United Kingdom. The place of shared decision making in UK mental health services

Abstract

This chapter focuses on the development of Shared Decision Making (SDM) as a UK policy in the field of mental health. It outlines the UK SDM policy, beginning with its location within the National Health Service (NHS) system. The UK highly centralized health system entitles all citizens in need of mental health support to use all services regulated by the Department of Health and Social Care (DHSC). SDM is a formally recommended practice (see NICE guidelines, 2021) in both physical and mental health, but the implementation of this policy is at its infancy, especially in the context of mental health inpatient services. This chapter explains why SDM is necessary in the context of mental health, its characteristics and innovative aspects. These include merging knowledge that comes from different stakeholders, the underlying process which is a key to its application, necessary conditions for its implementation, SDM aids, existing research methodology and evidence of its efficacy. SDM is a relatively new development which does not conform to the traditional medical model of treatment of mental illness. The chapter highlights existing attitudes of key stakeholders such as service users, service providers and informal carers towards it. It also discusses relevant policy and legislation relating to the development of SDM in practice, and different foci and forms of applying SDM within the UK context. The chapter looks at key dilemmas, such as the power differential between the key players, questions about the capacity of people experiencing mental ill health, the focus on risk avoidance without looking at the need to positive risk taking inherent in the UK health and social care system, and the prevailing inequality in UK society in terms of society in terms of the experience of people from ethnic minority communities. The research methodology included documentary analysis of updated key policy documents, historical development of SDM in mental health within the UK, and the perspectives of the key stakeholders. The final section about the NICE guidelines looks further at the process of consultation pertaining to SDM.