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

111who belong to minority groups or live within the community. Doctors and nursesmay know relatively little about the cultural experiences of minority mental healthconsumers, their recovery values, and how they view mental health treatment. Theymay be challenged to understand different styles of communication. In sum, someminorities may feel they are looked upon with caution. The impact of social classshould also be considered; consumers who are less educated or have less money mayfeel uncomfortable trying to make their wishes known to middle-class professionals.The development of culturally sensitive DAs, and of DAs that focus specifically onmental health issues that impact minorities, use the most appropriate language, andare geared to individuals with low literacy (including health literacy) might help tomitigate some of these factors.RecommendationsIn guiding the development of DAs for mental health consumers, SAMHSA might dowell to begin with the assumption that individuals will need DAs in different forms,and consider the scheme laid out in this paper suggesting the variety of formats andtechnologies available—for example, active and passive DAs. DAs with similar contentmight be developed in numerous formats: on paper, on the Web, on videotape,on CD-ROM, and for use by the individual alone or with assistance. Some DAsmight be developed explicitly for peer specialists to use with individuals or groups.In the absence of many DAs for mental health conditions, the type of generic frameworkthat offers guidance to individuals faced with any difficult decision might helpmeet the needs of mental health consumers. This type of paradigm might be especiallyuseful in providing consumers with a way to think about the decisions theyconfront, and with a tool they can use more than once.Developing DAs for mental health consumers will be challenging and costly. SAMH-SA can serve as a valuable resource to guide and support the process. In order forDAs to be effectively implemented, however, the provider community must be trainedboth to accept the general concept of SDM and to know how to make the best useof DAs with consumers. Trained peer specialists or mentors can play a valuable rolein the implementation process, helping providers understand the value of DAs andguiding consumers in their use. Ensuring the relevance and utility of DAs for linguistic,racial, and cultural minorities will also be critical.Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions