PRISM: ترویج انعطاف پذیری، استقلال و خود مدیریتی- یک استراتژی برای مدیریت بیماری های مزمن روانی

Many transformations in how mental health care is delivered have required the development of new ways of providing care, treatment and support to mental health consumers. In the recent past, to support consumers and their carers adequately and appropriately, there has been emphasis on case management and care coordination. There is a need to consider whether over-emphasis on case management should be limited to the minority of mental health consumers who are unable to make competent decisions, whereas majority of consumers should take complete charge of their own treatment. PRISM (Promoting Resilience, Independence and Self Management) is a conceptual framework that potentially offers an opportunity to empower consumers to take charge of their own treatment by using specific tools, including a PRISM Pack, Take Charge Sheet, Protocol for Appropriate Care and use of methods that ensure that the mental health consumer does become a key decision maker with regard to their own care and treatment.

Over the last 200–300 years, the mental health system has experienced several dramatic transformations. These have included a move from hospital to the community, greater recognition of human rights and self determination, focus on equality, introduction of the concept of recovery and rehabilitation, and so on. The move from the hospital to the community in particular necessitated consideration of different options to meet consumer needs that could previously be met within the walls of the institutions. For consumers, living independently meant a need to make more choices and decisions without institutional support structures previously available within hospitals. For services, consumer and the family (or carer), engagement become incredibly important. Without this support and assistance it was no longer possible to promote their well being. Concepts of recovery, rehabilitation and self management not only become acceptable and popular, but also necessary. All of the above required the sector to incorporate models of care coordination and case management, to be able to provide holistic supportive care to people with mental illness (Butler, 1969, Crow, 1971, Hafford, 1980, Hicks et al., 1970, Jones, 1970, Mound et al., 1991, Pittman, 1991 and Pyke et al., 1991).

To do things differently, there is a need for all stakeholders to be absolutely sure that the new way of thinking and doing things is likely to deliver significant gains. The logical first step in this process has to be willingness to interrogate the concept and trial various elements of the concept. The promise of effective care, proposed efficiency gains and improvement in the environment must be tested to ensure that the theory can be translated into practice. Adoption of PRISM challenges health care providers to question the contradiction in our orientation to case manage, even though the mental health sector wishes to facilitate self management and promote recovery. PRISM allows for the consumer to be empowered with the necessary tools and methods to self manage and take charge of their own recovery. To implement PRISM, it is important and necessary to customise the PRISM Pack to meet local needs, existing policies and procedures and documentation requirements. The PRISM Pack is built around the simple message of ‘Take Note, Take Charge, Take Home’ with the intention of gathering necessary resources to empower consumers and their carers. ‘Take Note’ resources include an information guide that contains information about supports that are potentially available and how to access their supports. ‘Take Charge’ sheet can be an 8–10 point check list of essential tasks that consumers must take charge of that are critical for their ongoing treatment, recovery and rehabilitation. ‘Take Home’ sheet can be a template for a care and relapse prevention plan prepared and owned by the consumer that then becomes the point of reference for everyone involved in supporting the mental health consumer.