Self-management practices

A well-designed self-management care plan will incorporate tasks and activities to advance the knowledge and skills of the patient. A collaborative approach also up-skills the carer. Consideration should be given to the individual needs of the patient and carer, for example a patient with comorbid conditions will require a different set of skills from that of a patient with an eating disorder.

Patients and carers could require support in some or all of the following areas:

• general mental health literature
• condition-specific facts
• condition-specific support groups
• carer support groups (generic and condition-specific)
• self-management understanding
• generic and condition-specific skills (self-management programs)
• knowledge, information and skills for individual needs such as indigenous groups, culturally and linguistically diverse groups and adolescents
• information on medication and side-effects
• general physical well-being
• local support networks

 Good self-management practices

Patients’ responses to the following question:

•  Are there any self-management practices that have worked well for you?

“Reading up on my condition and being fully informed”

“Educating myself and my husband about his mental and physical disabilities”

“Gaining knowledge of depression”

“Cognitive Behavioural Therapy”

“Self-help group for anxiety management”

“Managing signs and symptoms of the condition”

Information and knowledge

Education for patients and carers should be generic as well as condition-specific. Generic education includes areas such as background information on mental illness and aims and objectives of self-management. Condition-specific education can inform the patient and carer about symptoms, early warning signs and management of difficult emotional and behavioural problems.  

When shown the chronic condition self-management definition, the respondents to the Consumer and Carer Survey revealed that the two most important principles for patients and carers were:

1. knowledge of the condition
2. knowledge of management of the condition.

In addition, carers indicated the importance of two additional principles; having confidence in the ability to use support services and agreeing and negotiating a care plan with health professionals and others.

Ideally, the patient and carer should be prepared for each consultation and a checklist is an excellent tool that should be encouraged. A sample checklist can be seen below.⁽¹⁾

The Patient Checklist has been adapted from Appendix 3 of the resource The Partners in Health Handbook.⁽¹⁾

Where to find information

• Helplines can offer support and advice.

• The internet provides an ever growing source of useful information and support for a range of chronic conditions and good explanations on self-management. An excellent starting point for information on self-management is the Health Navigator New Zealand website http://www.healthnavigator.org.nz/, which has a dedicated self-management section. Although this site links to many New Zealand-specific activities, it provides some more generic information such as definitions of self-management and self-management support, information on self-management programs, links to care plans and action plans and advice on sharing in decision-making.

• Mental health organisations often produce generic and condition-specific resources. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has a free range of Clinical Practice Guidelines http://www.ranzcp.org/resources/clinical-practice-guidelines.html and is a valuable resource to support consumers, their carers, families and friends in learning more about mental illness and the treatments that are available. For each of the following titles, there is a New Zealand and an Australian resource.

-       anorexia nervosa

-       bipolar disorder

-       deliberate self harm (youth and adult)

-       depression

-       panic disorder and agoraphobia

-       schizophrenia

It is not possible to list every location to search for materials but other easy access alternatives include the library, medical clinics, hospitals, day care centres and voluntary organisations.

Skills

Many skills required for self-management are generic, such as goal setting, managing emotions and problem solving and can be obtained through attendance at self-management programs. Courses include the Stanford Chronic Disease Self-Management Program and adaptations of this course, such as the Living a Healthy Life course. Further information is provided later in this module.

References

1. Flinders Human Behaviour & Health Research Unit. The Partners in Health Handbook. A guide to help you become an active partner in the management of your health. South Australia, 2008.