Providing care while preserving people's rights and autonomy
The Sant Joan de Déu Health Park has historically and continuously reviewed its procedures to align them with the latest humanistic approaches and promote the rights and autonomy of the people it serves. Examples of this include the implementation of the Libera-Care Standard, the Housing First model, which places special emphasis on the physical environment for a person's recovery, and the humanistic psychology of Carl Rogers. The goal of this effort is to increase the overall well-being experienced by the people we serve.
A facilitating element in the implementation of these humanistic models, in the case of our institution, has been the progressive training of the professional teams, but also of the people served, whose opinion and participation in the entire recovery process has taken center stage.
The organizational management of the care process is also unequivocally aligned with this vision and approach, which places the individual at the center of its intervention area, considering all their human dimensions, including their rights, needs, and capabilities. Thus, around the individual receiving care, and in a bidirectional relationship, we must position the institution's rules, protocols, and processes (theoretical framework), the interventions and techniques used (practical framework), and the design of the environment—that is, the spaces, equipment, and staff.
The humanist model puts the person at the center, respecting their unique identity, dignity, autonomy, and significant environment.
In this way, the influence is mutual : from the institution to the person (as in the classical approach), but the person also influences the institution (a contribution of the humanistic approach), because they express their opinions and, most importantly, make decisions about their care, planning, and interventions. This model, therefore, is based on respect for the dimensions that make up the person : their unique identity; their dignity, independent of age, illness, cognitive status, or disability; their executive autonomy; and their significant environment, among others.
The recovery model, a paradigm shift in the approach to mental health
Applying the humanistic model in mental health hospitalization
As an example of this care model, since November 2019, the acute and subacute units of the Parc Sanitari Sant Joan de Déu have been certified as restraint-free services by the Libera Care Standard , which promotes a new paradigm of individualized, motivating, and restraint-free care. The supervision and integration of the Libera Care Model's benchmark quality standards, defined by indicators such as:
- Continuing education based on the experience of the person being served.
- Managing non-containment.
- Person-centered therapeutic and care plans.
- Knowledge of the degree of well-being experienced by the person being cared for.
This role of functional reconstruction represented the true evolution towards the humanist model and the return to the person being cared for of everything acquired during that time.
The future of care lies in abandoning restrictive measures
The first-person association ActivaMent Catalunya , which runs a weekly mutual support group in our subacute unit, provided awareness training to staff on empowerment and skills development, rights and responsibilities, stigma, and other related topics. This proved to be a real catalyst for change , a stark reminder of the positive and negative power that caregiving has on people, including their emotional well-being.
Therapeutic plans were also modified as progress was made in achieving this model, until the elimination of restrictive practices , and were reformulated, focusing on the prevention of behavioral disorders and emphasizing the abilities of the person being cared for and their constant support.
Implementing the recovery model in mental health requires constant review, with the involvement of professionals and the opinion and assessment of the people being cared for.
Finally, it remained to ascertain firsthand whether all this effort to assess the functional and relational relationship with the individual was effective, and to understand their perspective on the emotional well-being or distress they experienced as a result of our care in the unit. How would we do this? By measuring it through their experience in real-world dimensions such as autonomy, rights, emotional and physical well-being, self-determination , and so on. And it's worth noting that the results from over one hundred surveyed users were very positive, with the assessment of their capacity to exercise effective autonomy being particularly favorable; that is, the ability to control their own lives, choose, decide, and accept the consequences of their own decisions, despite the circumstances of their admission.
I want to emphasize the importance of this last point, as this practice is quite unusual in a context like ours. Typically, institutions opt for more paternalistic and benevolent approaches, prioritizing them over fundamental rights and viewing the latter as inherent risks. Of course, this approach requires a continuous and dynamic evaluation , depending on the individual's psychopathological and functional state, the specific context, the complexity of the situation or decision, its associated risks, and the user's and unit's environment.
Changes with a great impact on the person being served
Some small decisions that had a big impact at the time they were made are, for example:
- Being able to access your mobile phone to stay connected with your surroundings.
- Having the most personal clothes and belongings to preserve identity and contribute to self-destigmatization.
- Privacy to be able to reflect or simply isolate oneself.
- Therapeutic outings or simply leisure outings in a safe environment, even in times of clinical and functional severity.
- Clear use of the unit's space.
These changes also help strengthen the support network for future crises or income needs. Conversely, the traditional approach to everyday situations, based on restriction and solely focused on charity at the expense of autonomy, will weaken this bond and erode the trust of the person we are caring for.
This experience has allowed us to modify our practical framework , the way we interact with users, and therefore, the way we provide care. And, in addition, we have the results that the exploration of this experience offers us.
Natalia Kazah Soneyra
The importance of the physical and human environment
We must also discuss the environment, both physical and human. The physical environment should provide comfort and a sense of security. It should offer non-restrictive spaces that, fully integrated into the daily routine, allow an emotional or behavioral crisis to unfold safely without first resorting to restrictive measures. On the contrary, these should be well-ventilated spaces, preferably open and meaningful to the user. Some examples in our institution include the courtyard where sports can be played, the garden where alternative behaviors to agitation can be practiced, and the time-out room, equipped with physical release equipment and an immersive audiovisual system, where complex situations can be managed.
Finally, and most importantly, there is the human environment : simply "human" people, endowed with common sense, values, and willpower. You can't convince people to think or work this way; you have to truly believe you're doing the right thing for others like yourself, and that it couldn't be any other way.
We must empower the people we care for, through education and self-management, to prevent and reduce serious situations that may require hospitalization and intensive treatment and care.
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