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

48Rovner, 2006). SDM is explicitly person-centered within a goal of promoting theideal conditions for effective decision-making to occur. 2 This is consistent with nationalpolicy objectives to incorporate preferences in individualizing person-centeredcare. The values aspect of decisions, including identifying preferences, is especiallyrelevant in decisions for which preferences do (or should) significantly guide decision-makingand for situations in which an equal balance of pros and cons exists forat least two different alternative choices (i.e., in which there is more than one reasonableoption as defined by the key partners in the decision-making process) (Elwyn etal., 2000; Whitney, McGuire, & McCullough, 2004; Wills & Holmes-Rovner, 2006).These types of preference decisions constitute the large majority of mental healthtreatment decision-making.Self-directed Care, Self-determination, and Person-centered PlanningOne of the more challenging aspects of mental health recovery-oriented services andthe adoption of innovative practices is the establishment of working definitions foran evolving language. This is even more the case when one is attempting to refinepolicy-provoking nuances and societal implications. Within the context of SDM,particularly as it relates to mental health, there are specific terms and jargon thatshould be considered. A few of these are: self-directed care, self-determination, andperson-centered planning. It is important to note that each of these terms originatedoutside the context of mental health, but are deeply rooted in the larger crossdisabilitymovement. A linguistic task that is before the stakeholders is to flesh outthe nuance of yet another “foreign language” in order to adequately assess both theadaptability of the language and the application of the practice of SDM.Free To Choose: Transforming Behavioral Health Care to Self-Direction, a 2005publication of the Center for Mental Health Services (SAMHSA, 2005), identifiedthe following definitions for self-directed care and self-determination.Self-directed care is closely related, although not identical, to both a recoveryorientation and self-determination. The term self-directed care has beendefined as a system that is “intended to allow informed consumers to assesstheir own needs. . . determine how and by whom these needs should be met,and monitor the quality of services they receive” (Dougherty, 2003). Selfdeterminationis a philosophy designed to help persons “build [meaningfullives] with effective opportunities to develop and reach valued life goals”(Cook et al., 2004). It “focuses on the degree to which human behaviors arevolitional. . . that is, the extent to which people. . . engage in [their] actionswith a full sense of choice” (Cook et al., 2004). As Nerney (2001) states, selfdeterminationis based on five principles:2Effective decisions are informed, consistent with personal values, implemented, and associated with anincreased likelihood of positive outcomes (O’Connor, 1995).Shared Decision-Making in Mental Health Care:Practice, Research, and Future Directions