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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
81Shared Decision-Making in Mental Health Care: Practice, Research, and Future DirectionsFigure 2
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iiContentsIntroduction ............
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5outpatient commitment (Holmes-Rovn
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7Advantages• Practitioners can be
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9Section 2The Practice of SharedDec
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16Section 3SDM ResearchCurrent rese
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18Mental health care providers are
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21want mental health treatment or d
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23Some participants raised concerns
Page 37 and 38: 31Section 6ConclusionsShared decisi
Page 39 and 40: 33Fellowes, D., Wilkinson, S., & Mo
Page 41 and 42: 35Power, A. Kathryn. (July 10, 2007
Page 43 and 44: 37Appendix AResourcesThis list is p
Page 45 and 46: 39Appendix BShared Decision-MakingM
Page 47 and 48: 41Annelle Primm, M.D., M.P.H.Direct
Page 49 and 50: 43Supplement 1Shared Decision-Makin
Page 51 and 52: 45IntroductionThe consumer-driven r
Page 53 and 54: 47Background: Definitions of SDM an
Page 55 and 56: 49• Freedom to live in the commun
Page 57 and 58: 51providers only (Wills & Homes-Rov
Page 59: 53SDM for Schizophrenia TreatmentBu
Page 63 and 64: 57I interact with my consumers; I f
Page 65 and 66: 59ReferencesAdams, J. R., & Drake,
Page 67 and 68: 61Elwyn, G., Edwards, A., Kinnersle
Page 69 and 70: 63Murray, E., Pollack, L., White, M
Page 71 and 72: 65Thistlethwaite, J., Evans, R., Ti
Page 73 and 74: 67AbstractShared decision-making is
Page 75 and 76: 69Confronting Critical Challenges:
Page 77 and 78: 71into treatment should still be in
Page 79 and 80: 73these approaches, people are more
Page 81 and 82: 75consumers to engage with their pr
Page 83 and 84: 77that were produced in the U.S., w
Page 85: 79a healing partnership and develop
Page 89 and 90: 83However, peer support requires st
Page 91 and 92: 85ConclusionsImplementation of SDM
Page 93 and 94: 87Fellowes, D., Wilkinson, S., & Mo
Page 95 and 96: 89President’s Commission for the
Page 97 and 98: 91Supplement 3Aids to Assist Shared
Page 99 and 100: 93IntroductionSignificance of Share
Page 101 and 102: 95In recent years, a variety of tec
Page 103 and 104: 97• Provide balanced information,
Page 105 and 106: 99Form of Access or AdministrationC
Page 107 and 108: 101ences). Some of these Web-based
Page 109 and 110: 103video about shared decision-maki
Page 111 and 112: 105clarify one’s own values and p
Page 113 and 114: 107potential results, than on quant
Page 115 and 116: 109Once again, however, it is worth
Page 117 and 118: 111who belong to minority groups or
Page 119 and 120: 113Hamann, J., Langer, B., Winkler,
Page 122: U.S. DEPARTMENT OF HEALTH AND HUMAN
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