Stefan on Patient-Centered Care and Individuals with Psychiatric Disabilities

New on SSRN: Susan Stefan, The Application of the Concepts of Patient Centered Care and Self-Directed Care to Individuals with Psychiatric Disabilities: Legal, Policy and Programmatic Considerations. The abstract:

This article considers potential barriers to applying the Institute of Medicine's principle of patient centered care to individuals with psychiatric disabilities. It compares patient centered care to self-directed care, a concept used in Medicaid that is being considered for application to programs treating people with psychiatric disabilities.

The author concludes that 1) concerns about competence as a barrier to patient centered or self directed care are overstated; 2) barriers related to the involvement of the legal system in mental health treatment through commitment and compulsory medication orders create a more significant barrier to application of patient centered care and self directed care than concerns about competence; 3) the current understanding of informed consent for people with psychiatric disabilities inappropriately places too much of the burden of risky decisions on the health care professional; and 4) if self directed care were truly adopted in public mental health services, it would result in the welcome demise of the day treatment system as we know it. The paper proposes solutions to the barriers it discusses and endorses (with certain limitations) the concepts of patient centered and self directed care for people with psychiatric disabilities.