PATIENT EDUCATION: Part 1
Chronic Disease Self-Management Programs in Psychiatry
Helping Patients Help Themselves
By Evelina W. Sterling, PhD, MPH, Benjamin G. Druss, MD, MPH, and Kate Lorig, RN, DrPH |
January 9, 2012
Dr Sterling is Health Education Consultant in the department of health policy and management, Rollins School of Public Health, Emory University, Atlanta. Dr Druss is Professor and Rosalyn Carter Chair in Mental Health in the department of health policy and management, Rollins School of Public Health, Emory University. Dr Lorig is Professor in the department of medicine and Director of the Patient Education Research Center, department of medicine, Stanford University, Stanford, Calif. The authors report no conflicts of interest concerning the subject matter of this article.
The role of mental health providers in promoting self-management
Interactions with patients should be structured to identify problems from a patient perspective and to design real-life solutions through goal setting, problem solving, action plans, and regular feedback. Sharing responsibilities with patients and emphasizing the vital role patients play in improving health-related habits and self-managing their health conditions are key, regardless of diagnoses. One study found that 4 months after participating in the CDSMP, patients with diabetes mellitus showed significant improvements in eating breakfast, mental stress, aerobic activities, shortness of breath, and pain.12 These improvements continued after 1 year and resulted in increased physician utilization and decreased hospitalizations.
Over the past 20 years, self-management programs have yielded significant, measurable improvements in long-term health benefits, patient outcomes, quality of life, and utilization of health care resources for patients with many different chronic conditions, including diabetes mellitus, heart disease, lung disease, HIV infection, arthritis, autoimmune disorders, and mental illness. These programs have targeted a variety of populations in the United States and abroad.4,14-16 Self-management support assists patients as they take greater ownership of their care: patients are encouraged to live with their physical and mental health conditions long-term and full of hope.
Building on this approach, community mental health centers and other specialty providers are increasingly using peers to promote group work and mutual support to enable patients with mental health problems to draw on each other’s experiences regarding both mental health and general wellness. Mental health clinicians can also link patients to other established community self-management interventions located in health departments, health care organizations, and local non-profits. Through patient self-management, mental health clinicians can transfer the focus from managing symptoms to allowing patients to live well in the context of their mental illness and medical comorbidities. And, patient peers can help model behaviors aimed at improving both physical and mental health.
Also in this Special Report
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10. National Alliance on Mental Illness. Peer-to-Peer: NAMI’s Recovery Curriculum; 2005. http://nami.org/template.cfm?section=Peer-to-Peer. Accessed December 2, 2011.
11. Veteran Recovery. Vet-To-Vet Peer Program. http://www.veteranrecovery.org/peer_support/index.htm. Accessed December 2, 2011.
12. Druss BG, Zhao L, von Esenwein SA, et al. The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophr Res. 2010;118:264-270.
13. Parks J, Svendsen D, Singer P, et al, eds. Morbidity and Mortality in People With Serious Illness. Alexandria, VA: National Association of State Mental Health Program Directors; 2006.
14. Lorig KR, Sobel DS, Steward AL, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999;37:5-14.
15. Lorig KR, Ritter PL, Jacquez A. Outcomes of border health Spanish/English chronic disease self-management programs. Diabetes Educ. 2005;31:401-409.
16. Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part I). Health Promot Pract. 2005;6:37-43.