Towards a Person-Centered Care Model Among Community Mental Health Services
Abstract
Mental illness is widespread among adults and remains the foremost cause of years lived with disability. Despite its importance, there is a scarcity of research on person-centered care (PCC) from the viewpoints of mental health service users, particularly within clinical community mental health services. This study sought to investigate the potential for enhancing PCC through the lived experiences of individuals with mental health conditions who use local community mental health clinics (CMHC) in Malta. The goal was to obtain a thorough understanding of the current landscape, evaluate its strengths and weaknesses, and identify strategies for evolving the system towards a more PCC-focused model.
A qualitative research design was utilized, following the principles of Interpretative Phenomenological Analysis (IPA) as described by Smith et al. (2009). Ten participants from Malta, including six women, who frequently visit CMHCs, were recruited through intermediaries. Each participant took part in a one-hour semi-structured interview, conducted at a mutually convenient time and location. These sessions were audio-recorded and transcribed verbatim for subsequent analysis.
The analysis identified three main themes: Quality care, emotional support, and partnership and collaborative care, each comprising various sub-themes. The study illuminated both the strengths and shortcomings of the existing system and their implications for a PCC-oriented healthcare approach. While our findings reaffirm research on the critical role of empathy in care and other relevant factors, results also indicate that cultural factors in Malta, such as strong family ties, significantly influence the delivery of person-centered care (PCC), which may be relevant for other small communities. Furthermore, the research offers healthcare professionals (HCPs) a chance for ongoing professional development in accordance with the latest PCC principles.
References
Andresen, R., Caputi, P., & Oades, L. (2006). Stages of Recovery Instrument: Development of a Measure of Recovery from Serious Mental Illness. Australian & New Zealand Journal of Psychiatry, 40, 11-12. https://doi.org/10.1080/j.1440-1614.2006.01921.x
Bacha, K., Hanley, T., & Winter, L. A. (2020b). ‘Like a human being, I was an equal, I wasn’t just a patient’: Service users’ perspectives on their experiences of relationships with staff in mental health services. British Journal of Medical Psychology, 93(2), 367-386. https://doi.org/10.1111/papt.12218
Baker, A. (2001a). Book: Crossing the Quality Chasm: A New Health System for the 21st Century. BMJ, 323(7322), 1192. https://doi.org/10.1136/bmj.323.7322.1192
Building Resilience, Transforming Services. A Mental health Strategy for Malta 2020-2030. (2019). https://health.gov.mt/wp-content/uploads/2023/04/Building_Resilience_Transforming_Services_A_Mental_ Health_Strategy_for_Malta_2020-2030_EN.pdf
De Silva D. (2011). Evidence: Helping people help themselves - The Health Foundation. The Health Foundation. https://www.health.org.uk/publications/evidence-helping-people-help-themselves
De Silva D. (2012). Helping people share decision making - The Health Foundation. The Health Foundation. https://www.health.org.uk/publications/helping-people-share-decision-making
Ekman, I., Swedberg, K., Taft, C., Lindseth, A., Norberg, A., Brink, E., … Sunnerhagen, K. S. (2011). Person-centered care—ready for prime time. European Journal of Cardiovascular Nursing, 10(4), 248-251. [PubMed]
Fischer, A. H., Kret, M. E., & Broekens, J. (2018). Gender differences in emotion perception and self-reported emotional intelligence: A test of the emotion sensitivity hypothesis. PLOS ONE, 13(1), e0190712. https://doi.org/10.1371/journal.pone.0190712
Galea, M., & Zammit G., F. (2024). Towards a Person-Centered Care approach in Community Mental Health Services. Corporate Social Responsibility in Health and Social Care. IGI Global. In print.
Henderson, P., Fisher, N. D., Ball, J. M., & Sellwood, W. (2020). Mental health practitioner experiences of engaging with service users in community mental health settings: A systematic review and thematic synthesis of qualitative evidence. Journal of Psychiatric and Mental Health Nursing, 27(6), 807-820. https://doi.org/10.1111/jpm.12628
Hummelvoll, J. K. (2012). Helt – ikke Stykkevis og Delt. Psykiatrisk Sykepleie og Psykisk Helse. Oslo: Gyldendal Akademisk.
Karlsson, B., Borg, M. and Kim, H. (2008) From good intentions to real life: introducing crisis resolution teams in Norway. Nursing Inquiry, 15(3), 206-215.
Lauver, D. R., Ward, S. E., Heidrich, S. M., Keller, M. L., Bowers, B. J., Brennan, P. F., ... & Wells, T. J. (2002). Patient‐centred interventions. Research in nursing & health, 25(4), 246-255.
Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Pr J Psychiatry, 199(6), 445-52 https://doi.org/10.1192/bjp.bp.110.083733
Maassen, E. F., Schrevel, S. J. C., Dedding, C., Broerse, J. E. W., & Regeer, B. J. (2017b). Comparing patients’ perspectives of “good care” in Dutch outpatient psychiatric services with academic perspectives of patient-centred care. Journal of Mental Health, 26(1), 84-94. https://doi.org/10.3109/09638237.2016.1167848
Malmström, E., Hörberg, N., Kouros, I., Haglund, K., & Ramklint, M. (2016b). Young patients’ views about provided psychiatric care. Nordic Journal of Psychiatry, 70(7), 521-527. https://doi.org/10.1080/08039488.2016.1176251
McCormack, B. (2003). A conceptual framework for person‐centered practice with older people. International Journal of Nursing Practice, 9(3), 202-209.
McCormack, B., & McCance, T. (2017). Person-Centered Practice in Nursing and Health Care: Theory and Practice. John Wiley & Sons.
McCormack, B., & McCance, T., (2010). Person-centered nursing: Theory and practice. Chichester, West Sussex: Wiley-Blackwell.
Moore, L., Britten, N., Lydahl, D., Naldemirci, Ö., Elam, M., & Wolf, A. (2017). Barriers and facilitators to the implementation of person-centered care in different healthcare contexts. Scandinavian Journal of Caring Sciences, 31(4), 662-673. https://doi.org/10.1111/scs.12376
Newman, D., O'Reilly, P., Lee, S. H., & Kennedy, C. (2015). Mental Health Service Users' Experiences of Mental Health Care: An Integrative Literature Review." Journal of Psychiatric and Mental Health Nursing. Mental health service users.pdf (worktribe.com)
Polit, D. F., & Beck, C. T. (2018). Essentials of Nursing Research: Appraising Evidence for Nursing Practice. LWW.
Rogers, C. R. (1967) On Becoming a Person: A Therapists View of Psychotherapy. London: Constable and Robinson Ltd.
Scerri, J., Churchill, J., Banks, D., & Sultana, J. (2021). Advocating a person-centered care approach to drug safety. Expert Opinion on Drug Safety https://www.um.edu.mt/library/oar/handle/123456789/90465
Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative Phenomenological Analysis: Theory, Method and Research. SAGE.
Stanhope, V., Choy-Brown, M., Marcus, S., & Williams, N. (2021). Implementing Person-centered care planning: A randomized controlled trial. Psychiatr Serv, 72(6), 641-646. https://doi.org/10.1176/appi.ps.202000361
Starfield B. (2011). Is patient-centered care the same as person-focused care? The Permanente Journal, 15, 63-69. [PMC free article] [PubMed]
Trevillion, K., Stuart, R., Ocloo, J., Broeckelmann, E., Jeffreys, S., Jeynes, T., … Oram, S. (2022b). Service user perspectives of community mental health services for people with complex emotional needs: A co-produced qualitative interview study. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-021-03605-4
World Health Organisation. (2013). Comprehensive Mental Health Action Plan 2013–2030. 9789240031029-eng.pdf (who.int)
World Health Organisation. WHO. (2022). World mental health report: transforming mental. Transforming mental health for all. https://www.who.int/publications/i/item/9789240049338
World Health Organisation. WHO. (2023). Quality of care. https://www.who.int/health-topics/quality-of-care#tab=tab_1
World Health Organisation: WHO. (2020). Mental health. https://www.who.int/health-topics/mental-health#tab=tab_1
World Health Organization (2024). Towards collaboration on mental health in the Small Countries Initiative: background paper. https://www.who.int/europe/publications/i/item/WHO-EURO-2024-8941-48713-72418
World Health Organization. (2021). Guidance on community mental health services: Promoting person-centered and rights-based approaches. https://www.who.int/publications/i/item/9789240025707
Yardley, L. (2000). Dilemmas in qualitative health research. Psychology and Health, 15(2), 215-228.
Youssef, A., Wiljer, D., Mylopoulos, M., Yang, L., & Sockalingam, S. (2020b). “Caring About Me": A pilot framework to understand patient-centered care experience in integrated care – a qualitative study. BMJ Open, 10(7), e034970. https://doi.org/10.1136/bmjopen-2019-034970
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