Shared Decision-Making: An Autoethnography About Service User Perspectives in Making Choices About Mental Health Care and Treatment.

Joanna Fox

doi:10.3389/fpsyt.2021.637560

Abstract

Shared decision-making (SDM) between mental health medication prescribers and service users is a central pillar in the recovery approach, because it supports people experiencing mental ill-health to explore their care and treatment options to promote their well-being and to enable clinicians to gain knowledge of the choices the service user prefers. SDM is receiving increasing recognition both in the delivery of physical and mental health services; and as such, is of significance to current practice. As an expert-by-experience with over 30 years of receiving mental health treatment, I have made many choices about taking medication and accessing other forms of support. The experiences of SDM have been variable over my career as a service user: both encounters when I have felt utterly disempowered and interactions when I have led decision-making process based on my expertise-by-experience. In this article, I recount two experiences of exploring care and treatment options: firstly, a discharge planning meeting; and secondly, the choice to take medication over the long-term, despite the side effects. The article will explore both opportunities and barriers to effective shared decision-making, as well as skills and processes to facilitate this approach. The need to balance power between service users and professionals in this interaction is highlighted, including the need to respect expertise built on lived experience, alongside that of clinical expertise. This narrative is framed within an autoethnographic approach which allows me to contextualize my personal experiences in the wider environment of mental health care and support.

Highlights

Recovery is an aspirational practice at the center of mental health service delivery in the UK today (1, 2) and underpins the implementation of services for people experiencing complex psychosis (3)
Recovery promotes the development of agency and autonomy in the lives of service users (4); the process of shared decision-making (SDM) in choices about mental health interventions enables people who use services to co-produce recovery in partnership with the practitioner (6)
The first encounter occurred 30 years ago at an inpatient discharge planning meeting following my first episode of acute psychosis

Summary

INTRODUCTION

Recovery is an aspirational practice at the center of mental health service delivery in the UK today (1, 2) and underpins the implementation of services for people experiencing complex psychosis (3). This article will explore my experiences of decision-making processes in two professional encounters as a user of mental health services for over 30 years, enabling me to illuminate this approach from my perspective as both an expert-by-experience and a social work academic. This was a decision driven by expediency as I needed to function effectively in both my personal and professional life These encounters highlight two specific themes that are central to the practice of SDM in mental health care: the impact that a service user’s incapacity, lack of insight and acute distress can have when negotiating clinical interventions in the context of SDM; and the change in decision-making processes when the service user becomes a self- acknowledged expert-by-experience, as well as being recognized as such by practitioners

DISCUSSION

DATA AVAILABILITY STATEMENT