Person Centered Care for Patients with Mental Disorders

This article discusses on mental health care and how experiences with people living with mental disorder can contribute to person-centred health care. The principles of person-centred care, collaborative practice, communication, and coordination are discussed. The article also highlights the importance of understanding the patient's perspective and involving the family in the care process. Dementia care mapping and multimodal sensory stimulation are also discussed as approaches to providing person-centred mental care.

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Title: Person Centered Care for Patients with Mental Disorders

Person-centred health care is the type of care whereby the patient is the centre of the
nurse’s care and the nurse considers the needs of the patient. There exists a respectful and
collaborative partnership between the patient and the carer. The nurse or the carer respects
the contribution by the patient towards their health such as goals, decisions and health needs.
The patient also respects the nurse’s contributions such as the nurse’s knowledge and
expertise concerning the care, experience, values and their decisions concerning the care
(State of Victoria, 2006). The following principles must be applied so that a person-centred
care is effective; both parties should know each other well- this includes knowing the
patient’s or nurse’s individual and holistic approaches, the patient and the carer should share
power, duties and responsibilities; both parties should be accessible and flexible; they should
integrate and coordinate well and create an environment conducive for a person-centred care.
This article discusses on mental health care and how experiences with people living with
mental disorder can contribute to person-centred health care.
The world is suffering from strain due to complexity in patients and community
expectations, aging workforce, poor communication and nurse shortages, making it difficult
to offer quality care to patients especially the mentally challenged patients. The mental health
care has also suffered from disempowerment of carers and patient stigma. Poor coordinated
and cross sectional responses are among the factors hindering quality mental health care,
hence compromising the patient’s safety (Jones, 2014). The WHO (2010) define
collaborative practice as a health care practice (both clinical and non-clinical) whereby nurses
and carers from diverse backgrounds work in collaboration with the patient, their family and
the society so as to deliver a high quality health care. Person centred collaborative health care
is essential for patients with mental illness as it promotes coordination of response and hence
the patient’s health care and outcomes are improved (Wood, 2009).

A good communication in a collaborative person centred health care (involves
discussing about the patient’s understanding, feelings and expectations) leads improved and
positive outcomes in the client’s health. There is increased nurse and patient satisfaction and
the patient adheres more to the nurse recommendations. According to Reeves et al. (2011),
person centred health care is hindered by factors such as time since it is thought to be time
consuming, lack of autonomy to practice in the appropriate way, dissolution of professional
power where power and responsibilities are wrongly shared, lack of clarity on what involves
person centred mental health care and communication difficulties.
According to Jobb-Shanley & Shanley (2007), who worked with a mentally ill
colleague claim that most mental health carers fail in helping their clients to live an optimal
life due to may be negative attitude towards the patient’s involvement in the care practice
(Happell, 2008). People with mental disorders need a straight forward way of communication
and their involvement in the caring process. Sommerseth and Dysvik (2008) claim that if
success is to be attained in person centered mental health care, the carers must come up with
alternative ways of communicating and relating with patients with mental illness. White
(2005) takes a bio psychological approach and thinks that according to his expertise in mental
health care, the starting point to offer quality health care for people with mental disorders is
the people’s resources. According to him, these people need to be engaged in dialogue and
treat each one differently. The cares must understand the pathways so that they can plan on
how to respond to the patients’ needs. Sommerseth & Dysvik (2008) discovered that every
patient with mental disorder had different needs and therefore there is a need for a flexible
framework to deal with their needs. This also means that every patient has a specific pathway
and the nurses and carers should be available to offer the support they need. Involving the
patient’s family is important in enhancing interpersonal relationship between the stakeholders
involved in the health care. In most cases Featherstone (2006) thinks that the expertise of the

family members is overlooked in the care delivery not realizing that they are important
resources in the care practice.
Dementia care mapping (DCM) is a theory developed at Bradford University to help
patients suffering from dementia. This theory states that most of the problems facing patients
with mental disorders are due to the negative environment they find themselves in. This
theory helps carers and nurses to identify factors triggering ill and well-being of the patients
(Rochon et al. 2008). Multimodal sensory stimulation is another approach used to provide
person centred mental care though Van de Ven et al. (2012) think that it has a limited
approach as they are nurse and carer centred but exclude the psychological aspect in the
mental health care delivery. It also does not include systematic and climatic adaptations.
Regnard et al. (2007) had an experience with a patient with mental disorder who was
admitted to the hospital. This patient could call on her granddaughter anytime he wanted to
visit the washroom but the nurses could not know why he kept calling that very name until
they inquired from a family member. They then understood that whenever he called his
granddaughter he wanted to help himself. Regnard and his colleagues therefore concluded
that there is need to understand the needs and habits of the patient. They also discovered that
unknown environment and unfamiliar carers could cause distress to the patient and therefore
the need for a family member. Gluyas (2015) wrote that nurses should realize that not all
family members are close enough to the patient to be their true advocates. This was after
Gluyas encountered a case whereby a patient chose her best friend over her family members.
Carey (2016) claims that effectiveness in care delivery for patients with mental disorders
rotates around the convenience and organization of the service.
Most of the authors including Carey (2016) see poor communication and poor sharing
of powers and responsibilities between the nurses and the patient as the largest shortcoming

in achieving a high quality care for patients with mental disorders. Carey says that in most
settings, the clinicians and carers make stepping decisions for the patients. When the patients
need a higher level of therapy the doctors arrange it without involving the patient. It is not a
routine for carers and nurses to ask patients if they need appointment reminders before they
are issued. Though these appointment reminders could be of little importance to the patient,
according to Australia Nursing & Midwifery Federation (2017), it is wrong to impose
reminders to the patient following the carer’s preferences. In caring for a mentally ill patient,
I would consider the patient perspective care needs and become my motives to the caring
practice.
According to Bayliss-Pratt (2018), patient centred mental health care should be
replaced with patient perspective mental health care. The clinicians and carers must
understand the meaning of “care” and “help”. The helper cannot define the effectiveness of
help but the helpee is in a position to tell the touch and the convenience of care and help.
Therefore person centred mental health care should be patient centred in that the patient
should dictate what kind of care they require not the care providers. In this way the care
practice would be helpful to the patient. This calls for a high level of humility and curiosity
from the carer. The carers and nurses should understand and accept that they cannot fully
understand their patients and therefore stop assuming what the patients need. The carers
should conduct routine checks on the patient to ensure that what is happening to the patient is
what really should be happening according to the patient. This would see to it that mental
health care delivery is acceptable to the patient and also delivered to their best interest (Hyde,
2009).
Dealing with irrational patients with mental disorder could pose a problem in
determining what is best for them. In these cases the carers decide what is best for the patient
but the patient perspective care approach requires that time is taken to determine the patient’s

experience. Even when the patient cannot speak, systematic observation would help the
carers know how and with who the patients spend their time and what is good and bad for the
patient. I recommend that the priority for patient centred mental health care should be shifted
to patient perspective mental health care if efficiency and effectiveness are to be achieved in
caring for mentally challenged patients. The carers should understand and promote the
patient’s right of self-determination. Therefore, in designing mental care delivery framework,
the patient should considered as the core player not the nurses and carers.

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