Article

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/appi.ps.57.11.1636
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.

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    • "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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    • "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). "
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