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Chronic Disease Self-Management Programs in Psychiatry

Chronic Disease Self-Management Programs in Psychiatry

How people manage their chronic condition when not under direct medical supervision makes a difference in their quality of life, their health, and their utilization of the health care system—and such self-management can be both time-consuming and complex. While health care providers routinely educate patients about understanding medical conditions, diagnoses, and treatment options, self-management is defined as the tasks that individuals must undertake to live well with 1 or more chronic conditions.1 These tasks include having the confidence to deal with the medical and emotional management of their condition.

Self-management programs are an effective complement to the work provided by clinicians. While variation exists regarding the implementation of self-management programs in terms of program location, staffing, and the extent of personal interaction between self-management coaches and patients, the overall objective of self-management programs is to change behavior.

These changes allow patients to effectively cope with their chronic conditions—many of which can be progressive and debilitating—by learning healthier ways to live, gaining confidence and motivation to manage their health, and feeling more positive about their lives.

Making behavior changes is difficult, and the changes are often hard to maintain. For behavior change to occur, patient education alone is not sufficient. Having the confidence to make the change is critical. This confidence can be translated to self-efficacy—the belief that one is capable of attaining certain goals.

Self-efficacy can be enhanced through specific self-management tools and techniques, such as skills mastery through the achievement of action plans; modeling, which allows self-management program participants to see people like themselves helping others and being successful; reinterpretation of beliefs; and social persuasion. All self-management programs are built on 3 important underlying skills: action planning, problem solving, and decision making. Evidence-based self-management programs stress that for action plans to be effective, they must2,3:

• Reflect what the patient really wants to do

• Be specific about what is to be accomplished, how much, how often, when, and where

• Be realistic in what can be achieved successfully

• Incorporate problem-solving and decision-making techniques that allow for adjustments when issues arise that might interfere with the action plan

The Chronic Disease Self-Management Program (CDSMP) is the most extensively tested peer-led self-management program designed to address the needs of persons who have a wide range of chronic medical conditions, such as diabetes mellitus, arthritis, chronic pain, and HIV infection.2-4 As with all self-management programs, the CDSMP enhances regular treatment and disease-specific education. The program consists of 6 structured small-group sessions that focus on a set of self-management tasks that have been found to be common across chronic conditions, including becoming a better self-manager, increasing healthy behaviors, and using the health care system effectively.

The elements of the intervention, grounded in self-efficacy theory, include regular action planning and feedback, modeling of behaviors and problem solving, reinterpretation of symptoms, and self-tailoring (ie, making your own plans based on what you have learned), so choices are based on the preferences and voice of the patient (see the Table for key subjects covered by the CDSMP).

Self-management and mental health

Efforts to improve the treatment of more common mental health conditions, such as depression, often incorporate elements of the chronic illness care model that support the improvement in self-efficacy.5 By implementing behavioral changes, the patient is better prepared for crises and relapse prevention. Allowing mental health patients to assume a greater role in decision making and self-management is a main theme described by proponents of recovery.

The recovery model is based on understanding personal meaning; attending to personal experiences, contexts, and meanings; building better patient-clinician partnerships; and creating integrated, self-management support structures. Both recovery and self-management stress wellness by removing the blame for the disease or condition from the patient and empowering him or her to take control of his or her life and health. In fact, self-management of psychiatric illnesses has become a central tenet of patient-directed mental health treatment.6,7

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