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

53SDM for Schizophrenia TreatmentBunn et al., in an exploratory descriptive study with 96 people receiving outpatientservices for schizophrenia, found that these individuals were interested in and ableto participate in their health care decision-making (Bunn, O’Connor, Tansey, Jones,& Stinson, 1997). O’Neal et al., in a study of role preference for SDM among olderadults with severe mental illnesses, found that these individuals were interested ininformation, preferred SDM with their psychiatrists, and were more interested indecision-making involvement compared to younger adults (O’Neal, Adams, Drake,& Bartels, 2007). Similarly, Adams et al. found that approximately three in fourpeople with severe mental illness preferred a shared role in decision-making aboutnew psychiatric medications (Adams, Wolford, & Drake, 2007). Seale et al., in aqualitative study of 21 general adult psychiatrists in the United Kingdom, found thatthere was a general commitment to achieving concordant relationships with consumersaround antipsychotic medication decision-making, but that concerns aboutconsumer competence for decision-making were a key concern for fully shared decision-making(Seale, Chaplin, Lelliott, & Quirk, 2006).Some interventions are beginning to be developed and tested. For example, Deeganhas recently developed and is testing an innovative three-tiered approach to assistmental health consumers to participate in SDM related to use of psychiatricmedication. This pilot program includes a peer-to-peer workshop, a specializedsoftware program to support SDM that can be effectively used by all service recipients(including those with active symptoms), and a training program for casemanagers and therapists to help consumers navigate decisional conflict related tomedication (Deegan, 2007). Hamann et al., in a randomized controlled trial of anSDM program compared to usual care with 107 people receiving inpatient care forschizophrenia, found that the intervention was feasible for most individuals withoutexceeding the available time of physicians. Individuals in the SDM group hadbetter knowledge and higher perceived involvement in decision-making comparedto the usual care group (Hamann et al., 2006). Hamann et al., in a survey study of122 people receiving inpatient care for schizophrenia, also found that there was asomewhat stronger preference among the individuals for SDM compared to primarycare consumers, and that younger people with a negative attitude toward medicaltreatment were relatively more interested in participation (Hamann, Cohen, Leucht,Busch, & Kissling, 2005). Malm et al., in a 2-year randomized controlled trial oftwo community-based treatment programs with 84 people with schizophrenia inSweden, found that there was significantly improved social function and consumersatisfaction for an integrated care model incorporating SDM and consumer empowermentcontent (Malm, Ivarsson, Allebeck, & Falloon, 2003). These studies showthat there is the potential for SDM interventions, including structured decision supportinterventions, to be of interest and feasible for use among people with seriousmental health conditions. Testing of interventions is in the very initial stages, how-Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions