Shared Decision Making and Medication Management in the Recovery Process

University of Kansas, Lawrence, Kansas, United States
Psychiatric Services (Impact Factor: 1.99). 12/2006; 57(11):1636-9. DOI: 10.1176/
Source: PubMed

ABSTRACT 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.

1 Follower
    • "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). "
    [Show abstract] [Hide abstract]
    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
  • Source
    • "This scenario creates an inequality, wherein the patient is highly dependent on the expertise of the clinician and cannot participate fully in medical decision making. In recent years, the ethics of such medical paternalism have been called into question [4]. To better prepare patients for meetings with their clinician, tools have recently been developed to support shared decision making [5] [6], which is considered an ethical imperative [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The results of routine patient assessments in psychiatric healthcare in the Northern Netherlands are primarily used to support clinicians. We developed Wegweis, a web-based advice platform, to make this data accessible and understandable for patients. OBJECTIVE: We show that a fully automated explanation and interpretation of assessment results for schizophrenia patients, which prioritizes the information in the same way that a clinician would, is possible and is considered helpful and relevant by patients. The goal is not to replace the clinician but rather to function as a second perspective and to enable patient empowerment through knowledge. METHODS: We have developed and implemented an ontology-based approach for selecting and ranking information for schizophrenia patients based on their routine assessment results. Our approach ranks information by severity of associated schizophrenia-related problems and uses an ontology to decouple problems from advice, which adds robustness to the system, because advice can be inferred for problems that have no exact match. RESULTS: We created a problem ontology, validated by a group of experts, to combine and interpret the results of multiple schizophrenia-specific questionnaires. We designed and implemented a novel ontology-based algorithm for ranking and selecting advice, based on questionnaire answers. We designed, implemented, and illustrated Wegweis, a proof of concept for our algorithm, and, to the best of our knowledge, the first fully automated interpretation of assessment results for patients suffering from schizophrenia. We evaluated the system vis-à-vis the opinions of clinicians and patients in two experiments. For the task of identifying important problems based on MANSA questionnaires (the MANSA is a satisfaction questionnaire commonly used in schizophrenia assessments), our system corresponds to the opinion of clinicians 94% of the time for the first three problems and 72% of the time, overall. Patients find two out of the first three advice topics selected by the system to be relevant and roughly half of the advice topics overall. CONCLUSIONS: Our findings suggest that an approach that uses problem severities to identify important problems for a patient corresponds closely to the way a clinician thinks. Furthermore, after applying a severity threshold, the majority of advice units selected by the system are considered relevant by the patients. Our findings pave the way for the development of systems that facilitate patient-centered care for chronic illnesses by automating the sharing of assessment results between patient and clinician.
    Artificial intelligence in medicine 02/2013; DOI:10.1016/j.artmed.2013.01.002 · 1.36 Impact Factor
  • Source
    • "First, there is a larger concern consumers' access to fundamental rights and inclusion in society (Davidson et al. 2006; Ware et al. 2008). Second, it is recognized that the recovery process is a unique endeavor for each person and that any attempts at treatment should involve the full participation of the consumer as a shared decision maker (Deegan and Drake 2006; Loveland, Weaver Randal, and Corrigan 2005). Third, the process perspective recognizes that the best setting for recovery is in the community, rather than a traditional treatment setting because it is within this setting that consumers can begin to reengage with ''normal'' aspects of their lives (Davidson and White 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The meaning of recovery from serious mental illness (SMI) has evolved over time. Whereas it was not even considered to be a primary goal of treatment thirty years ago, it is the main focus of mental health policy today. These changes are partially the result of the work of sociologists who were studying mental health during the time of institutional treatment and the early stages of community-based care. Despite these early influences, the sociology of mental health has largely overlooked the explicit study of recovery. This is because sociologists began shifting their focus from the study of SMI to the study of less severe mental health problems beginning in 1970s. In this paper I (a) discuss the evolving history of mental health recovery; (b) how recovery is defined today in policy, practice, and research; and (c) present an argument for why sociological perspectives and methods can help shed light on the tensions between the definitions while assisting to develop better understandings of the recovery process. In this argument I place particular attention on qualitative social psychological perspectives and methods because they hold the most potential for addressing some of the central concerns in the area of recovery research.
    Humanity & society 11/2012; 36(4):290-308. DOI:10.1177/0160597612458904
Show more