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

107potential results, than on quantitative data. Moreover, DAs for mental health mightbe thought of broadly, and encompass decisions regarding issues such as housing,education, and employment as well as the medical aspects of care (e.g., medicationand various forms of psychotherapy). Web-based aids could be developed to helpmental health consumers make decisions about their treatment. Brief video clipsshowing individuals who have confronted various decisions, and how they thoughtthem through, might help consumers by demonstrating that others have faced similarconcerns and have made decisions that were appropriate for them. Also, as notedearlier, some DAs for individuals with mental illnesses might be thought of as toolsnot to be used once, but to be returned to over time.Aids such as the Decision Board might be adapted for mental health care. The DecisionBoard was devised by Canadian physicians to help women with breast cancerdecide on a course of treatment. The board consists of a set of panels, each coveredby a sliding door. During an appointment, the patient and her physician open thepanels in succession and read the information, stopping to discuss the patient’s specificsituation. The patient also receives a copy of the Decision Board on paper tohelp her recall the information (Supportive Cancer Care Research Unit, 2008; ACSNews Center, 2003). Research has demonstrated that the Decision Board helpedwomen feel more knowledgeable about their chances of recurrence and better satisfiedwith their decision-making.Issues Related to Implementation in Mental Health CareThe use of DAs in mental health care can empower the consumer to be a genuinedecision-making partner and can help foster mutual respect among consumers,doctors, nurses, case managers, and others as they all seek to support the recoveryprocess. The word “empower” is especially meaningful in this context, because thepower disparity between providers and consumers can impose a particular burdenon the latter, as observed in the discussion below.How is the Use of DAs in Mental Health Care Different From Their Use in PhysicalHealth Care?In physical health care, at least for certain forms of treatment, there may be moreobjective criteria according to which decisions can be made. The relative likelihoodof one outcome or another resulting from a course of action can be estimated reasonablywell for many physical conditions, and the outcomes themselves are perhapsmore quantifiable. For mental health conditions, there is often less evidence, lesscertainty of a particular outcome, and less clarity as to which outcome is best. Thus,DAs in mental health might be usefully seen as helping the consumer evaluate tradeoffs,for example, thinking about the side effects and effects of beginning or ending use ofmedications, and of other potential steps that might enhance recovery.Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions