1 Person-centred care in Psychiatric Practice and Training @subodhdave1 Dr. Subodh Dave Associate Dean, Trainee Support Hon. Asso. Professor, University of Nottingham, V/Professor, SRM University, India and Consultant Psychiatrist, Derby Aims Person Centered Training and Curriculum Scoping Group (PCTC) Why should we be interested in Person Centred Care? What is Person Centred Care? Scope of Person Centred Care? Relevance to Postgraduate training Recommendations for training Non-Adherence rates (your patients) A. 25% B. 33% C. 50% ١ ٢ ٣ ٤ ٥ ٦
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Person-centred care in Psychiatric Practice and Training
@subodhdave1Dr. Subodh Dave
Associate Dean, Trainee SupportHon. Asso. Professor, University of
Why should we be interested in Person Centred Care?
What is Person Centred Care? Scope of Person Centred
Care? Relevance to Postgraduate
training Recommendations for
training
Non-Adherence rates (your patients)
A. 25%B. 33%C. 50%
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Non-Adherence rates (yourself as a patient)
A. 25%B. 33%C. 50%
Non-Adherence rates
A. 25%B. 33%C. 50%
Reasons for non-adherence
Inadequate knowledge about a drug and its use
Not being convinced of the need for treatment
Fear of adverse effects of the drug Cost Complex treatment regime or dosing
schedules
Major cause of Non-adherence
Patient-physician discordance (seen in 60% of consultations)
Another 60% of patients did not understand the treatment plan
Another 60% felt they had no involvement in the design of the care plan
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Patient and
Person Centred
Care
Patient v/s Person
At present a patient’s history, mental state examination, social circumstances, goals, strengths, values and beliefs are considered to inform decisions about diagnosis, treatment and support
Focusing on the person rather than the diagnosis allows us to see diagnosis, treatment and support as tools that will help the person achieve what they wish to in their life
Therapeutic Alliance
Focus on the patient’s concerns Positive regard and personal respect Shared decision making Genuineness and a personal touch Use of a psychological treatment
model (Priebe)
Good Psychiatric Practice
Compassionate Care Intelligent Kindness Values-based Practice Human-rights based approach Reflective Practice Spirituality Holistic Care Ethical Practice Recovery-oriented practice
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Have you offered sub-optimal Rx to your
patients? (with their agreement)
A.YESB.NO
Why Person-centredcare?
The Case for Person Centred Care
Ethical Case Is it acceptable for healthcare to fail to offer people dignity, compassion or
respect? be poorly coordinated? treat people as a set of diagnoses or
symptoms, without taking into account their wider emotional, social and practical
maintain dependency, so that people fail to recognise and develop their own strengths
The Case for Person Centred Care
Consumer Case Institute of Health Improvement (IHI,
Harvard) global survey of patients: Safe Effective Humane
Psychiatry outpatients prefer collaborative model of working (Chewning, 2002)
The Case for Person Centred Care
Professional Case Professionals practising person-centred
care report Reduced stress Reduced burnout Improved work satisfaction
(Brownie, 2013; van den Pol-Grevelink, 2012)
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The Case for Person Centred Care
Instrumental Case Person-centred care associated with
better patient outcomes - both physical and mental health (The Health Foundation, Priebe)
Improved patient satisfaction and compliance
In Psychosis, associated with fewer admissions and better social functioning (McCabe, 2016)
Active ingredient –therapeutic alliance
The Case for Person Centred Care
Economic Case Person-centred care associated with
Better self-management and Reduced service utilisation (Cochrane review, 2003)
In Psychiatry, co-production and peer support associated with Early discharges (Lawn, 2008) Reduced admissions (Min, 2007)
The Case for Person Centred Care
Legal Case Montgomery v Lanarkshire Health Board
(UK Supreme Court, 2015) Shared decision-making based on the
individual’s values the basis of consent to treatment
Supersedes Bolam test
Montgomery and Psychiatry
Better management of emotionally charged consultations
Reduced threat of litigation Reduced by shared decision making
Reduced need for resources (Australia)
Barriers to Implementing Person
Centred Care Clinician Attitudes Clinicians overestimate their ability to
involve patients in clinical decision making (Goosensen, 2007)
Clinician Knowledge Human rights legislation, SDM tools
Clinician Skills Psychiatrists vary in their ability to
engage in shared decision making (McCabe, 2016)
Not clearly signposted in the curriculum
Barriers to Implementing Person
Centred Care Resource Constraints 80% of psychiatric consultation time
spent in establishing diagnosis with very little time devoted to SDM (Loh, 2006)
Clinicians often mistakenly believe that person-centred care will be more time consuming and adversely affect patient outcomes when in fact the evidence points to the contrary
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Training Issues
ICE (Ideas, Concerns, Expectations) + OSCE formats can encourage task-focused communication (breaking bad news) with focus on diseases rather than on people
Tick-box approach can lead to loss of humane connection
Embedding Person Centred Care in Practice Shared Decision Making Co-production Formualtion Skills Self-Management Support – Peer support Personal Recovery Values based Practice Human Rights legislation Staff Engagement – Compassion Reflective Practice
Co-production
Derbhyshire Healthcare Foundation Trust, University of Nottingham
