Nurturing self-management

For the past half-decade, we have been thoroughly engaged by a quite delightful story. First, we came to understand the key role played by personal health literacy. This simple notion reflects how well we understand our own health, including those things that can make us ill and those that can make us healthy. Then, we added health activation—taking those actions necessary to prevent the onset of an episode of illness and those required to improve wellness.

Now, we are opening chapter three of this trinity—self-management. (This often is referred to as self-direction in behavioral health.) Here, we are concerned with literacy and activation, plus those skills and actions required to maintain one’s housing, hold a job, and enjoy the benefits of good social and family relationships. Collectively, one could say that these activities give ones a strong sense of personal wellbeing.

Let me put this story together for persons with behavioral health conditions: Literacy, activation, and self-management are cumulative steps that can lead to continuing, successful, recovery rooted in personal wellbeing. How wonderful!

To turn this story into the reality of recovery will require, however, that we assist primary consumers to develop personal literacy, activation, and self-management skills.  

The U.S. Department of Health and Human Services is supporting a range of projects to achieve much better self-management by persons who have long-term health conditions. Currently, the Centers for Disease Control and Prevention (CDC) is applying an intervention called the Chronic Disease Self-Management Program (CDSMP) for use by persons with epilepsy, arthritis, heart disease, and diabetes. Originally, this program, as described below, was developed and tested at the Stanford School of Medicine.

The CDSMP is a 15 hour workshop given over a period of six weeks in a broad range of community settings, including churches and libraries. Importantly, participants in each workshop have different chronic health conditions, and trainers are non-health professionals who themselves have chronic diseases.

Topics addressed include: techniques to deal with frustration, fatigue, pain and isolation; exercises for maintaining and improving strength, flexibility, and endurance; use of medications; communicating effectively with family, friends, and health professionals; good nutrition; good decision making; and how to evaluate new treatments. Hence, one reasonably can conclude that the CDSMP addresses principally the literacy and activation components of self-management.

The Substance Abuse and Mental Health Services Administration (SAMHSA), by contrast, has identified eight dimensions of wellness. These include:

1. Emotional—Coping effectively with life and creating satisfying relationships
2. Environmental—Good health by occupying pleasant, stimulating environments that support well-being
3. Financial—Satisfaction with current and future financial situations
4. Intellectual—Recognizing creative abilities and finding ways to expand knowledge and skills
5. Occupational—Personal satisfaction and enrichment from one’s work
6. Physical—Recognizing the need for physical activity, healthy foods, and sleep
7. Social—Developing a sense of connection, belonging, and a well-developed support system
8. Spiritual—Expanding a sense of purpose and meaning in life

Clearly, for the most part, these dimensions address self-management--one’s living situation, one’s work, and one’s social relationships. 

To accompany the eight wellness dimensions, SAMHSA also has identified a set of wellness strategies. These strategies address emotional and general health; nutrition and diet; smoking and tobacco use cessation; and stress management. Hence, they relate closely to the topics addressed in the CDSMP. As we move forward, a primary goal must be to increase the number of people in recovery who are able to achieve a strong sense of personal wellbeing rooted in literacy, activation, and self-management.

Just as peers already have taken leadership in developing wellness strategies, now they also are at the forefront in designing ways to enhance self-management. A key piece of this work will be peer support grounded in mutuality that offers direct examples of self-management.

SAMHSA has a primary role to stimulate this very important work. SAMHSA also should collaborate with CDC, since many persons with behavioral health conditions have the long-term health conditions that CDC is emphasizing in its self-management work.

Self-management can be a win for everyone!