Shared decision-making in mental health

Abstract

Abstract Shared decision-making (SDM) was originally described as an approach for physician-patient communication in the context of health decisions for which several treatment options exist (Charles et al., 1997). Positive outcomes of SDM including increased patient knowledge, satisfaction, and treatment adherence have been reported for various “physical” health conditions, but less research has been done on SDM for mental health conditions. Research on SDM in mental health care is a high priority for quality-of-life, autonomy, and health outcomes reasons (Wills and Holmes-Rovner 2006b), and results of early studies are favourable regarding the potential of SDM to improve mental health care (Loh et al., 2007; Swanson et al., 2007). SDM is highly relevant in mental health care due to the presence of multiple treatment decision options and the preferences of many consumers to participate in decision-making (Hamann et al., 2005). With its focus on mutual information sharing and respect for individual preferences, SDM can be an empowerng experience, assisting mental health recovery for people who have encountered stigmatization and discrimination due to mental illness (Pinninti and Bokkala-Pinninti, 2007). In the US, the incorporation of mental health consumer preferences into person-centered treatment focused on recovery is supported by the President’s New Freedom Commission Report (Hogan, 2003). Consumer participation in decision-making is also advocated by international clinical practice guidelines for mental disorders, e.g. in the UK and Germany, as well as training manuals (Härter et al., 2007, Härter et al., 2008, NICE 2002; Lehman et al., 2004). Individual values, explicit negotiation, empowerment, and self-determination are essential values for the treatment of people with mental illness and have been in the focus of psychiatric rehabilitation for decades (Anthony, Cohen and Pierce 1980; Anthony, Cohen and Farkas 1999; Deegan and Drake 2006; Lazare, Eisenthal and Wasserman 1975). SDM is also consistent with a fundamental assumption that rehabilitation is done with the person and not to the person (Schauer, Everett and del Vecchio, 2007).