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44AbstractThe consumer-driven recovery movement and informed shared decision-making(SDM) are of central contemporary interest for quality improvement in mentalhealth interventions and services. SDM is being advocated as a promising healthcare reform paradigm for the improvement of mental health services via recognitionand provision of support for consumers to be equal partners with their health careproviders in health-related decision-making. This paper reviews SDM definitions,research, and practice in relation to SDM in the mental health care and recoveryprocess. A small but increasing number of studies provide evidence of consumerinterest in and favorable outcomes of SDM in the mental health care context, butSDM is not widely and fully implemented in practice. There is an urgency that existsin implementing practices that are consistent with and supportive of consumerrecovery, within additional research to describe and test the effects of SDM in mentalhealth contexts, including that of diverse populations.Shared Decision-Making in Mental Health Care:Practice, Research, and Future Directions
45IntroductionThe consumer-driven recovery movement and informed shared decision-making(SDM) are of central contemporary interest for quality improvement in mental healthinterventions and services. It is increasingly recognized that the active engagement ofconsumers in the treatment and the recovery process is essential to achieving highqualityoutcomes. This interest has led to a number of key national reports in recentyears emphasizing the essential role of consumers in achieving positive outcomes.For example, the final report of the President’s New Freedom Commission on MentalHealth (2003) and two Institute of Medicine (IOM) reports, Crossing the QualityChasm (2001) and Improving the Quality of Health Care for Mental and Substance-Use Conditions (2006), emphasize a goal of understanding and honoring consumers’preferences and supporting fully shared decision-making with service providers todevelop person-centered plans of care to foster improved satisfaction, better meetingof needs, and meaningful recovery. Federal agencies that support research on healthclinical interventions have also highlighted the importance of a person-centered approachand shared decision-making to achieve high-level recovery (Schauer, Everett,del Vecchio, & Anderson, 2007). For example, patient-provider decision-making isidentified as a key research priority for the Primary Care Research Program by theNational Institute of Mental Health (National Institute of Mental Health, 1999). TheSubstance Abuse and Mental Health Services Administration (SAMHSA) conveneda National Consensus Conference on Mental Health Recovery and Mental HealthSystems Transformation in 2004, in which 10 fundamental components of recoveryhighlighted the role of individual preferences and active participation in decisionmaking(SAMHSA, 2004). Three of the ten identified fundamental components ofrecovery—self-direction, individualized and person-centered, and empowerment—describe the importance of consumer choice, control, preferences, and active participationin decision-making. SAMHSA has set forth principles and characteristics ofconsumer- and family-driven care that emphasize the control of decision-making byfamilies and individuals (SAMHSA, 2006).In the mental health interventions and services literature, consumers also are increasinglyacknowledged as full partners in SDM with their health care providers as socialperspectives evolve regarding mental illness treatment and meaningful recovery(Deegan & Drake, 2006; Wills & Holmes-Rovner, 2006). SDM is being advocatedas a promising health care reform paradigm for the improvement of mental healthservices via recognition and provision of support for consumers to be equal partnerswith their health care providers in health-related decision-making. This shift in perspectiveto support and better appreciate the consumer’s role comes from the recognitionthat well-achieved SDM can avoid some significant limitations of the traditionalmedical (paternalistic) model and the unsupported informed choice modelof care that have often resulted in suboptimal care processes and outcomes (Deegan& Drake, 2006; Hamann, Leucht, & Kissling, 2003). Effective approaches forShared 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 and 28: 21want mental health treatment or d
Page 29: 23Some participants raised concerns
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: 43Supplement 1Shared Decision-Makin
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
Page 79 and 80: 73these approaches, people are more
Page 81 and 82: 75consumers to engage with their pr
Page 83 and 84: 77that were produced in the U.S., w
Page 85 and 86: 79a healing partnership and develop
Page 87 and 88: 81Shared Decision-Making in Mental
Page 89 and 90: 83However, peer support requires st
Page 91 and 92: 85ConclusionsImplementation of SDM
Page 93 and 94: 87Fellowes, D., Wilkinson, S., & Mo
Page 95 and 96: 89President’s Commission for the
Page 97 and 98: 91Supplement 3Aids to Assist Shared
Page 99 and 100: 93IntroductionSignificance of Share
Page 101 and 102:
95In recent years, a variety of tec
Page 103 and 104:
97• Provide balanced information,
Page 105 and 106:
99Form of Access or AdministrationC
Page 107 and 108:
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
Page 115 and 116:
109Once again, however, it is worth
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111who belong to minority groups or
Page 119 and 120:
113Hamann, J., Langer, B., Winkler,
Page 122:
U.S. DEPARTMENT OF HEALTH AND HUMAN
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