Traditional mental health settings assign sole treatment authority to the therapist reducing patients to a classified diagnosis followed by the indicated treatment. Traditionally, after reviewing the case history and a brief initial interview, patients are assigned a diagnosis and “told what is good for them.” The caseworker retains total authority over the patient’s treatment plan usually focused on symptom reduction. Case notes are kept confidential even from the patients themselves. Providers feel pressure to document primarily for billing purposes and must submit notes within 24 hours for Medicaid reimbursement. There is little time allotted for consulting with patients to illicit their input on their treatment plan.
A more modern outlook on mental health care is beginning to emerge in social work academic circles. Victoria Stanhope, PhD, MSW, MA, associate dean of faculty affairs, a professor, and director of the PhD program at NYU Silver School of Social Work says, “One of the most effective ways to achieve the triple aim of ‘better health, better care, and lower cost through improvement’ is to practice person-centered care, providing consumers with a unique plan based on their needs, supported by meaningful choices, and the opportunity to give input regarding their health goals.”
One of the adages of this mental health recovery movement is - nothing about us without us. The collaborative-care movement advocates for writing clinical notes through an open process. Charting progress changes quite a lot when the person sitting next to the clinician can read what is written about them. Whereas most clinicians write notes after the client leaves, collaborative documentation is a practice where clinicians write the note with the consumer, potentially transforming the “busy work” of documentation into a more meaningful activity. “So, person-centered care planning,” says Stanhope, “is an intervention that orients care toward a person’s unique life goals.”
Stanhope says the first step toward successful patient-centered care is building a relationship with your client. “Relationships take time,” she says, acknowledging that many agencies don’t give the providers enough time to understand the person they’re working with. “There’s this drive to diagnose and then come out with a treatment plan,” Stanhope says. “I think the challenge is trying to make it a more meaningful activity,” she says. “Despite the limited appointment time, there’s a possibility for greater engagement when people are encouraged to share their perspectives. Ask yourself, how much of this treatment plan is being developed collaboratively? How much does the person get to determine it themselves?”
Allowing enough time to build a relationship with a client is step one. Reaching out to people who are part of the client’s network or important to them is step two. “We rarely ground people’s recovery in the community,” Stanhope says. “So as much as you can, bring in nontraditional and informal supports that allow people to integrate into the community rather than just being in a bubble of services.” Feeling alone and somewhat ashamed of their affliction only adds to a client’s isolation and mental health issues. Helping them feel understood and supported can move a client along more rapidly in the healing process.
Finally, she says people often have a hard time getting out once they’re in the system. “I think one of the most controversial parts of recovery—but very important—is that people’s recovery is not linear. We must be flexible and calibrate care on an individual basis,” Stanhope says. Part of this, she says, is allowing people to take risks. “Providers make a lot of decisions for people, like ‘you’re not ready to do this, I don’t think you can live independently,’” she says. “Not surprisingly, agencies are very risk averse. And that prevents people from being able to grow.”
Admittedly, a person-centered approach to therapy takes more time, but if it leads to more positive outcomes the time expenditure is well worth it.
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