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92AcknowledgementsThe authors thank Patricia Deegan for the information she provided and for hercomments on an earlier draft.AbstractThis paper presents information on decision aids (DAs) that mental health consumerscan use to support their participation in shared decision-making. DAs are farmore readily available, and have been studied in more detail, in physical health thanin mental health. The recent Institute of Medicine and Annapolis Coalition reports,however, point to the importance of developing more and better DAs in mentalhealth. DAs may be distinguished from other informational materials because theypresent objective evidence and explicit alternatives, and also offer guidance in clarifyingpersonal values. DAs may be used passively, actively, or with assistance. Theymay be accessed over the Internet (increasingly common), on paper, with a CD-ROM, and/or through audio or video formats. They may focus on a specific treatmentdecision or on decision-making in general, and they may be related to one-timedecisions or to ongoing decision-making. The paper lists sources of DAs that areavailable to the public, including some in the mental health arena, and notes thedearth of evidence regarding the results of their use, especially in mental health. Itconcludes by presenting a number of questions regarding implementation of DAs inmental health care, and recommendations for consideration by the Substance Abuseand Mental Health Services Administration (SAMHSA).Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions
93IntroductionSignificance of Shared Decision-making (SDM) in Mental Health CareThe concept of shared decision-making (SDM) has been discussed for nearly 30years (Adams & Drake, 2006), but its significance has been highlighted by the recentefforts of several bodies working in both physical and mental health care. The Instituteof Medicine’s (IOM’s) groundbreaking volume, Crossing the Quality Chasm(2001), included among the “rules for patient-centered care” the notion that thepatient should be the “source of control,” and, “The health system should be able toaccommodate differences in patient preferences and encourage shared decision making”(p. 61). The President’s New Freedom Commission on Mental Health (2003)emphasized the need (within goal 2) for an individualized plan of care for eachconsumer. It noted that “Consumer needs and preferences should drive the type andmix of services provided. . . . Providers should develop these customized plans in fullpartnership with consumers” (p. 35). Thus, implicitly if not explicitly, the commissionsuggested the value of what this paper refers to as SDM.Improving the Quality of Health Care for Mental and Substance-Use Conditions(2006), the report produced by the IOM Committee on Crossing the Quality Chasm:Adaptation to Mental Health and Addictive Disorders, focused on the 10 rules laidout in Crossing the Quality Chasm. Key among the steps this committee discussedwas “providing decision-making support to all M/SU [mental and/or substance-use]health care consumers” (p. 105). SDM has thus been seen over several years as representingone potentially important means to achieve a mental health system that isstrength based and recovery oriented.New confirmation of the importance of involving mental health consumers in theirown care also comes from the Annapolis Coalition on the Behavioral Health Workforce.Its Action Plan (2007) lists seven goals that are intended to provide a “frameworkfor discussion” of ways to relieve the crisis in the behavioral health care workforce.It notes that, “Perhaps no change has as much impact on the workforce as theemerging redefinition of the role of the consumer in making health care decisions”(p. 10). First among their seven goals, which were developed through a multiyearcollaborative process, is “Significantly expand the role of individuals in recovery,and their families when appropriate, to participate in, ultimately direct, or accept responsibilityfor their own care; provide care and supports to others; and educate theworkforce” (p. 15). The coalition’s initial statement therefore relates to broadeningthe concept of “workforce” to include consumers and their families.Definition“Shared decision-making (SDM),” according to Adams and Drake, “denotes an interactiveprocess in which clients and practitioners collaborate to make health caredecisions. It assumes that both members have important information to contributeShared 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
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33Fellowes, D., Wilkinson, S., & Mo
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35Power, A. Kathryn. (July 10, 2007
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37Appendix AResourcesThis list is p
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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 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: 91Supplement 3Aids to Assist Shared
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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