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
    • "Within such approaches, the role of a healthcare professional is to inform the person of the options and persuade them to accept the option that the professional perceives is best for that person; whereas SDM involves sharing information, identifying the person's preferences, and jointly agreeing an option (Schauer et al 2007, Hamann et al 2011 The Health Foundation 2012 ). Making such choices about their own lives acknowledges individuals' rights, selfdetermination , autonomy and empowerment (Deegan and Drake 2006). "
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    ABSTRACT: Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients’ care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.
    No preview · Article · Jan 2016 · Journal of Interprofessional Care
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    • "Recovery and shared decision making values the expertise of service users and carers (Deegan and Drake 2006). This is grounded within notions of the person as an active participant in their own care. "
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    ABSTRACT: Collaboration between service users and mental health professionals is at the heart of values based practice and shared decision making. However, there has been limited analysis of the implications of these approaches within a healthcare context that involves depriving service users of their freedom. This article proposes a framework that aims to promote shared decision making which acknowledges, all participants must be Informed, Involved and Influential in the decision-making process. However, these are fluid; they refer to a sliding scale of influence that moves between these different positions depending on context, capacity and desire to influence.
    Full-text · Article · Dec 2015
    • "Recovery-oriented models are increasingly employed in mental health treatment. The mental health recovery model favors consumers' personal dictates of recovery (i.e., consumers choose a self-determined pathway to wellness), rather than traditional definitions of treatment success (e.g., symptom abatement, medication compliance; Carpenter 2002; Deegan and Drake 2006). Promoting consumer choice as critical to the recovery process also means working with consumer risk-taking. "
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    ABSTRACT: This mixed-method study used administrative data from 68 supportive housing programs and evaluative and qualitative site visit data from a subset of four forensic programs to (a) compare fidelity to the Housing First model and residential client outcomes between forensic and nonforensic programs and (b) investigate whether and how providers working in forensic programs can navigate competing Housing First principles and criminal justice mandates. Quantitative findings suggested that forensic programs were less likely to follow a harm reduction approach to substance use and clients in those programs were more likely to live in congregate settings. Qualitative findings suggested that an interplay of court involvement, limited resources, and risk environments influenced staff decisions regarding housing and treatment. Existing mental health and criminal justice collaborations necessitate adaptation to the Housing First model to accommodate client needs.
    No preview · Article · Oct 2015 · Community Mental Health Journal
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