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

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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
23Some participants raised concerns about the need for cultural competence in ensuringthat SDM is hospitable to all consumers. They stated that, in many cultures, familyand/or community members were expected to participate in important decision-makingprocesses and cautioned against promoting models of SDM that were not inclusiveof a variety of perspectives, expectations, and values regarding decision-making.The Role of Peer SpecialistsPeer specialists emerged as a central strategy for promoting SDM among meetingparticipants. Participants felt that peers would be best able to support mental healthconsumers in trusting the process of SDM. In addition, a participant spoke to theway provider perceptions of mental health consumers can be changed when consumersjoin the staff. Greater support for peer specialists within the mental healthsystem was identified as a significant step forward in improving care in general andin promoting SDM.Communication and SDMMeeting participants discussed the relationship between communication and SDM.Some felt that SDM was simply a type of respectful communication, while othersspoke to the need to promote better communication skills among providers as necessaryprecursors to SDM. Some participants expressed concern that many providersfeel they are “already doing” SDM; they pointed to the need to develop measures bywhich providers could assess their practice.Financial ConsiderationsThe decisions available to consumers of mental health care are often determined bythe payer system that supports their care. Consumers may choose not to use medicationbecause of its cost—or to use medication because it is the only reimbursedoption. Also, there is the issue of whether payers are willing to reimburse providersfor their time in the use of SDM and decision aids. Payers must be educated andinvolved in the promotion of SDM and associated practices, if SDM is to be viable.Shared Decision-Making in Mental Health Care:Practice, Research, and Future Directions
Page 4: iiContentsIntroduction ............
Page 11 and 12: 5outpatient commitment (Holmes-Rovn
Page 13 and 14: 7Advantages• Practitioners can be
Page 15: 9Section 2The Practice of SharedDec
Page 22 and 23: 16Section 3SDM ResearchCurrent rese
Page 24: 18Mental health care providers are
Page 27: 21want mental health treatment or d
Page 37 and 38: 31Section 6ConclusionsShared decisi
Page 39 and 40: 33Fellowes, D., Wilkinson, S., & Mo
Page 41 and 42: 35Power, A. Kathryn. (July 10, 2007
Page 43 and 44: 37Appendix AResourcesThis list is p
Page 45 and 46: 39Appendix BShared Decision-MakingM
Page 47 and 48: 41Annelle Primm, M.D., M.P.H.Direct
Page 49 and 50: 43Supplement 1Shared Decision-Makin
Page 51 and 52: 45IntroductionThe consumer-driven r
Page 53 and 54: 47Background: Definitions of SDM an
Page 55 and 56: 49• Freedom to live in the commun
Page 57 and 58: 51providers only (Wills & Homes-Rov
Page 59: 53SDM for Schizophrenia TreatmentBu
Page 63 and 64: 57I interact with my consumers; I f
Page 65 and 66: 59ReferencesAdams, J. R., & Drake,
Page 67 and 68: 61Elwyn, G., Edwards, A., Kinnersle
Page 69 and 70: 63Murray, E., Pollack, L., White, M
Page 71 and 72: 65Thistlethwaite, J., Evans, R., Ti
Page 73 and 74: 67AbstractShared decision-making is
Page 75 and 76: 69Confronting Critical Challenges:
Page 77 and 78: 71into treatment should still be in
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73these approaches, people are more
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75consumers to engage with their pr
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77that were produced in the U.S., w
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79a healing partnership and develop
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81Shared Decision-Making in Mental
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83However, peer support requires st
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85ConclusionsImplementation of SDM
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87Fellowes, D., Wilkinson, S., & Mo
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89President’s Commission for the
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91Supplement 3Aids to Assist Shared
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93IntroductionSignificance of Share
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95In recent years, a variety of tec
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97• Provide balanced information,
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99Form of Access or AdministrationC
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101ences). Some of these Web-based
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103video about shared decision-maki
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105clarify one’s own values and p
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107potential results, than on quant
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109Once again, however, it is worth
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111who belong to minority groups or
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113Hamann, J., Langer, B., Winkler,
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U.S. DEPARTMENT OF HEALTH AND HUMAN
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