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

79a healing partnership and developing a mutually agreeable plan. Recording decisionsin a document most commonly referred to as a “treatment plan” may extendthe collaborative relationship and serve as an ongoing and shared reference or recoveryguide.Barriers to SDM from the mental health care systemHistorically, the service delivery system has been organized around the provider’spreference to control decision-making about pharmacotherapy and psychosocial interventionsand supports. The role of the helping professional was defined by his orher ability to provide guidance and sound advice to consumers who did not have thesame level of knowledge, training, and experience. Treatment plans were developedwith the expectation that the consumer would be compliant with prescribed treatment.However, unless deemed otherwise by a court, consumers make their ownindependent decisions on a daily basis to accept or reject the professional’s plan witheach dose of a medication or participation in a prescribed activity.SDM can only proceed from a shared understanding of the consumer’s recoveryhopes and dreams as well as the barriers that lie in the way of success. However,neither the infrastructure nor the encounter-level practice of mental health has putshared understanding at the center of the process. This omission is critical becauseshared understanding is the first—and in many respects, the most critical—of all thedecision points in creating an effective and acceptable recovery and services plan.Understanding is based on the ability of the provider and consumer to weave all thethreads of information gathered in an assessment into at least partial (if not whole)cloth. Compassionate and empathic understanding is often the key that unlocks thedoor of possibility for individuals feeling overwhelmed and unable to proceed intheir own recovery. It must be shared and mutual if it is to serve and support theoverall process, beginning with setting goals, then developing a plan, and providingservices. Without this understanding, there cannot be the productive interactions thatare identified in the Wagner care model. Without this understanding, there is no realbasis for SDM even if the best DAs are available. In most service delivery systems today,this essential step is all too often overlooked. Even when such understanding isconsidered, disagreements that become barriers to true mutuality in decision-makingare avoided and may go unrecognized rather than being acknowledged and resolved.Promising Approaches to System RedesignCalMEND is a joint quality improvement initiative between the California Departmentof Mental Health (DMH), the State’s Medicaid agency (Medi-Cal), and theCalifornia Institute for Mental Health (CiMH). The work of CalMEND draws heavilyon not only the participation and input of paid staff, but also on committeeand task group volunteers who represent all stakeholders and in particular providers(including physicians and pharmacists), consumers and recovery specialists, andfamily members. Initiated as a disease-management project to address quality of careShared Decision-Making in Mental Health Care: Practice, Research, and Future Directions