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

68IntroductionShared decision-making (SDM) is a potentially radical change in current mentalhealth practice. It proposes that people learn how to be active participants in drivingtheir own recovery, with the support of providers and others while working withinthe limitations and constraints of the delivery system. Accomplishing this requires afundamental change in historical relationships between providers and mental heathconsumers. It requires that providers and consumers learn different ways to talk toeach other in clinical encounters, to engage in making decisions, and ensure theirfollow through. SDM’s goal is to engage people in decision-making and recovery.SDM embodies the recovery values of empowerment, choice, and self-determination,and promises to “make recovery real” and facilitate individuals’ recovery as well asoptimize the use of resources.To accomplish the move to SDM, a number of strategies have been developed andtested that address the needs and concerns of providers and consumers, as well asthe changes required in the process of providing care. Interventions to train healthprofessionals have focused on interviewing skills and patient-centered care. Interventionsfocused on consumers have included chronic disease self-management,question-asking skills (with and without prompt sheets), decision aids, peer counseling,and other educational interventions. The assumption has been that if providerslisten better, and consumers learn more about their choices and become more assertive,both providers and consumers will come together prepared to make encountersmore productive and the health care system will work better.In order to successfully implement SDM within mental health care, it is necessaryto identify barriers that may originate with providers, consumers, and the mentalhealth care system. This paper examines traditional provider and client perspectivesabout decision-making, the legacy of judgments of competency (and the coercionsolution), as well system-level barriers to implementation. We describe an adaptationof the chronic care model (Bodenheimer, Wagner, & Grumbach, 2002) to mentalhealth, and describe promising approaches that help support consumers and providersin their efforts to achieve SDM. Our analysis reflects the current literature, ourperspectives as consumers and providers of mental health services, and our experiencesas developers of interventions.Shared Decision-Making in Mental Health Care:Practice, Research, and Future Directions