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

6Values and SDMSDM holds the promise of transforming the relationship between providers andconsumers of health care into a relationship of equals with diverse expertise. As itadvances mental health recovery, SDM may also change the understanding and perceptionof mental illness in our Nation.“SDM is a basic human right.” —SDM meeting participantSDM promotes what Schauer et al. (2007, p. 55) identify as “. . . psychiatric rehabilitation’sfundamental belief that rehabilitation is done with people and not topeople.” SDM attempts to change the traditional power imbalance between providerand consumer present in general health care and perhaps amplified in mental healthcare, given concerns about the capacity of persons with mental illnesses and the presenceof legal coercive power within the mental health care system. Deegan (2007)defines the traditional psychiatric goal of consumer “compliance” with a treatmentplan as constituting oppression at its core.SDM goes beyond the traditional model of health care and informed consent. Inthe traditional model (also sometimes called a “paternalistic” model), the providermakes all the decisions and is responsible to educate the consumer only to the extentrequired to attain treatment compliance. Informed consent ensures that the consumerunderstands the planned treatment, but does not ensure that the consumer hadany role in developing the treatment plan. The SDM approach shifts responsibilityfor understanding and making decisions to the consumer who is working in collaborationwith his or her provider.SDM upholds the autonomy of health care consumers by engaging them in shapingthe course of treatment. SDM assumes that consumers have chosen to participate inthe process and recognizes that some level of information is necessary for consumersto make the choice in an informed manner (Schauer et al., 2007). The health careprovider plays a crucial role as a consultant to decisions, providing information andsupporting consumers in the consideration of treatment options and their individualvalues. Some consumers do not prefer an SDM approach to health care. Choosingto have one’s provider make the health care decision may be related to other issues,such as the values and preferences of one’s cultural background. In honoring consumers’autonomy, proponents of SDM must honor the choice of not engaging inSDM as well.Advantages and Disadvantages of SDMA number of researchers have identified advantages of SDM; disadvantages havealso emerged. Schauer et al. (2007, p. 57) provide a succinct synopsis.Shared Decision-Making in Mental Health Care:Practice, Research, and Future Directions