Person-centered services are emphasized as a standard of behavioral health practice. They are individualized, relevant to the person being served, more likely to engage them and have a greater probability to result in a positive outcome. This focus asks the question, “How can we help you?” rather than assuming that the consumer will fit into our expectations.
This all seems simple, but it does not always happen. When we meet consumers, they are often very sick with mental illness, substance use disorders and physical health problems. They feel second-class, unworthy, hopeless about the future and pushed around. They often have been in treatment multiple times. They are likely to be cynical about the next provider to come along. But if we treat them with dignity and respect, get a roof over their head, food in their stomach, clean clothes on their back and show a willingness to be connected to them, then we begin to build a trusting relationship that can lead them to the next step: treatment.
You are probably familiar with Lawrence Kohlberg, who developed stages of ethical reasoning. To simplify these, you are born at stage 1, where you seek to avoid pain or discomfort (you cry to get your bottle). At the highest levels, stage 5 balances individual rights against the rights of the larger group, and in stage 6 (what I call the Gandhi stage), one operates out of principled thinking.
Kohlberg had different thoughts over his lifetime about whether anyone could even reach stage 6. While difficult to operate at level 5 and 6 for a sustained time, I believe it is possible to make decisions and to operate out of a more abstract, principled view and that these decisions can benefit our consumers. So, what principles apply?
There are four universal ethical principles that Kohlberg thought applied at stage 5 and 6 reasoning: dignity, respect, justice and equality. In our business, I add in three others, all of which can be found in our U.S. Constitution and the major religions of the world: beneficence (do good), non-maleficence (do no harm) and autonomy.
Here is how high-level ethical reasoning makes a difference:
- If our motivation is to do good by our consumers, then we seek the education we need to prepare for the myriad issues that people experience;
- We complete our paperwork to be responsible for the good care they deserve;
- We think carefully about circumstances they present so we make the decision that is likely to result in the best outcome for them (not us but them);
- We always work to prevent harm and to promote their own decision-making; and
- We get plenty of sleep and eat a good breakfast so we are as sharp as we can be to help them with their challenges (seems sappy, but it’s true).
That is Gandhi thinking.
Having a clear understanding of what each of us brings to the business in terms of our own sensitivities is critical. Treatment is never about the therapist, counselor or the agency. When it is, there is no person-centered care. Our days of discharging people because they relapsed or broke the rules must be relegated to the past. Responsibility for their actions is important, but we must show the flexibility to stay with them while they thrash through this difficult recovery. That is person-centered.
Understanding how these illnesses manifest in the brain and manifest in behavior brings us closer to focusing on solutions that let the consumer begin to get better from the point they occupy on the recovery continuum. If they need mental health care, be ready for that with the appropriate license. If they need treatment for substance use issues, be ready for that with the right credentials. If they need housing, be ready for that. Our work is to anticipate what issues will present and to fully prepare ourselves for that moment.
If a professional or an organization in behavioral health develops a big tool box filled with solutions that consumers may need, then the therapist or organization can listen to the complaint, form some independent assessment, combine it all to make a plan and confirm with the consumer that the plan represents what they want to work on. This is person-centered care: decision-making that benefits the consumer, does not harm them, is fair to them, respects them, treats them with dignity and promotes their autonomy.
This philosophical focus of person-centered care not only is more likely to benefit the consumer, it is also more likely to be a positive experience for them—and as a result, your business will do well.
Topher Hansen, JD is the CEO CenterPointe in Lincoln, Neb.
This perspectives article was contributed courtesy of the National Council for Behavioral Health.