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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    • "Being open to, and making space for, patients to share their lived experiences may illuminate opportunities for healing by linking individual experiences of suffering to legacies of oppression, trauma, or the daily grind of lives on the 'institutional circuit' (Hopper et al. 1997). Knowledge of patients' lives is important for providing empathic care that is oriented to the outcomes that matter to patients (Deegan & Drake, 2006). In addition, care that attends to the person-in-context motivates and sustains mental health providers by putting meaning back into medicine (Carpenter-Song & Torrey, 2015). "
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    ABSTRACT: Mainstream psychiatry emphasises controlling symptoms by taking medications. This approach ignores the role of context in shaping illness experiences and how people engage with mental health professionals. The focus on symptom control and medication management also narrows the function of the psychiatrist. This editorial argues that knowledge of patients' lives is important for providing empathic care that is oriented to the outcomes that matter to patients. In addition, care that attends to the person-in-context motivates and sustains mental health providers by putting meaning back into medicine. Truly patient-centred care demands pushing back against the reductionism of contemporary psychiatry to thoughtfully engage with the complexities of patients' lives.
    Epidemiology and Psychiatric Sciences 05/2015; 24(04):1-4. DOI:10.1017/S2045796015000475 · 3.91 Impact Factor
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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
    • "Despite its promise in the general health field, professional , public, and legal and political forces have debated the movement toward shared decision making in the mental health field for several reasons (Adams & Drake, 2006; Deegan & 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 around persons with mental illnesses (Adams & Drake, 2006; Substance Abuse and Mental Health Services Administration, 2010). "
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    ABSTRACT: Dissemination of innovations is widely considered the sine qua non for system improvement. At least two dozen states are rolling out evidence-based mental health practices targeted at children and families using trainings, consultations, webinars, and learning collaboratives to improve quality and outcomes. In New York State (NYS) a group of researchers, policymakers, providers, and family support specialists have worked in partnership since 2002 to redesign and evaluate the children's mental health system. Five system strategies driven by empirically based practices and organized within a state-supported infrastructure have been used in the child and family service system with more than 2,000 providers: (a) business practices, (b) use of health information technologies in quality improvement, (c) specific clinical interventions targeted at common childhood disorders, (d) parent activation, and (e) quality indicator development. The NYS system has provided a laboratory for naturalistic experiments. We describe these initiatives, key findings and challenges, lessons learned for scaling, and implications for creating evidence-based implementation policies in state systems.
    Journal of Clinical Child & Adolescent Psychology 01/2014; 43(2). DOI:10.1080/15374416.2013.869749 · 1.92 Impact Factor
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