Person-Centered Psychosis Care: An Educational Intervention for Inpatient Staff

Background

Schizophrenia is a major mental illness that presents in young adulthood. It affects approximately 1% of the population and is a major cause of Disability-adjusted Life Years worldwide. Besides impacting on the ability to independently carry out daily activities, work/studies and interactions with family and community, the illness has a profound effect on physical health. Diabetes and cardiovascular diseases are common complications and life expectancy is reduced by as much as two decades. The long term nature of this complex illness highlights the need for more effective, holistic care models. Increased patient involvement is central, as it has been shown that patients' views of appropriate interventions often differ from those of formal care providers.

Person-centered care (PCC) is recognized by the WHO as a valuable approach to the care of chronic conditions. A basic assumption of person-centered care (PCC) is that healthcare must recognize the patient as a person, with own knowledge, capacity and preferences along with needs and problems. The PCC way to deal with illness and disease is to form a partnership with the person and together form a plan of action to increase health (i.e. not only focus on symptoms or signs of diagnosed disease) taking into account the person's context and priorities. Previous studies show that persons with serious mental illness can and want to participate in their own care and participation might increase adherence. Improved social function and consumer satisfaction were demonstrated when a person-centered care approach, Integrated Care (IC) was tested in a psychosis outpatient-based randomized controlled trial.

To the best of the authors knowledge, PCC has yet to be tested in an inpatient setting for persons with severe mental illness. Favorable results have been demonstrated with regard to both ward level and patient level outcomes from inpatient settings within somatic care. Person-centered care in geriatric settings, which might share some common issues with hospital care for persons with schizophrenia (decreased cognitive function, lack of insight, compromised autonomy), have shown positive outcomes for QoL and agitation in patients and job satisfaction for staff. Reviews show mixed results though. Thus, we wanted to evaluate an intervention for inpatient psychiatric care for persons with schizophrenia and similar psychoses. To this end, we developed Person-centered Psychosis Care (PCPC), a staff educational intervention involving components of PCC as well as IC. Person Centered Psychosis Care was defined as having four key elements; dialogue, building partnership, formulation and documentation of a health plan, and early involvement of the patient's outpatient facility. The latter means that the patient's outpatient-based social resource group can come into play already during the inpatient stay.

Purpose