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

20“We can’t promote cutting-edge practices with old training models.”—SDM meeting participantThe variety of care settings was also discussed as a dimension to consider in promotingSDM. One meeting participant pointed out that SDM could be utilized in eventhe most coercive settings and suggested that special efforts be made to promoteSDM at facilities where consumers are involuntarily committed. These consumers,she suggested, are among the most vulnerable and might receive the greatest benefitfrom SDM. She also noted that staff at State mental hospitals are not often providedwith opportunities to engage in new mental health initiatives.Engaging Consumers in SDMMeeting participants acknowledged that SDM would not be appealing to all consumers;they suggested, however, that the reasons for avoiding SDM should be explored.Meeting participants suggested that some reasons—lack of understanding, fear ofcoercion, fear of irritating the provider—should be overcome. Culturally competentmodels of SDM also need to be developed.“When we are labeled with mental illness, we can lose friends, families, jobs,housing, possessions. . . our confidence in our ability to manage our lives.”—SDM meeting participantParticipants also suggested that SDM should be incorporated in all stages of care;this includes goal setting in treatment planning as well as decisions about specific interventions.This strategy, they suggested, could build confidence and competence incommunicating and making decisions. In addition, using SDM throughout the careprocess may improve the provider-consumer relationship.As consumers are supported in taking on a larger role in their own recovery, however,one participant cautioned that the responsibility for the success or failure of anencounter or treatment plan should not be placed solely on consumers’ shoulders.“We must do more than plant the seeds. We must nurture their growth.”—SDM meeting participantIssues of Competence and Coercion in Mental Health CareMeeting participants identified provider and community concerns about competence—andconsumer concerns about coercion—as barriers to the promotion ofSDM in mental health. If a provider considers a consumer not competent to makedecisions, then SDM may not occur. A clear majority of consumers are able to makehealth care decisions (IOM, 2006). For those who may have difficulty with decisionmakingand wish to engage in SDM, it should be recognized that making one smalldecision may be the first step to making other decisions. For those who do notShared Decision-Making in Mental Health Care:Practice, Research, and Future Directions