The Promise of Shared Decision Making in Mental Health

Psychiatric Rehabilitation Journal (Impact Factor: 1.16). 06/2010; 34(1):7-13. DOI: 10.2975/34.1.2010.7.13
Source: PubMed


Shared decision making connotes a process, supported by specific information technologies, that reengineer how practitioners and people with diagnoses work together. The articles in this section of the journal provide just a glimpse of the activity underway to promote shared decision making in mental health. Nevertheless, they are important windows into the new world of possibilities regarding care planning, medication management and the use of information technology. Thus, in this paper we discuss the promise of shared decision making for advancing the field. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

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    • "In mental health contexts, although SDM interventions have been argued to be effective methods for information sharing, some have criticized them as strategies " to increase clients' behavioral conformity to a practitioner's view of optimal treatment " rather than to treat the client and clinician both as experts who " must share their respective knowledge and determine collaboratively " what is optimal (Deegan & Drake, 2006, p. 1636). Nevertheless, because SDM has the potential to improve client–clinician collaboration and provide clarity for clients making complex decisions (Drake et al., 2010), many perceive SDM to be an ethical imperative (Drake & Deegan, 2009). "
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    ABSTRACT: Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management, and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued client-centered priorities such as autonomy and empowerment when making decisions. However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: (a) the role of communication and information exchange and (b) the value and stability of clinician and client epistemic expertise. Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of Shared Decision Making (CEM-SDM).
    Health Communication 11/2015; DOI:10.1080/10410236.2014.993296 · 0.97 Impact Factor
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    • "Email: 1998; Drake, Deegan, and Rapp 2010). National policy documents and legislation have globally articulated the importance of client participation. "
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    ABSTRACT: Individuals with severe mental illness have often been perceived by themselves and others as stigmatised and unable to make decisions about their lives. However, perceptions of mental illness and health care have experienced significant changes; as a result, community-, consumer- and recovery-based approaches have been developed. The aim of this article is to deepen our understanding about client participation as interactive and shifting positioning work. It examines how a client constructs him/herself as a decision-maker and how others support or hinder that position. The study is based on 25 mental health client interviews. Findings are reported in three sections that examine: (1) restricted participation; (2) supported participation; and (3) independent participation. It is argued that, when dealing with client participation in mental health, we need to focus on the subtle discursive practices by which clients perform positioning and are given positions. The findings provide a basis for discussing client participation as relational and interactive phenomena. Client participation is bound by client-practitioner interaction as well as by discursive practices. For the client to participate, he/she first needs to accomplish participant positioning, become an actor with a voice and be able to make decisions and choices. This is a crucial (but not easily accomplished) precondition of client participation.
    12/2014; 5(1):1-15. DOI:10.1080/2156857X.2014.909875
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    • "GAM has in common with other approaches that address the issue of medication like shared decision making, the partnership philosophy, the sharing of expertise, and of point of views (Deegan and Drake, 2006; Drake et al., 2010; Duncan et al., 2010). In GAM terms, the " safe space of open dialogue " about the issue of mental health medication extends beyond the patient-doctor relationship and encompasses the different stakeholders: other providers and carers. "
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    ABSTRACT: Purpose – Formal recognition of the human rights of people living with mental health problems has greatly progressed. We must ask ourselves, however, to what extent the formal recognition of these rights has transformed the culture of psychiatric care and improved their quality of life. Gaining Autonomy & Medication Management (GAM) is an approach that strives to empower service users and providers and promotes the exercise of users’ rights by transforming their relationship with the central component of psychiatric treatment in community services: psychopharmacology. The purpose of this paper is to show how GAM highlights the issues surrounding the establishment of a culture of rights. Design/methodology/approach – For this analysis qualitative data were collected in Brazil and in Quebec, Canada, through over 100 interviews done with people living with mental health issues and practitioners who participated in the different GAM implementation projects. Findings – Issues, challenges and obstacles facing the instauration of a human rights culture in mental health services are presented. The profound changes that the understanding and exercise of users’ rights bring to the lives of individuals are supported by excerpts illustrating recurring issues, situations and common experiences that appear in the various contexts of the two different countries. Research limitations/implications – This is not a parallel study taking place into two countries. The methodologies used were different, and as a consequence the comparative power can be limited. However, the results reveal striking similarities. Originality/value – There is scant research on human rights in mental health services in the community, and the issues surrounding the prescribing and follow-up of pharmacological treatment. The joint analysis of the researches in Brazil and in Canada, identified common challenges which are intertwined with the dominant approach of biomedical psychiatry.
    Journal of public mental health 12/2014; VOL. 13(NO. 4):pp. 179-188. DOI:10.1108/JPMH-06-2013-0039
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