Person-centred care: implications for training in psychiatry CR215, September 2018
The practice of medicine has changed over the past 50 years. One notable change has been a move away from the traditional deference of the patient to medical authority towards a more active role for the patient, who is now becoming 'person' rather than 'patient'. Medicine as a whole is becoming more person-centred.
Psychiatry is focused on the person; it is impossible to practise psychiatry well without listening carefully to a person's concerns and making them the focus of clinical attention. A collaborative approach to care is fundamental. Nevertheless, there are concerns that care in the UK National Health Service (NHS) has become commodified and impersonal as was, for example, demonstrated in the Mid-Staffordshire scandal (Francis, 2013). Parity of esteem between physical and mental health services is still lacking.
Psychiatry has received criticism for its sometimes remote approach to individuals, ignoring their broader subjective and cultural experiences. A person-centred and recovery-oriented approach is now explicitly part of health service policy in the UK. Other medical specialties and professional bodies are taking active steps towards a more person-centred approach. Psychiatry, with its background in a holistic approach to care, can lead in this area.
However, at present there is no explicit reference to person-centred practice in the curriculum for psychiatrists in training. This topic is often neglected in training programmes and person-centred care is sometimes discussed only in the context of a peripheral approach to practice, rather than as a professional frame of reference.
This report reviews the case for strengthening the focus on the person in clinical practice and giving person-centred approaches a central position in the practice and training of psychiatrists. It aims to:
- outline the rationale for embedding person-centred practice in postgraduate training and assessment
- provide recommendations to enable the delivery of person-centred care through postgraduate psychiatric training and assessment.
In setting out a case for reinforcing and prioritising person-centred care, this report does not suggest a new or different approach to that already supported by the guiding values of our profession. Rather, it offers guidance to bridging the gap between values and experience, principles and practice, and intention and achievement.