Q: What is strengths-based care and how do I focus on the strengths of patients with mental illness versus their weaknesses?

First, it is important to understand the various roles of home healthcare clinicians caring for patients with mental illness. Home healthcare clinicians function in many roles-they communicate with the primary care physician or nurse practitioner, the psychiatrist, and other members of the interdisciplinary team. They educate the patient and family on disease management, medications, sometimes administer monthly intramuscular injections such as an antipsychotic, provide cognitive behavioral therapy, screen for anxiety and depression with valid and reliable instruments, teach coping mechanisms, promote support systems and healthy habits, and track progression of care management.

Although it may seem natural to focus on what the patient is lacking or what needs to be "fixed," it is more beneficial to address their strengths, the positive aspects of the situation, and what the patient can do in conjunction with the home healthcare team. The patient and primary nurse should work together while focusing on strengths, goals, and the support network. All patients have weaknesses, with or without mental illnesses. If home healthcare clinicians only pay attention to weaknesses and focus solely on those, the patient may not feel empowered and may not be viewed as an individual with unique needs, who is capable of being an active member on their care team.

Strengths-based care focuses on each patient as an individual and does not label them by their diagnosis. Consider the strengths of the patient-how can they assist in their treatment? Ask the following questions: What is their knowledge level of the disease or disorder? What are their learning capabilities and how do they learn best? Does the patient prefer to read or write in a language other than English? Should a learning questionnaire be offered to assess preferred style? What are their experiences with the disease or disorder? What motivates the patient to engage in their care and improve? Consider the family or important loved ones who can influence and benefit their treatment. Try not to prioritize the patient's weaknesses over strengths. Empower the patient by emphasizing what they can do. Encourage development and growth. Empowerment allows patients to resolve certain issues on their own, with resources and tools that have been provided to them. Personal recovery plans may assist the patient who is a major stakeholder in their care and should mutually set goals along with the interdisciplinary team and their support system. The goals should be based on strengths, and be specific, measurable, achievable, realistic, and timed (SMART). It is also helpful to set goals that are sustainable and do not end in the short term. Focus on goals when the patient is in their best mental state, with ability to comprehend, plan, and implement. Assess the patient's support system, which may vary significantly from person to person. Types of support may include family, friends, neighbors, religious congregations, state, local or national organizations, support groups such as Alcoholics Anonymous or Narcotics Anonymous, case workers, guardians, housing specialists, and the interdisciplinary team.

Strengths-based care is an approach that is therapeutic and collaborative in nature. Using a therapeutic approach and building relationships with patients can create a strengths-based care plan. The following types of therapeutic communication techniques should be used: active listening, reflecting, silence, exploring, clarifying, accepting, giving recognition, offering self, giving broad openings, placing events in time or sequence, and making observations.