No abstract

Objectives: To review the conceptual bases of Person-centred Integrative Diagnosis (PID) as a component and contributor to person-centred psychiatry and medicine and to outline its design and development. Method: An analysis was conducted of the historical roots of person-centred psychiatry and medicine, tracing them back to ancient Eastern and Western civilizations, to the vicissitudes of modern medicine, to recent clinical and conceptual developments, and to emerging efforts to reprioritize medicine from disease to patient to person in collaboration with the World Medical Association, the World Health Organization, the World Organization of Family Doctors, the World Federation for Mental Health, and numerous other global health entities, and with the coordinating support of the International Network for Person-centered Medicine. Results: One of the prominent endeavours within the broad paradigmatic health development outlined above is the design of PID. This diagnostic model articulates science and humanism to obtain a diagnosis of the person (of the totality of the person's health, both ill and positive aspects), by the person (with clinicians extending themselves as full human beings), for the person (assisting the fulfillment of the person's health aspirations and life project), and with the person (in respectful and empowering relationship with the person who consults). This broader and deeper notion of diagnosis goes beyond the more restricted concepts of nosological and differential diagnoses. The proposed PID model is defined by 3 keys: broad informational domains, covering both ill health and positive health along 3 levels: health status, experience of health, and contributors to health; pluralistic descriptive procedures (categories, dimensions and narratives); and evaluative partnerships among clinicians, patients, and families. An unfolding research program is focused on the construction of a practical guide and its evaluation, followed by efforts to facilitate clinical implementation and training. Conclusions: PID is aimed at appraising overall health through pluralistic descriptions and evaluative partnerships, and leading through a research program to more effective, integrative, and person-centred health care.

It may seem logical that if people can break down or become ill, then they can also overcome their problems and recover. Yet providers of mental health services often fail to emphasise such positive possibilities for people with mental health problems-particularly those with the most severe diagnoses. Psychiatric services often emphasize maintenance rather than recovery, and many survivors report that receiving a psychiatric label has been severely detrimental to their efforts to lead a worthwhile and enjoyable life and contribute to others.

No abstract

BackgroundA cluster randomised controlled trial (RCT) of a national Kenyan mental health primary care training programme demonstrated a significant impact on the health, disability and quality of life of clients, despite a severe shortage of medicines in the clinics (Jenkins et al. Submitted 2012). As focus group methodology has been found to be a useful method of obtaining a detailed understanding of client and health worker perspectives within health systems (Sharfritz and Roberts. Health Transit Rev 4:81–85, 1994), the experiences of the participating clients were explored through qualitative focus group discussions in order to better understand the potential reasons for the improved outcomes in the intervention group.MethodsTwo ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 10 clients from the intervention group clinics where staff had received the training programme, and 10 clients from the control group where staff had not received the training during the earlier randomised controlled trial.ResultsThese focus group discussions suggest that the clients in the intervention group noticed and appreciated enhanced communication, diagnostic and counselling skills in their respective health workers, whereas clients in the control group were aware of the lack of these skills. Confidentiality emerged from the discussions as a significant client concern in relation to the volunteer cadre of community health workers, whose only training comes from their respective primary care health workers.ConclusionEnhanced health worker skills conferred by the mental health training programme may be responsible for the significant improvement in outcomes for clients in the intervention clinics found in the randomised controlled trial, despite the general shortage of medicines and other health system weaknesses. These findings suggest that strengthening mental health training for primary care staff is worthwhile even where health systems are not strong and where the medicine supply cannot be guaranteed.Trial registrationISRCTN 53515024.

No abstract

BackgroundA cluster randomised controlled trial (RCT) of a national Kenyan mental health primary care training programme demonstrated a significant impact for health workers on the health, disability and quality of life of their clients, despite a severe shortage of medicines in the clinics. In order to better understand the potential reasons for the improved outcomes in the intervention group, the experiences of the participating health workers were explored through qualitative focus group discussions, as focus group methodology has been found to be a useful method of obtaining a detailed understanding of client and health worker perspectives within health systems.MethodsTwo ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 10 health workers from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training during the earlier randomised controlled trial.ResultsThese focus group discussions suggest that the health workers in the intervention group perceived an increase in their communication, diagnostic and counselling skills, and that the clients in the intervention group noticed and appreciated these enhanced skills, while health workers and clients in the control group were both aware of the lack of these skills.ConclusionEnhanced health worker skills conferred by the mental health training programme may be responsible for the significant improvement in outcome of patients in the intervention clinics found in the randomised controlled trial, despite the general shortage of medicines and other health system weaknesses. These findings suggest that strengthening mental health training for primary care staff is worthwhile even where health systems are not strong and where the medicine supply cannot be guaranteed.Trial registrationISRCTN 53515024

Purpose-The purpose of this survey was to describe the impact of the diagnosis of schizophrenia on the lives of people who receive the diagnosis. Design/methodology/approach-The authors designed a questionnaire to investigate attitudes to and experiences of the diagnosis of schizophrenia. After a pilot study, they made the questionnaire available online and, through a network of service user and other organisations, solicited responses. Findings-Of the 470 responses, 27.4 per cent were from service users. Content analysis of their responses revealed three main categories: concern with the consequences of the diagnosis and its negative impact on their lives, the life contexts of individuals before receiving the diagnosis, and concerns with medication and treatment. This paper deals with the first two. Research limitations/implications-It is impossible to generalise the results of this survey because respondents self-selected, and thus might be expected to have strong feelings against (or for) the diagnosis of schizophrenia. Practical implications-The diagnosis of schizophrenia in this sample had devastating negative implications. It was experienced as harmful and stigmatising. Very few people understood their experiences as a biomedical disorder. Social implications-A gulf exists between the experiences of people diagnosed with schizophrenia and the concerns of academics and others currently involved in debates about the merits of different systems of diagnosis. Originality/value-This survey is valuable because it draws attention to experiences of diagnosis that are easily lost in the storm of academic controversies about diagnosis in psychiatry.