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

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84disproportionately subjected to involuntary outpatient commitment (U.S. PsychiatricRehabilitation Association, 2007). The results of such treatment have often beento alienate individuals from the alleged services designed to help them. Homelessnesscan be preferable to being in a system viewed as controlling, unhelpful, andnot respectful of individuals’ culture and ethnicity. Value and social class differencesbetween providers and consumers may interfere with establishing the engagementthat is desired by the health care professional. The experience of peer mentors cancontribute to provider training as well as peer training.One peer-decision support model (Deegan & Drake, 2006) attempts to build andsupport consumer decision skills immediately before the clinical encounter. The decisionsupport center is a place where consumers can go to work with a peer anddecide what they want from their next appointment with their health care professional.The systematic approach examines goals, helps the person focus and state thegoal, examines desired outcomes, and supports the individual during the health careappointment if desired. These centers are staffed by trained peer mentors, offer lightsnacks and beverages, and are inviting and flexible, often replacing the usual waitingroom. The center becomes an inviting and stimulating place where social connectionsand coaching for the clinical encounter can occur.Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions
85ConclusionsImplementation of SDM requires important changes in the values and principlesthat guide interactions between consumers and providers. SDM builds on recoveryorientedservices and goes further. It invites candid disclosure of consumers’ personalvalues about what is important to them, and it invites providers to clearly present allthe treatment choices that may be effective, along with discussion of which optionswork best and what side-effects may occur. The mental health field provides specialchallenges to implementation of SDM because of the history of interventions thatassume limitations in mental health consumers’ capacity to make decisions in theirown best interests.By itself, supplying decision support tools cannot be expected to accomplish majorreforms. In order to make SDM a vehicle for true person-centered care in mentalhealth, these promising interventions must be sustained, strengthened, and repeated.Provider training in SDM and the use of decision support tools must become apart of training in many preclinical, clinical, and postgraduate education settings.Consumers also require training and practice in how to accept the challenge andresponsibility for making choices and following through. SDM requires new skillsfor effective self-advocacy for individuals with mental illnesses. Service delivery systemsmust assist in delivering treatment choice information to both consumers andproviders. It must also develop quality measures that establish reward systems forSDM, and the ability to document negotiated treatment decisions, including thosethat may be somewhat novel in matching treatment with consumers’ priorities andprovider expectations. Where such treatment decisions include specific followup expectations,these must also be documented. Episodes of treatment have to give wayto trajectories of treatment that allow for trial and error and new strategies forreaching recovery goals.Mental health research is far from devoid of participation in research on SDM interventionsand services. There is an active field of research, with some of the mostpositive results in the whole health field being found in studies of depression. Buildingon these successes requires concerted effort at all levels of the service deliverysystem, including the community and formal health care systems. Training and educatingboth providers and consumers, structuring the service delivery system and/orprocess, and ensuring access to decision support may all contribute incrementally tobringing SDM into routine practice as the standard of care.Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions
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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
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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 and 86: 79a healing partnership and develop
Page 87 and 88: 81Shared Decision-Making in Mental
Page 89: 83However, peer support requires st
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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