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

57I interact with my consumers; I find I listen more closely,” and, “Shared decisionmakinghelps me acknowledge the expertise and role of the consumer.” Likewise,consumers report feeling “heard, acknowledged, listened to.”The motivation for adopting SDM processes within the context of mental health servicesdoes need to be closely examined. There are many common attributes betweenmental illnesses and the illnesses in general health care to which shared decisionprocesses are applicable. However, there are also some key differences. The impactof stages and lengths of acuity of health conditions need to be examined in SDMresearch. Social and environmental factors differ dramatically, encompassing everythingfrom social and legal discrimination to lack of parity in insurance. Historicalimplications and assumptions must be overcome. Too often, a paternalistic and authoritarianapproach of compliance and coercion in mental health treatment mayaffect both the willingness of the care provider and the adaptability of the recipient.Moving from a passive patient role to an expert partner in the decision-makingprocess will take some time. Also, identification of effective decision aids that arefeasible and acceptable for people who vary in symptoms, and in cultural and socialbackgrounds, will take time.Challenges exist in attempts to change systems as well. Appropriate funding andbilling codes that allow for increased technology and information exchange are fewand far between. Treatment planning and documentation that focus on lack of progressas a condition for continued access to services disempower both the consumerand provider of services. Overreliance on judicial or criminal interventions affectsefficacy of self-agency.Overcoming these and other yet-to-be-identified challenges will require a firm commitmentto educational exploration that must include all the experts. The principlesof a good decision aid can be used to provide a solid evaluation guide for the process.The overall aim is to improve decision quality and to reduce undesirable practicevariations by: (1) providing facts about the condition, options, outcomes and probabilities;(2) clarifying patients’ evaluations of the outcomes that matter most to them;and (3) guiding patients in the steps of deliberation and communication so that achoice can be made that matches their informed values (O’Connor et al., 2007).Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions