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

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