Shared Decision-Making in Mental Health Care - SAMHSA Store ...

106CommonGround. CommonGround (CG) is a program that supports shared decision-makingand offers electronic decision support in psychiatry (Deegan, 2007a).Developed by Patricia Deegan, Ph.D., it does not meet formal criteria as a decisionaid, but does fulfill several of the related functions noted earlier. CG entails transforminga waiting room in a mental health clinic into a “peer-run Decision SupportCenter.” Individuals who are in recovery from psychiatric disorders staff the centerand invite arriving consumers to use a Web-based software program that helps organizethe concerns the consumer wants to raise with his or her clinician. The consumerchooses whether to read or listen to the program, which can be completed inabout 20 minutes or less. The software generates a one-page report for the consumerto bring to the appointment. The program also includes brief vignettes of people tellingtheir recovery stories.Each consumer may use an electronic version of his or her report as a portal for connectingto a variety of information including DAs and factsheets. Through a simpleinterface, a consumer can graph recovery and access decision support worksheetsand peer support to help resolve decisional uncertainty about medication.Evidence Regarding Effectiveness of DAs in Mental Health CareVery few studies have been done to assess the use of DAs in mental health care(Hamman, Leucht, & Kissling, 2003). Indeed, Adams and Drake point out, “In themental health field. . . shared decision-making is a relatively novel and somewhatcontroversial concept” (2006, p. 88). One possible reason for the paucity of DAsin mental health care, and for the lack of research on them, may be the presence ofmore significant barriers to the creation of DAs in mental health than in physicalhealth. The IOM (2006) focuses on prejudice, discrimination, and coercion as theprincipal reasons why mental health consumers may not always “receive care thatis respectful of and responsive to their individual preferences, needs, and values” (p.77), and why there is less support available for mental health consumers’ decisionmaking.Prejudice and the resulting discrimination lead to questions about mentalhealth consumers’ decision-making capacity, which is irrelevant for most of them.Mental health consumers have been shown to be competent to make decisions regardingtheir own care (Hamann et al., 2006). According to the IOM (2006, p. 97),“research has shown that although patients’ decision-making performance is correlatedmodestly with psychotic symptoms, it is correlated more strongly with cognitivedysfunction.” Adams and Drake concluded their recent paper by saying, “Researchon shared decision-making in mental health lags considerably behind work ingeneral medicine and urgently needs attention” (2006, p. 100).Types of DAs That Might be Adapted for Use in Mental Health CareBecause definitive outcome data are relatively lacking in the field, DAs for mentalhealth might need to focus more on the options that consumers face, and some of theShared Decision-Making in Mental Health Care: Practice, Research, and Future Directions