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

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