- Psychiatric Times Vol 29 No 1
- Volume 29
- Issue 1
Chronic Disease Self-Management Programs in Psychiatry
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.
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.