Modern psychiatry seems to focus more on objective data than it does on patient experiences and circumstances. Sometimes it centres on symptoms, forgetting that we are dealing with people who have problems. This is why there is a constant demand for a paradigm shift from “patient” to “person”. The aim is not to ignore or discredit the reductionist biomedical model, but rather to include additional areas to better understand individuals who have mental health problems. We will analyse 2 concepts; person centred care and recovery.
Thus due to this demand for a change of paradigm, approaches that centre on the individual are now wanted, in the form of person centred-care, thereby emphasising the needs and desires of the person more than medical or clinical questions. Although this concept is hard to define, and it is complicated to specify which variables it should cover, some authors have tried to delimit and define it so that it can be included in medical praxis1–3 and even in the field of mental health. Certain fundamentals have been suggested for this.4
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It has to be a multidimensional construct.
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It has to be person-focussed.
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It has to be controlled by the person him- or herself, so that informed consent is indispensible for any clinical act.
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The person must have the right to decide beforehand in questions about their health.
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This has to be seen as an approach which is contextualised in a personal history and circumstances.
A good example of its applicability, with good clinical results, can be found in people with dementia, as is the case for the VIPS model–values, individualised, perspective and social–proposed by Brooker5:
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Values that claim the absolute value of all human lives.
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An individualised approach that recognises personal singularity.
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Interpreting the world from the person's point of view.
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Providing a social framework that satisfies psychological needs.
Nevertheless, we should know that if we centre our attention on the person, we have to reflect on the nature of the final aim of psychiatric praxis, given that biomedical variables are now not the only factors to be taken into account, as also and very importantly the patient's desires and values, etc. in connection with their clinical situation have to be taken into account. This will allow us to respect the person more and understand the situation better.
Given that some patients with mental disorders have multiple pathologies and that they are vulnerable and dependent people with biological, psychological and social needs, with limited functioning (difficulties in their everyday life and interpersonal relationships, etc.), it may be worthwhile to include the concept of recovery in care plans, to consider what these patients appreciate the most.6 The aim is therefore to discover and appreciate how people with mental diseases understand life, as they have to live with their own disease.7
Leamy et al.6 proposed a theoretical–practical framework that covers this concept and expresses it in 5 categories: 1) satisfaction (in interpersonal relationships and their role in the community); 2) hope and optimism about the future; 3) identity (reconstruction of the self and overcoming stigma); 4) meaning in their life (quality of life and roles, etc.), and 5) empowerment.
All of these components express the demand that we centre more on personal re-insertion and self-esteem than we do on simply reducing psychiatric symptoms. We have to ensure they have a good quality life that is worth living, in which their treatment will be based on their personal values. It has to be said that to gain greater knowledge of this concept it is necessary to ask the patients themselves what they understand by recovery.8 This may occur by adopting person-centred models, by reaching shared decisions9 or even by patients expressing their decisions about any health-related matter in advance.10
This is therefore about aspiring to more humane and higher quality healthcare, basing ourselves on ethical questions too which guide the treatment process. While including biomedical questions, it will not forget personal values and wishes. It will cure–or try to cure–individuals, but will also care for them.
Please cite this article as: Ramos Pozón S. Person centered-care y recovery: ¿pueden servir para alcanzar una asistencia sanitaria más humana? Rev Psiquiatr Salud Ment (Barc). 2017;10:179–180.