Summary: The purpose of this narrative-analysis is to: Consider medical conditions and substances that may induce psychotic symptoms; identify some unique challenges that providers and patients dealing with psychotic disorders must overcome in order to establish effective recovery strategies; and to illustrate the benefits of participatory concepts in mental health care. This article describes one patient’s experience with discovering that her psychosis might have been caused by toxic encephalopathy from occupational exposure, and the benefit she gained from becoming an active participant in her own care.
Keywords: psychosis, mental health, mental illness, bipolar disorder, schizophrenia, violent behavior, e-patient, participatory medicine, Psychiatric Advance Directives, PADs, Joint Crisis Plans, JCPs.
Citation: Mangicaro MA. Psychosis possibly linked to an occupational disease: an e-patient’s participatory approach to consideration of etiologic factors. J Participat Med. 2011 Mar 28; 3:e17.
Published: March 28, 2011.
Competing Interests: The author has declared that no competing interests exist.
The Importance of Patient Empowerment in Mental Health Care
As an individual who has experienced psychotic episodes, I believe that the emergence of participatory concepts in mental health care can empower consumers to become engaged in recognizing symptoms, selecting treatment options, and working in partnership with providers to develop illness self-management recovery programs. Patient empowerment is critically needed to strengthen the mental health care system. Innovative strategies targeting informed, safe decisions are needed in order to effectively involve mental health consumers in the prevention and recovery of psychotic disorders.
My journey to becoming an empowered patient started by developing an understanding of psychotic disorders and the dismantling effect they have on one’s life. Psychosis results in loss of contact with reality, sometimes including delusions, insomnia, hallucinations or impaired cognitive functioning. Psychotic behavior affects the ability to manage and maintain personal relationships, employment, medical care, and in some cases, housing. A psychotic experience distorts an individual’s belief system and perceptions. Most individuals experiencing a psychosis have poor insight regarding their illness and refuse to acknowledge that a problem even exists.
Involuntary commitment and incarceration often become necessary in cases of severe mental illness. During times of psychiatric crisis that results in involuntary commitment, people may experience a frightening loss of choice and self-direction, which can be damaging and traumatic. My experience led me to believe that forced hospitalizations failed to encourage participatory concepts. While intervention may be deemed an absolute necessity during a mental health crisis, coercive psychiatric treatment tends to have an adverse effect on patient empowerment because of the loss of autonomy and exclusion from participation in treatment options.
To help overcome this, many mental health care advocates now recommend Psychiatric Advance Directives (PADs), or Joint Crisis Plans (JCPs). PADs are legal documents allowing individuals to express their wishes for future psychiatric care and to authorize a legally appointed proxy to make decisions on their behalf during incapacitating crises. The JCP is a statement expressing a mental health consumer’s preferences for treatment in the event of a future psychotic episode. It is developed with the clinical team and an independent facilitator. Use of these documents offers a potential alternative to compulsory treatment. They also act as an innovative tool for patient empowerment regarding treatment options and recovery strategies.
Click here to read the full article at the Journal of Participatory Medicine website.