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

22use medication may change over time in light of life circumstances, the presence orabsence of symptoms of mental illness, and the presence or absence of side effects.Meeting participants pointed out, for example, that sexual side effects might be toleratedby a consumer who is in crisis and isolated, but may be less well accepted asthat consumer recovers and begins to form relationships with others.Dr. Deegan shared the understandings she developed through conducting interviewswith people with psychiatric disabilities who use medication in their efforts to recoverfrom major mental disorders (Deegan, 2007). She shared a conversation shehad with a man who described his marriage as one of the strongest supports for hisrecovery. He recognized that the paranoia he sometimes felt threatened his marriage,and so he would agree to take medication at those times. The medication, however,precluded sexual intimacy with his wife—another threat to his marriage. Dr.Deegan referred to this type of situation as a “medication trap,” in which psychiatricmedication works against other strategies or tools that consumers use to addresstheir illnesses.In the case she shared, the consumer’s marriage was an important support for hisrecovery. Dr. Deegan suggested that psychiatric medication be viewed within thecontext of such supports and strategies—what she termed “personal medicine.” Shesuggested that consumers should be taught to identify their personal medicine andencouraged to bring it into discussions of care and treatment with mental healthproviders. Personal medicine can include a job, a marriage, children, or friendships.It also includes strategies consumers employ to manage symptoms in conjunctionwith, or in place of, medication.Maintaining the Consumer’s VoiceParticipants expressed concern that the consumer’s voice could be “drowned out”in situations in which treatment decisions are made by a team of providers, or inconjunction with family members. A participant noted that, in some cases, decisionsmade within a clinical setting could be undone by a skeptical community or family.Meeting participants shared concerns that provider, community, and/or familypreferences often have more weight in treatment decisions than the preference ofthe consumer. They expressed hope that SDM could provide tools to ensure that theconsumer’s voice is heard and honored, and that consumers could be strengthenedin supporting their decisions beyond the clinical encounter.“The individual receiving care should have the loudest voice in planning thatcare.” —SDM meeting participantShared Decision-Making in Mental Health Care:Practice, Research, and Future Directions