Shared Decision Making and Medication Management in the Recovery Process

University of Kansas, Lawrence, Kansas, United States
Psychiatric Services (Impact Factor: 2.41). 12/2006; 57(11):1636-9. DOI: 10.1176/
Source: PubMed


Mental health professionals commonly conceptualize medication management for people with severe mental illness in terms of strategies to increase compliance or adherence. The authors argue that compliance is an inadequate construct because it fails to capture the dynamic complexity of autonomous clients who must navigate decisional conflicts in learning to manage disorders over the course of years or decades. Compliance is rooted in medical paternalism and is at odds with principles of person-centered care and evidence-based medicine. Using medication is an active process that involves complex decision making and a chance to work through decisional conflicts. It requires a partnership between two experts: the client and the practitioner. Shared decision making provides a model for them to assess a treatment's advantages and disadvantages within the context of recovering a life after a diagnosis of a major mental disorder.

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Available from: Patricia Deegan, Oct 27, 2014
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    • "A shared decision-making process provides an opportunity for assessing a treatment's advantages and disadvantages from both a service provider and a service user perspective—and those views can be significantly different (Covinsky et al. 2000; Deegan and Drake 2006). Despite its promise in the general health field, professional , public, legal and political forces have countered the movement towards shared decision-making in the mental health field for several reasons (Adams and Drake 2006; Deegan and Drake 2006). These include concerns about the capacity of persons with mental illnesses to make informed decisions, discomfort among some providers with the shift in roles required by shared decision-making, unease among some consumers regarding their ability to take on the responsibilities offered through shared decision-making, and lingering public fear and prejudice about persons with mental illnesses (Adams and Drake 2006; SAMHSA 2010). "
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