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

80and cost concerns associated with the use of atypical antipsychotics, CalMEND hasbecome a comprehensive effort to redesign the service delivery system and processacross all sites and settings that deliver mental health services.CalMEND has developed a process map (see Figure 2) that has become centralto communicating its work as well as organizing the project’s structure and furtherwork. Inspired by Gustafson’s (2007) work with addiction treatment and thevalue of understanding existing processes to drive systems improvement, CalMENDat first tried to capture and map the service user’s experience of the existing system.This effort quickly collapsed in frustration with the recognition that there wasmore variance and perhaps even chaos than a consistent person-centered approachto consumers.In place of a map of the existing system, a framework was developed; that frameworkis shown in the visual diagram (Figure 2) of how a service delivery systemshould be organized and function in order to promote the IOM goals, honor recoveryvalues, ensure person-centered approaches, promote cultural competence, andsupport SDM. While the many lanes of the diagram are complex, a virtual walkthroughof the service-seeking experience can identify both barriers and opportunitiesthat must be addressed. Barriers may include a lack of resources; issues relatedto financing a truly person-centered system; regulatory requirements; the knowledge,skills, and abilities of providers; and the needs and skill levels of consumers andfamily members for information, preparation, and support. At the same time, theprocess map helps to focus on those innovations, interventions, resources, training,policy changes, and other factors that can be made to support implementation ofthe model.The process map shown in Figure 2 is organized into seven phases (also called swimlanes), each representing a cluster of associated activities that moves from left toright, from access to community integration and self and/or community reliance. Thecompanion narrative for the flowchart that explains and describes the values, intent,and concerns embedded in each lane, and the accompanying performance goals andmeasures to support their implementation, are being vetted and pilot tested in severalCalifornia counties. The arrows in the figure depict the transition from one phaseto the next and reflect a logic model in which each step builds on the completion ofthe preceding activity and becomes a virtual condition for moving forward. Activitiesand tasks are depicted by rectangles in the figure, and the diamonds symbolizedecision points that, with the possible exception of access and/or eligibility, shouldbe consensus-based shared decisions. Backflow, or the need to repeat steps in theprocess, is identified by lines and arrows.Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions