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55tations; improved ability to formulate decisions; improved congruence betweenpreferences and choices; more active involvement; and improved communicationbetween consumers, providers, and significant others (O’Connor et al., 2003;Thistlewaite et al., 2006). The overall intent of DAs is to aid in the task of helpinghealth consumers make evidence-based decisions (O’Connor, 2001) as an enhancementof usual care approaches. DAs also include values clarification exercises tohelp individuals consider what is important to them in evaluating the pros and consof various options. DAs have been developed and tested for a number of healthconditions in which complex choices are made (O’Connor et al., 2003), but havemostly focused on discrete, one-time choices as opposed to “continuance” andeveryday decisions made by people who are living with long-lasting or ongoinghealth conditions (Wills & Holmes-Rovner, 2006). DAs have been developed inmany formats, including decision boards, interactive computer-based support guidesand DVDs, booklets, interactive group discussions, and individualized person-topersoncoaching (Wills & Holmes-Rovner, 2006). An international consensus panelrecently developed and published criteria for evaluating the quality of decision aids(see http://ipdas.ohri.ca for additional information and criteria) (Elwyn et al., 2006).The Recovery Movement and SDMDespite the limited and early stage of research on SDM in the mental health context,there is good reason to explore the implications of adopting SDM practices withinmental health care. As previously noted, social advocacy and public policy advanceshave called for increased participation by consumers of mental health services. Oneexample can be found in goal 2 of the New Freedom Commission Report on MentalHealth (2003, p. 5): “in a transformed mental health system mental health care isconsumer and family driven.” Other examples are found in the 10 fundamental componentsof recovery as identified in the National Consensus Statement on MentalHealth Recovery released by the Center for Mental Health Services in 2006—self-direction,individualized and person centered, empowerment, strengths-based, respect,and responsibility (CMHS, 2006). The elemental recognition “that both members[of the shared decision-making process] have important information to contribute”(Adams & Drake, 2006, p. 87) is consistent with a recovery orientation.There is an urgency to implement practices that are consistent with and supportiveof recovery. Overwhelming evidence continues to build that mental illness is aholistic disease that must be treated with holistic interventions. The mortality ratesassociated with mental illness are becoming more clearly defined. It is known thatthere is a significantly higher frequency of deaths from accidental and intentionalinjuries, particularly poisoning by psychotropic medications, in people who experiencepsychiatric symptoms (Dembling, Chen, & Vachon, 1999), but what is mostalarming is the evidence around medical comorbidities. Heart disease, obesity, andShared Decision-Making in Mental Health Care: Practice, Research, and Future Directions