Guiding Principles
Monday, September 17, 2007
National Goals for U.S. Mental Health Settings
Best practices in mental health treatment settings, both inpatient and outpatient, are rapidly changing. The New Freedom Commission (2003) has found the U.S mental health system of care to be fragmented, that many barriers impede care, and that the system is not oriented to the “single most important goal of the people it serves - the hope of recovery” (p. 3). Recovery is defined by the New Freedom Commission, as:
“…the process in which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability. For others, recovery implies the reduction or complete remission of symptoms” (p. 5).
Research has noted that ‘having hope’ and being empowered to ‘hope’ plays an integral role in helping people to recover. This has clear implications for mental health treatment settings in that they must evaluate their operational processes and systems to assure these are focused on recovery principles (NF Commission, 2003).
In 2001, the Institute of Medicine (IOM) published a landmark work, which focused on the identification of strategies for achieving a substantial improvement in the quality of healthcare delivered to Americans. In 2005, the IOM applied these strategies specifically to the mental and substance abuse treatment fields.
The following guidelines for the Delaware Psychiatric Center (DPC) Task Force are taken from these two documents, as well as the Surgeon General’s Report on Mental Health that was released in 1999. All of these nationally respected reports make similar recommendations, and these have been adapted herein, for a mental health inpatient setting, such as DPC.
Safety must be a system priority. This means that all treatment settings must ensure the safety of the people they serve and the staff who serve them. However, controlling practices and rigid, institutional rules do not lead to safety but instead lead to rebellion and conflict. The safest treatment settings in the U.S. have prioritized the values inherent in individualized and compassionate care, an avoidance of coercion, a minimization of the use of violent and restrictive measures such as seclusion and restraint, and have focused staff training on learning how to listen, negotiate, and mediate disputes.
Admission and treatment services must focus on principles that support recovery including self-direction, person-centered, empowerment, non-linear, peer support, respect, responsibility, and hope. These principles should be observed in the environment of care, including in the facility’s philosophy of care, policies, and procedures; staff hiring processes, job descriptions, training activities, and performance evaluations; treatment planning activities that includes service users; discharge planning processes; and performance improvement measures and the use of data to track key performance indicators.
Admission and treatment services must be customized to individuals, based on their needs, values, and choices. Mental health treatment facilities must make all efforts to create options for service users in treatment planning and daily activities and respect the wishes of services users, even when that is to refuse treatment. (Comment – this needs to be an informed decision, enabling the user to fully comprehend the consequences of such a decision)
Services provided in inpatient settings need to be based on evidence. The implementation of evidence-based practices lags behind current practices by 15-17 years across this country. All efforts need to focus on the use of evidence-based treatments and promising practices, including assuring the accountability of staff to learn and provide these services.
The patient, or service user, must be the source of control of their services and care. Service users must be given the knowledge, education, motivation, access to information, and opportunity to exercise control over what happens to them, whenever possible. This means staff must understand both their own and the service users roles and responsibilities and understand how to tailor services to meet patient’s goals, as well as how to challenge them to move toward recovery.
Delaware Psychiatric Center Specific Issues
Recommendations
1. The Task Force needs to explore DPC’s operational response to high risk and problem prone events, such as abuse and neglect issues, the use of seclusion and restraint, and patient and staff injuries.
2. The DPC Task Force will focus on the specific charges as identified in Executive Order 100 and utilize past reports and/or information from other bodies concerned about the care at DPC, as a means to highlight possible trends in need of immediate attention and correction. All discussions need to begin with a “is this relevant to the present?” question.
3. DPC practices and processes should be judged in comparison with the standards of practice in other similar facilities.
4. It is important for the task force to understand DPC’s current compliance with both the federal Centers for Medicare and Medicaid and the Joint Commission on Accreditation of Healthcare Standards of care.
5. The Task Force needs to explore whether DPC leaders have the means, resources, guidance, leadership, and commitment necessary to move toward a recovery oriented system of care and what are the barriers they are struggling with.
References
Institute of Medicine. (2005). Quality treatment for people with mental and substance-use
disorders. Rockville, MD: Institute of Medicine Academies Press.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming
mental health care in America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD: DHHS.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2005). Consensus
statement on mental health recovery. Proceedings from the National Consensus Conference on Mental Health Recovery and Systems Transformation. December 16-17, 2004. Rockville, MD.
U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon
General. Rockville, MD: USDHHS, SAMHSA, CMHS, NIH, NIMH. |
