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

15Peer support specialists may be uniquely qualified and positioned to provide thistraining and support. Peer support specialists are trained mental health care consumerswho meet one-on-one with other consumers to listen, discuss concerns, and providesupport. Because they have lived experiences with mental illnesses and makingtreatment decisions as well as experience in navigating the mental health system asconsumers, peer support specialists are able to engage in a nonhierarchical, reciprocalrelationship. Peer support specialists may also be more likely than health careproviders to share and reflect a consumer’s culture and language (Perlman et al.,Supplement 3).“Hiring consumers as staff changes the attitudes of providers and modelsrecovery to other consumers.” —SDM meeting participantBarriers to consumer use of SDM include “learned helplessness” (where a person haslearned to behave in a helpless manner because of lack of control of their situation)on the part of consumers whose experience has been limited to a paternalistic mentalhealth system focused on ensuring their compliance to treatment (Holmes-Rovneret al., Supplement 2). Participants at the SDM meeting identified additional barriers.• A culture of silence among consumers surrounding the use of psychiatricmedication.• “Caretaking” of providers by consumers. Consumers may hesitate to shareinformation about medication’s side effects, to ask questions, or to seek changein treatment for fear of inconveniencing or distressing their care providers andrisking a loss of services.• Lack of consumer knowledge about medication options—including the optionto have treatment without medication—and consumer acceptance of side effectsas unavoidable.“There’s an enormous taboo against those of us using psychiatric medicationsdiscussing them with one another. Many patients don’t believe theyhave a right to mention side effects to their providers; they think they justhave to live with them.” —Patricia Deegan, Ph.D.Shared Decision-Making in Mental Health Care:Practice, Research, and Future Directions