Wellness Self Management
What Is Wellness Self-Management?
Recovery is what occurs when people with a psychiatric diagnosis discover or rediscover their strengths and abilities, pursue goals, and develop a sense of identity that allows that person to grow beyond his or her diagnosis. Wellness self-management offers tools that may assist a recipient on his or her own path to recovery. Specifically, these tools may assist an individual to manage the stress associated with every day events, provide education on the symptoms of their diagnosis in addition to offering the individual skills to assist him or her to overcome barriers and pursue personal goals. There are three primary wellness self-management interventions including education, skills training, and cognitive therapy (Drake et al., 2000). Education provides basic information about mental illness from diagnosis to recovery. Education is provided on the characteristic symptoms of the individual's mental health diagnosis, effects and side effects of medications, the principles of recovery, management of stress, and early warning signs of relapse. Skills training offers learning activities that enable recipients to acquire interpersonal, self-care, and coping skills. Cognitive therapy is a tool that may assist recipient(s) to evaluate his or her belief system and explore and/or formulate alternative, more viable explanations when faced with evidence that is inconsistent with their beliefs.
Why Is Wellness Self-Management Important?
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Wellness self-management improves recipients' recovery. Research shows that its interventions, when combined, are more effective at improving the course of schizophrenia than standard treatment.
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Wellness self-management skills training clearly improves social functioning, including social relationships, leisure and recreation skills, and self-care ability. Cognitive therapy has been demonstrated to decrease the severity of psychotic symptoms, and may decrease psychiatric service utilization (Zygmunt et al., 2001).
- All programs serving adults diagnosed with a serious mental illness should offer wellness self-management services in a manner which operationalizes values of respect, partnership, and person-centeredness.
Connecting People to Wellness Self-Management Services
All individuals diagnosed with a mental illness should be offered wellness self-management. In order to connect people with these services, all new recipients should be asked about their interest in improving their abilities to manage the symptoms of their diagnosis, overcome barriers, and pursue personal goals. Wellness self-management programs should work collaboratively with the recipient and members of his or her support network, and other service providers to develop and regularly update a wellness self-management and relapse prevention plan that describes the roles of everyone involved in the plan.
Family, Recipient, Cultural PerspectivesThe development of the descriptions for these OMH Priority Evidence-Based Practices included extensive involvement from clinical experts, recipients of mental health, family members, and people who represent culturally diverse viewpoints. Their perspectives are critical to the understanding of these important practices and programs in mental health.
Family Perspective
Most families are eager to have their relative learn new ways to cope; manage stress; better understand the diagnosis and its treatment; and, identify and achieve goals that will help them move toward recovery. But when an individual with a long history of mental illness lives at home (and sometimes, even when they don't), there are often struggles with other family members about rules, money, and independence.
Even as an individual's symptoms abate, family members may be overprotective or confused about how much autonomy they should actually provide. As individuals with a psychiatric diagnosis move toward recovery, family members will need to recognize these changes and make adjustments in their own behaviors to foster their relative's growing competence and independence. This may need to occur in small steps as families slowly gain trust. Families may find that they need to adopt new patterns of relating. Wellness self-management programs should take these issues into account and work collaboratively with family members and recipients to resolve them.
Recipient Perspective
When evidence-based practices specific to wellness self-management are provided in a recovery focused, person centered way, these approaches may be extremely helpful. A person may experience psychiatric distress for a number of reasons and the symptoms of this distress greatly vary from one person to another. When these approaches are provided in a way that looks and judges an individual based on his or her diagnosis and not as a person first, they may be counter-productive. It should also be noted that when considering wellness self-management tools, information on non-traditional approaches should always be offered.
Cultural Perspective
Effective skills teaching
for symptom management and recovery education requires a holistic and culturally
accurate understanding of the individuals receiving the service. Cultural considerations
need to be taken into account to facilitate new learning and recovery. The foundation
for healing for many is centered in traditional, alternative and spiritual approaches
that need to be discussed and integrated. Efforts here need to meet the recipient
where they are, build on strengths to incorporate new information.
Quality Measures for the Treatment of Schizophrenia
The above hyperlink directs you to schizophrenia measures and data sources, organized by domain of quality. These quality measures for schizophrenia may be found with further discussion in the research article: Hermann RC, Finnerty M, Provost S, Palmer RH, Chan J, Lagodmos G, Teller T, Myrhol BJ. (2002). Process measures for the assessment and improvement of quality of care for schizophrenia. Schizophrenia Bulletin, 28 (1), 95-104.
Description of Quality Measure for Wellness Self Management
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Self-Care |
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Description |
Percent of adults diagnosed with schizophrenia who were assessed for the ability to adequately care for themselves |
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Numerator |
Number of persons in the denominator who engaged in activities that contributed to individual's wellness self management in the past year |
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Denominator |
All persons age 18 and older with a diagnosis of schizophrenia |
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Data Source |
none |
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Developer |
American Psychiatric Association Office of Quality Improvement |
1. Progress and periodic treatment plan reviews identify and address outcomes associated with the recipient's self-management of symptoms and relapse.
2. The agency/program has a system to continuously collect, analyze, and act upon illness self-management and relapse prevention data:
- Percent of medical records including a wellness self-management and relapse prevention plan
- Rates of relapse
- Severity of symptoms measures
- Hospitalization events and lengths of stay
- Number or percentage of emergency visits
- Pre- and post-tests measuring skill and knowledge acquisition
Drake, R.E., Mueser, K.T., Torrey, W.C., Miller, A.L., Lehman, A.F., Bond, G.R., et al. (2000). Evidence-based treatment of schizophrenia. Current Psychiatry Reports, 2 (5), 393-397.
Zygmunt, A., Olfson, M., Boyer, C. A., Mechanic, D. (2002). Interventions to improve medication adherence in schizophrenia. Manuscript submitted for publication. American Journal of Psychiatry, 159, 1653-1664.