Enhancing mental health care: a problem, resources and goals oriented multidimensional framework (PRoGO)

Abstract

Background: Lawrence Weed introduced the "Problem-Oriented Medical Records" (POMR) approach to medicine. Its core principle is that treatment should be organised around patients' specific problems. This approach gained widespread adoption in the United States during the 1970s. However, few studies have compared POMR with the traditional "source-based" method, and evidence supporting its application in mental health remains particularly limited.

Methods: We carried out a narrative review to examine whether POMR is appropriate for mental health care and which modifications are necessary for this purpose.

Findings: Psychiatry and psychotherapy address brain-mediated disorders that lack clear biological markers. Diagnoses rely on the assessment of psychopathological symptoms, which are grouped into syndromes. These symptoms and syndromes can be effectively categorized as "problems". Given that psychiatric treatment is often symptomatic in that it focuses on symptoms rather than diagnoses, POMR provides an ideal framework for organizing care. Furthermore, mental health is inherently multidimensional, encompassing biological, psychological, social, and existential domains. This complexity necessitates interdisciplinary collaboration. However, under the conventional source-based approach, professional groups often operate in parallel rather than jointly together. POMR, by contrast, facilitates seamless collaboration by aligning teams around patient-centred problems. A special aspect of mental health care is the emphasis on considering patients' individual goals and resources, rather than focusing only on their deficits.

Interpretation: By systematically applying POMR to psychiatric care-particularly through tightly coordinated interdisciplinary treatment-clinicians could enhance both clinical and functional outcomes, improve both patient and team satisfaction, and better align treatment with patients' unique needs. To support this approach, we propose a practical grid which we refer to as the Problem-Resources-Goals Oriented framework (PRoGO), reflecting the necessary adaptations for mental health. Clinical trials are warranted to assess the effectiveness of POMR/PRoGO in psychiatric practice and its potential to advance the field.

Keywords: Anxiety; Depression; Lawrence Weed; Mental health; Problem-oriented medical records; Psychiatry; Schizophrenia; Transdiagnostic.