For Effective Communication in Treatment, Center the Person, Not the Illness

“A medication is a communication," says Christoph Correll, MD. When treating patients with mental illness, it is important to maintain a healthy level of effective conversation. Dr Correll believes that the answer to effective care lies in centering the person, not the illness, and shared decision-making.

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Christoph Correll, MD, is a professor of psychiatry at Hofstra Northwell School of Medicine, New York, and medical director of the Recognition and Prevention program at the Zucker Hillside Hospital, New York. Dr Correll completed his medical studies at both the Free University of Berlin in Germany and at the Dundee University Medical School in Scotland. Dr Correll is board-certified in general psychiatry, having completed his residency at The Zucker Hillside Hospital in New York City.

Dr Correll’s research and clinical work focus on the identification, characterization, and psychopharmacological management of adults with severe psychiatric disorders. His areas of expertise range from the prodrome and first episode to the refractory illness phase of patients with severe mood and psychotic disorders. His research further focuses on psychotropic medication efficacy, effectiveness, and adverse effects as well as on physical health in the mentally ill.

Read the Transcript: 

When treating people with mental illness, be it depression, anxiety, schizophrenia, or bipolar disorder, it's important to take a person-centered approach. You want to align with the patient, you want to have a relationship that they can trust you and they tell you also, when they don't want to take the medication.

And patients feel somehow acknowledged. Without that relationship, it's very difficult to really get anywhere, because then the medication will be seen as something alien that you're forcing onto them. And there's a disconnect, a miscommunication. A medication is part of a communication, as is psychotherapy. So it's important to understand who the patient is. And to do that, you need to learn a little bit about them. Where they're coming from, what they're doing, what they like to do. And very important, what are their goals, what do they want to achieve? And then you have to do motivational interviewing. Understanding their goals and linking them with your goals as a healthcare professional. Knowing what's good for the illness, so that if they want to have a boyfriend, if they want to have a job or be independent, "Well, the last time you didn't take the medication, the last time you relapsed and was really hard. Your parents wanted to throw you out, you lost your girlfriend or your boyfriend. And what about school? You can't think as clearly anymore. It's important that you stay the course, that you keep medication on board. And it's not because I tell you, it's because you told me that you want to achieve certain things."

So that's the more holistic, motivational interviewing kind of stance. And the second buzzword is shared decision-making. Shared decision-making means that you're not this paternalistic healthcare professional who says, "You have to do X. My way or the highway." But it also doesn't say that you do what the illness wants. If the illness says, "Oh, I don't want medication, leave me alone." We shouldn't sit back and say, "That's fine. Why don't you have another relapse? And then we'll talk again."

It's like a cardiologist when somebody just had a heart attack and you go to them and say, "Well, I don't like the headache and I have a little bit of indigestion from the medication. I want to stop my antihypertensives and my lipid-lowering drugs." And he would say, "That's fine. Next time you have a heart attack, if you survive it, let's talk again." It's a real emergency when people have a relapse, it changes the psychosocial fabric, it changes the psychological fabric, how you see yourself in the world, and it changes the brain.

So we need to make sure that we have, with shared decision-making, 2 experts; the patients are their experts in their life, but we are the expert in medicine. We need to be at eye level and try to come a conclusion what is best. But you will not get to the conclusion in the first session. It's a process. You need to discuss it and you might actually change some plans based on the information you get, and based on whether certain medication course is or is not helpful—whether psychosocial interventions are helpful or not.

So we need to also be open to revisit the diagnosis and to revisit our plan and do it conjointly. And if you can't do it alone with the patient, get partners of care into the room or at least into the care plan. So family members, friends, significant others are really important to also help create a healthy and good treatment environment.