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

49• Freedom to live in the community;• Authority over the funds needed for one’s own care;• Support for participants’ efforts to make the choices that are best forthem;• Responsibility for managing finances, choosing services, and handlingthe tasks of daily living, and for the appropriate use of public funds; and• Confirmation or Participation, that is, the opportunity for service recipientsto participate in decision making about the care delivery system.. . . self-directed care represents one method for achieving the goals of selfdeterminationand ultimately of a recovery-oriented system through changesin financing and the elimination of third parties in the health care system(pp. 3-4).Neal Adams, M.D., M.P.H., and Diane Grieder, M.Ed., who authored the text,Treatment Planning for Person-Centered Care: The Road to Mental Health andAddiction Recovery, state that person-centered care is characterized as a partnershipbetween the provider and consumer that establishes meaningful recovery andwellness goals for consumers and a therapeutic relationship that is collaborative,consultative, and mentoring (Adams & Grieder, 2004). The person-centered approachhelps the provider recognize consumers’ strengths and unique cultural backgrounds,and helps consumers to become good problem-solvers on the road to recovery.This process can also help providers to better communicate with payers,document medical necessity, and coordinate services. A thorough discussion of theorigins of person-centered planning by C. O’Brien and J. O’Brien can be found athttp://thechp.syr.edu/PCP_History.pdf.Models of Decision-Making in Health CareShared decision-making as a model of care falls between the traditional (paternalistic)medical model and the informed choice model (Charles et al., 1997; Hamann etal., 2003). In the traditional model, the care provider controls information exchangeand decision-making. Consumer values, expertise, and preferences are not necessarilyconsidered, and are not weighed equally with those of the care provider ifconsidered. The main (passive) consumer role is to be a “good patient” in complyingwith the prescribed treatment (Emanuel & Emanuel, 1992). In the informed choicemodel, the care recipient actively controls the information exchange and decisionmakingabout the options (Hamann et al., 2003), but without necessarily takingthe provider’s perspective into account or weighing it equally in decision-making.Shared Decision-Making in Mental Health Care:Practice, Research, and Future Directions