Health Behavior Change: Self-Management (Part 2 in a Series)
Musings on Consumer Self-Management
William A. Anthony, PhD, Executive Director of the Center for Psychiatric Rehabilitation, Boston University, and Member of the CIHS Steering Committee
In my professional role, I have been a strong proponent of people managing their own health behavior change processes to the greatest extent possible. However, it wasn’t until I had to manage a serious and potentially long-term disabling condition of my own (multiple sclerosis) that I came to understand the challenge of health behavior management from the insider’s perspective. By examining my own attempts to manage my MS, I thought I might learn something about the issues related to self-management of severe mental illnesses. I draw this comparison between severe mental illnesses and MS as a metaphor only to promote understanding of the tremendous number of issues that a person with a serious health condition must manage (no one-to-one relationship intended).
As the complexity of my condition and the sheer number of new people and programs involved in my life began to look overwhelming, I did a quick analysis of my healthcare situation with respect to what factors needed managing in order to increase my chances of success. I found the numbers startling. For example, I am now involved with:
- different healthcare provider organizations;
- different types of healthcare provider personnel;
- different kinds of meds/vitamins/medical equipment;
- different sources for paying for meds/vitamins/medical equipment;
- different payers of MS related healthcare services; and
- different MS advocacy group memberships.
Just keeping track is becoming a part-time job. And the above healthcare categories do not include care un-related to MS (e.g., optometry, dentistry, dermatology, internal medicine); non-health related services sometimes associated with a severe condition (e.g., housing services, transportation services, employment services); or individuals and agencies involved in healthcare that people with MS often use (e.g., therapists, trainers, personal care assistants, neuropsychologists, SSA).
Though it could be MS related fatigue, it tires me out just adding all of these up. Managing any serious, potentially long-term condition is a lot of work. And people with MS don’t have to confront the level of coercion, ignorance, prejudice, and discrimination that people with severe mental illnesses do.
This metaphor stimulated me to think further about what resources could help manage a severe condition and the resources ostensibly trying to help. Several self-management tips stand out that primary and behavioral healthcare providers can encourage among their clients:
Identify what each provider can offer and use them accordingly. Try to organize providers by time and location to avoid running around. Ensure that you see them as much (or as little) as you need. Sometimes it is as difficult to refuse unnecessary help, as it is to ask for it. Engage a provider in helping with this task.
Seek out opportunities for interactions with peers who have the same health condition. Talking and listening to people I have met in my MS support group and at educational conferences and the like is invaluable to learning how to manage my MS and my MS treatment providers. Peers often share helpful, personal material with each other that they may not share with a professional.
Be clear and assertive about what goals you want to achieve. Professionals may suggest MS medications and other medical treatments because they assume you want them — without checking how their suggestions affect your goals.
· Try “alternative” resources. Not too long ago people with MS were advised that exercise would worsen MS. Now, exercise is seen as a valuable, evidence-based intervention. If you believe an alternative may help you, you may be right.
Self-management is not easy or simple, and needs to be seen for the task that it is. The system sometimes seems to thwart people’s difficult self-management efforts. That is when a peer, a helpful provider, a new resource, or the passage of time itself can help people in their desire to captain their own healthcare ship.
For more on health behavior change and self-management and other integration topics, visit www.integration.samhsa.gov.
Check out the first part of this Health Behavior Change series in last month’s issue of eSolutions, where CIHS focused on health behavior changes from the clinician/provider perspective on consumer engagement.
PBHCI Grantee Profile:
Greater Cincinnati Behavioral Health Services (Part II)
Last month, CIHS interviewed Greater Cincinnati Behavioral Health Services (GCB) Community Services Director Jeff Jeff O'Neil, MEd, LPCC, to discuss behavioral change from the provider perspective of consumer engagement. This month, we continue the conversation, offering perspective from GCB Peer Specialist Linda Andersen who shares the consumer perspective of self-management.
A consumer’s motivation to begin better self-managing their health and illnesses can stem from many sources. In the case of Linda Andersen at Greater Cincinnati Behavioral Health Services (GCB), that motivation came by way of an invitation to participate in GCB’s integrated health program. Under the program, Linda worked closely with a nurse care manager skilled in effective consumer engagement. The nurse encouraged her, never spoke down to her, focused on Linda’s strengths, and used positive reinforcement. Today, Linda has lost over 40 pounds, reduced her insulin by more than 70%, and has been able to come off a diabetes medication she once relied on.
Before engaging in this program, Linda heard doctors tell her, “You can’t eat that” and “You are going to die.” Once she learned a new approach she realized, “I can eat whatever I want, but I can have only one portion.” She uses a food diary to keep track of her food and calories and does not think about what she “can’t have,” instead eating in moderation and keeping attuned to her body’s needs, asking, “‘Am I hungry’?”
But she understands that planning for change can feel overwhelming. In the beginning she thought, “I can’t walk 20 minutes every day — that’s impossible. Then, I looked at my watch and walked 10 minutes away from my apartment. And when you walk away, you have to walk back.”
Linda debated sharing her successes with peers at GCB since she is a paid peer employee. Ultimately, she determined that it could help motivate others. She now leads a series of activities at GCB, including walking groups, indoor exercise groups, meditation, healthy eating groups, obesity support groups…and more. She is also trained in Whole Health Action Management (WHAM) and shares the importance of self-management and whole health to all of GCB’s clients.
Access more information on self-management and consumer engagement on the CIHS website.
The SAMHSA-HRSA-supported Whole Health Action Management (WHAM) training aims to guide individuals with mental illnesses and addictions in their efforts to self-manage their health and illnesses. Specifically, it emphasizes six whole health self-management skills in which individuals work towards with support from whole health peer support groups.
· Engaging in person-centered planning to identify strengths and supports in 10 whole health and resiliency factors:
1. Stress management
2. Healthy eating
3. Physical Activity
4. Restful Sleep
5. Service to Others
6. Support Network
7. Optimism Based on Positive Expectations
8. Cognitive Skills to Avoid Negative Thinking
9. Spiritual Beliefs and Practices
10. A Sense of Meaning and Purpose
· Writing a whole health goal based on person-centered planning
· Creating and logging a weekly action plan
· Participating in WHAM peer support groups
· Eliciting the Relaxation Response to manage stress
· Engaging in cognitive skills to avoid negative thinking
New from CIHS
CIHS Launches Health Disparities Leadership Program
CIHS’ new Addressing Health Disparities Leadership Program will nurture a workforce focused on reducing health disparities for racial, ethnic, and LGBT populations by receiving community-based integrated primary and behavioral healthcare. Through a competitive process that received nearly 300 applications, CIHS selected 20 mid-level managers who work with diverse populations in community health and behavioral health organizations around the nation. Through this 7-month program, these managers will build on their current knowledge and practice to implement strategies and leadership skills to eliminate disparities in service, quality, access, and outcomes through integrated health programs. Participants represent primary care, substance use, and mental health community organizations from around the country.
Did you miss past CIHS Webinars on topics such as motivational interviewing, billing for integration services, health behavior changes, and much, much more? Go to www.integration.samhsa.gov/about-us/webinars to access recordings, presentations, transcripts and more.
Visit www.integration.samhsa.gov often for newly announced webinars and resources.