What is a Personalized Mental Health Treatment Plan?

If you are receiving mental health care, the treatment plan is a key document that you will develop in collaboration with your treatment provider. The treatment plan lists your treatment goals, the types of interventions that will be used, and how outcomes would be measured. In addition to these generic elements of a treatment plan, a personalized treatment plan also incorporates your strengths, needs, vision of your own recovery, and desired quality of life. 

6 key elements of a treatment plan

A successful personalized treatment plan has the following six attributes (Adams & Grieder, 2005):

1. Is centered on your goals and values
2. Respects your experience in dealing with your mental health issues
3. Addresses not only managing symptoms but also learning to successfully cope with life’s challenges and building resilience
4. Empowers you to move toward self-management of your mental illness
5. Focuses on positive functioning in a variety of roles and building positive relationships
6. Is oriented toward increasing hope with an emphasis on positive mental health and wellness

5 criteria for medical necessity for a treatment plan

A personalized treatment plan, while being centered on your goals, also has to meet the administrative requirements of medical necessity as imposed by healthcare insurance agencies, including Medicare and Medicaid. Stated in simple terms, medical necessity means that there is a legitimate clinical need for treatment and the services of your provider are appropriate for treating your condition. Medical necessity has five components (Adams & Grieder, 2005; Jensen, 2006):

1. Service is indicated: This requires a diagnosis and clinical symptoms that support that diagnosis. It is recommended that mental health professionals use evidence-based tools when screening for a mental health condition. Examples include the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. 
2. Service is appropriate: A service is considered appropriate when there is a match between a service and an individual’s needs. For example, a person with imminent risk of suicide will be treated in a psychiatric hospital and not in an outpatient setting. Another example of inappropriate service would be treating a depressed person with psychosis using psychoanalytic psychotherapy.
3. Service is efficacious: An efficacious service is one that is an evidence-based practice proven to work for a particular condition. For example, Cognitive-Behavioral Therapy and Interpersonal Psychotherapy are both evidence-based therapies for treating depression. However, one has to balance efficacy based on research needs with one's individual choice and preference because an unacceptable treatment is most likely to fail even if there is strong evidence to support it.
4. Service is effective: Effectiveness of a service is determined by the impact of the service in achieving treatment goals and if there were any negative consequences of the service. Sometimes an individual may continue long-term therapy that may not be “necessary” as it has not resulted in achieving the desired change. In this respect, "measurement-based care" is being increasingly used in mental health and involves matching treatment interventions with the outcomes for those treatments (Morris et al., 2012). For instance, if a person is not making progress based on scores on symptoms rating scales, then it would be prudent to modify the treatment.
5. Service is efficient: Efficiency takes into consideration the type, intensity, frequency, site, and duration of service. For example, it is not efficient to provide a service in a hospital when one could be treated at a lower level of care such as a partial hospitalization program or an intensive outpatient program. Or, what should be the frequency of individual therapy when one starts therapy compared to when one is stable?

Although the medical necessity criteria are geared more toward health care professionals to ensure that the treatment is clinically appropriate, having a basic knowledge of these criteria prepares you to ask the right questions about your care as discussed next. 

Questions to ask yourself before choosing a personalized treatment plan

An ideal treatment plan should blend the six attributes of a personalized treatment plan and the five components of medical necessity. This ensures that your goals, values, and preferences are respected and at the same time you are getting evidence-based care that is appropriate for your condition. Some questions that may help you write your treatment plan are below:

• “What am I seeking?”
• “What kind of services do I want?”
• “What do I hope to accomplish from this treatment?”
• “What are my hopes and dreams for the future?”
• “Are my goals based on my strengths?”
• “What are my preferences in receiving this treatment?”
• “Who else can assist me in achieving what I am hoping to?”
• “Did the provider explain the treatment options I have available?”
• “Did the provider give the rationale for choosing a particular modality of treatment?”
• “Did the provider give information regarding the effectiveness of the treatment?”
• “Did the provider respect my preferences, values, and needs while making a decision to choose this treatment?”

3 categories of treatment goals

While seeking mental health treatment, your primary goal understandably is to get help with a mental health condition. However, there may be additional goals that you may choose to address during your treatment because they either motivate you to seek help to get better or support your wellness and resilience while you are in recovery. The following 3 broad categories of goals will provide you some guidance on choosing such goals (Adams & Grieder, 2005):

1. Service or treatment goals: These are the goals that directly address the current symptoms of your mental illness. A goal must state a positive change and must be measurable. For example, “I want to learn to self-manage my depression or I want to learn coping skills to deal with my anxiety by the end of this year.” Avoid non-specific goals such as, "I don't want to feel this way." 
2. Life goals: Life goals are your hopes and aspirations for the future. For example, “I want a job,” or “I want to be married.” Life goals may not be directly related to the treatment of your mental illness, but they motivate you to seek help for your mental illness and stay on track with your treatment goals.
3. Enhancement goals: These goals may not be linked to your treatment of mental illness, but reflect your quality of life concerns and needs. For example, “I want to have more friends,” or “I want to learn how to play a piano.” These goals are useful when you are planning to add activities that give you a sense of pleasure or mastery as a part of your ongoing recovery. 

In summary, having a strength-based individualized treatment plan that not only takes into account your treatment goals but also your personal preferences and values is the cornerstone for a successful and resilient mental health recovery.

To learn more about evidence-based self-management techniques that are proven to work for depression, check out Dr. Duggal's Author Page. 

HARPREET S. DUGGAL, MD, FAPA

REFERENCES

Adams, N., & Grieder, D. M. (2005). Treatment planning for person-centered care. Burlington, MA: Elsevier Academic Press.

Jensen, P. R. (2006). A refresher on medical necessity. Family Practice Management, July/August, 28-32.

Morris, D. W., Toups, M., & Trivedi, M. H. (2012). Measurement-based care in the treatment of clinical depression. FOCUS, X(4), 428-433.