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

21want mental health treatment or do not acknowledge the presence of a mental illness,the first step may be to engage these persons to accept negotiations (Adams& Drake, 2006).Participants noted that the 2007 shooting of students and faculty by a student withmental illness who attended Virginia Tech would strongly color public perception ofpersons with mental illness, and spoke to the need to educate the community at largethat consumers of mental health services are much more likely to be victims thanperpetrators of violent crime.Participants also spoke about the presence of coercion in the mental health caresystem, and the effect of that threat upon consumers. A consumer participant atthe meeting suggested that involuntary commitments should always be consideredtreatment failures. Participants strongly supported efforts to eliminate coercion frommental health care.Meeting participants expressed a deep desire to reduce or eliminate coercion withinthe mental health care field and spoke of the need to support consumers in trustingthe system and developing their own capacity to make decisions. Learned helplessness,prejudice, and fear of coercive consequences may result in consumers’ reluctanceto embrace shared decision-making.A participant pointed out that consumers who have difficulty in communicatingmay be more likely to be judged incompetent to make decisions, and suggested thatspecial efforts be taken to reduce this risk.Complexities of Medication Use in Mental Health CareParticipants discussed a recent report by the National Association of State MentalHealth Program Directors (NASMHPD, 2006), which acknowledged that “personswith serious mental illness are now dying 25 years younger than the general population”(p. 4). The NASMHPD report called for state mental health directors to embracethe principles of wellness in mental health recovery and overall health as anessential element of mental health. In addition to the concerns about issues of generalhealth raised by the NASMHPD report, meeting participants discussed the sideeffects of some psychiatric medications, particularly atypical and first-generationantipsychotics.“Overall health and mental health are intertwined and cannot be separated.[SDM] must promote and address overall health and wellness.”—SDM meeting participantIn light of these health concerns, SDM meeting participants promoted a complexview of decision-making around the use of medication. Decisions to use or not toShared Decision-Making in Mental Health Care:Practice, Research, and Future Directions