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

78coercion. Thus, they may well feel that SDM programs are unlikely to really meanparticipation in decision-making on their terms.Observations from within a peer-operated agency yield a number of insights fromthe perspectives of service users that provide context for designing approaches toSDM. Users of mental health services, who are seeking wellness and a lifestyle thatthey have selected (not one mandated by a health care professional), often find it difficultto follow the provider-recommended or -directed treatment plans. It is not simplya lack of motivation that can cause these failures. Although lack of motivationcan play a part, more typically a host of other factors can contribute. For example,consumers may find that they:• Do not have sufficient knowledge of the condition or its treatment;• Have not had an opportunity for reflection to determine if this is the desiredcourse of action;• Lack the self-confidence or skills to manage the condition well;• Do not have adequate support from friends or family members;• Lack financial resources to buy items necessary to maintain and sustain a wellness-focusedlifestyle;• Are not be able to reach out to others to have any successful social interactionor relationship as a result of their symptoms; and• Have lost hope that things can change and recovery is possible (Wills 2005).These concerns often create a level of what appears to be defensiveness and disinterestin “going along with providers” that can derail a clinical encounter long before itever gets to collaborative decision-making about treatment. Wills (2005) found thatdepressed patients may be more receptive to information about treatment options,possible outcomes, and the chances of those outcomes when they access the materialsfirst from the Internet. With this information, consumers and their families arebetter able to judge the value of benefits versus risks associated with any treatmentdecision—including the option to forgo treatment. Accurate and usable informationcan be critical to engaging consumers in SDM.Studies have shown that if consumers use DAs and are able to engage in SDM, theresult is reduced uncertainty, improved knowledge, and more realistic expectationsabout treatment outcomes (O’Connor et al., 2003). Although the decision-makingpartnership may never be fully equal, it proceeds based on mutual respect for theprofessional’s expertise along with the consumer’s preferences, values, and lived experience.Having shared access to the same information to guide decisions ultimatelyempowers both professionals and consumers, and supports their efforts in sustainingShared Decision-Making in Mental Health Care: Practice, Research, and Future Directions