“Work with me”: service users’ perspectives on shared decision making in mental health

Abstract

PurposeWhile shared decision making (SDM) in general health has proven effectiveness, it has received far less attention within mental health practice with a disconnection between policy and ideals. The purpose of this paper to review existing developments, contemporary challenges, and evidence regarding SDM in mental health with a particular focus on the perspectives of service users.Design/methodology/approachThis is a review of international papers analysed using narrative synthesis of relevant data bases.FindingsThe review shows significant barriers to the utilisation of SDM including ethical and legal frameworks, accountability and risk. The medical model of psychiatry and diagnostic stigma also contributes to a lack of professional acknowledgement of service user expertise. Service users experience an imbalance of power and feel they lack choices, being “done to” rather than “worked with”.Practical implicationsThe paper also presents perspectives about how barriers can be overcome, and service users enabled to take back power and acknowledge their own expertise.Originality/valueThis review is the first with a particular focus on the perspectives of service users and SDM.