015). Stigma is the shame and disgrace attached to something that is deemed socially unacceptable. Mental health stigma contributes to social isolation (Wu et al., 2017). Once mental health issues are made public, friends phoned less, invitations to social events decreased, and problems navigating both platonic and sexual relationships increase (Munten, 2018). Therefore, tackling discrimination and stigma experienced by people experiencing mental illness is crucial in promoting their recovery.
The person-centered care approach focuses on a person’s individualism. As Wu et al. (2017) propose, persons suffering from serious mental illnesses should be treated using the same approach since it does not discriminate. Miller et al. (2017) argues that such a focus capitalizes on individual goals or values which promotes the person-centered practice, even further. Zaday (2015) adds that such an approach results in more significant possibilities for outcome measurement for individuals. It is not uncommon for healthcare professionals to fear they will be held liable if treatment and care are conducted as partnerships with the patient. Health care professionals have different concerns about the adoption of the patient-centered care model. Many but not all concerns stem from lessening medical knowledge and proficiency of the professional. It was also determined that many practitioners feel that the model is already being implemented, but upon investigation and study, many patients of the mental health system feel differently. Time and money were cited as additional reasons for avoiding the patient-centered care model, and this may be a result of the influence of the medical infrastructure on physicians. The economic cost of mental health treatment for both providers and patients is significant and correlates to a lack of care for those who cannot afford it. The demand for such health services outweighs the capacity, which affects the quality of care within the system (Dave and Boardman 2018). An increase in mental health coverage by insurance and a decrease in premiums may decrease the burden on physicians and patients. Also, insurance payments to providers have been increased in the case of improved patient-centered care provisions. By increasing the payment to providers, the burden on both the physician and patient may be decreased.
Treatment Efficacy
Eventually, ‘recovery’ has gained a foothold as an approach to understanding mental health, which acknowledges that recovery is more than symptom reduction, that healing takes place in everyday life, and that the person’s perspective is crucial (Brekke, 2019). However, Alharbi (2014) feels that results emanating from the application of person centered care ought to be evident for everyone to see. As Santana et al. (2017) says, such results would encourage psychiatrists to implement the model since they already know its benefits. Mezzich et al. (2015) propose an in-depth analysis of the person-centered care approach to ascertain all the structures that may hinder its physical or financial operability. Santana et al. (2017) on their part propose the identification of health-care access determinants as one of the ways to help patients access preferred quality health care services promptly. Santana et al. (2017) and Kolanowski et al. (2015) agree that besides reducing health- care system costs, this would also result in improved health outcomes. Their findings agree with Feinberg (2014) who believes that timely care access results from efficient implementation of person centered care. Dixon et al. (2016) separates the time used into operations and referral waiting times, consultation waiting times, and time wasted waiting for available health- care providers. As Brekke (2019) posits, the timely access to care helps reduce the number of hospital admissions. Mezzich et al. (2016) on their part cite a reduction in the utilization of healthcare services such as duration of stay in hospital or emergency department visits as some of the benefits. Besides, it can also cause a reduction in morbidity for chronic diseases (Munten, 2018). Opportunities for cost savings relevant to both patients and the system must also be identified, particularly the lack of affordability of healthcare services, which can hurt patients and families (Santana et al., 2017). For instance, ambulance and emergency care, and pharmaceutical costs can hinder access to care, jeopardizing patient safety. As Munten (2018) suggests, the proposals can be integrated into the person-centered finance model as some of the healthcare system’s costs. While person-centered care could have high initial costs, it is cheaper in the long run (Santana et al., 2017). As Miller et al. (2017) says engaging patients in decision-making for their care is a better utilization for healthcare money, since it ensures that the expenditure and cost are redirected to what patients value most. Therefore, as Dixon et al. (2016) observe, person-centered and recovery approaches must operationalize personal, spiritual, and social aspects of mental health in the enhancement of patient welfare (Corrigan et al., 2015).
Polone and Marcos (2017) postulate that research that projects the life experiences of patients, friends, their family members, and practitioners ought to be recognized in person centered care. Multidisciplinary cooperation is crucial in the recovery process since professionals aim beyond symptoms, disease, or disability reduction. As Manthorpe and Samsi (2016) note, it also aims at helping recovering individuals get a home again, find new work, and new friends. Feinberg (2014) indicates that this happens through the cultivation of a partnership attitude where the individual continues to make positive contributions depending on their previous experience. In this case, their experience extends to interactions with close friends and family members who understand their needs (Mezzich et al., 2015). It is considered a promising method of engaging patients in medical decisions and improving health-related outcomes. Indeed, as Hummelvoll et al. (2015) argues, person-centeredness is radical in that it attempts to assign the patient a central position which challenges existent bureaucracies and promotes the equality of humans.
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