Autodeterminación y calidad de vida en salud mentaldos conceptos emergentes

Abstract

Self-determination and quality of life are two concepts that in recent years have been submitted to numerous studies in order to find relationships between them with the aim of improving the quality of life of mental illnesses patients and their families. Starting with the psychiatric reform, people began to see from the patients’ perspective the necessity to improve their quality of life by increasing their participation in mental health services and in the decisions and planning of the treatment. The evaluation of patients’ satisfaction with the services provided by social programs shows the necessity to improve their autonomy. To achieve this objective, their opinions, desires, and necessities were kept in mind as well as promoting their integration into the community. The patients’ perception about their quality of life and their own reality is a factor that is already a part of many psychosocial rehabilitation programs designed in recent years. The models of quality of life, where more importance has been given to the concept of self-determination, have been the ones focusing on the community, together with the framework proposed by Schalock and validated by the literature published in the 1985-1999 period. These multidimensional models consider that the patients’ subjective perception should be kept in mind in designing the different interventions or rehabilitation programs under way. The concept of self-determination was initially used in the evaluation of programs as a principle to guarantee well-being and quality of life. Beginning with the psychiatric reform, it was used first as an indicator in community models, and is currently applied as an important dimension inside the programs of psychosocial rehabilitation. Due to the paradigm change, the attention in mental health was focused on the users and family rather than on the professionals. This change was reflected in the use of longitudinal, quantitative and qualitative evaluation designs. The objective of this article is to analyze the impact of the concepts of quality of life and self-determination in mental health. To do this, we focus on the existing research on quality of life and self-determination during the 1985-1999 period, showing when, why, and how both concepts began to be used. Next, we analyze their use in professional practices and their influence in the paradigm change. To conclude, we propose several future directions and performance rules, directed at people interested in improving the quality of life and selfdetermination in mental health.