Shared Decision Making in Mental Health: International Perspectives on Implementation

Abstract

The application of shared decision making (SDM) to mental health issues and services is a recent development. An increased range of different styles of SDM in mental health exists, reflecting varieties concerning the power differential of clinicians vs. service users, and the place allocated to experiential knowledge vs. scientific knowledge. Yet, current evidence highlights that compulsory interventions are still very common in the context of mental illnesses compared with physical-somatic illnesses; and in some situations the threat of compulsion is overt or barely concealed. Although more decision-making aids exist, these tools are not always equally validated, and their application does not necessarily ensure that the principles of SDM are either applied in practice or contributes to SDM and health outcomes. While there is increased acceptance of the potential usefulness of applying SDM in everyday mental health practice, its implementation in practice is still lacking. Service users often do not know what SDM could mean, and clinicians often have reservations concerning the capacity of service users to make decisions and they often fear that SDM may lead to harmful risk taking (e.g., increase treatment non-adherence). Current research of SDM in mental health demonstrates the importance of an easy access to information concerning mental health interventions, and the relevance of respect and trust by both clinicians and service users in the process of SDM. Yet, SDM in mental health research ignores that many service users are keen to make their own decisions and experience SDM as a subtle form of manipulation by clinicians. In addition, we see less discussion of the fact that some service users stop taking medication unrelated to whether they are engaged in SDM or not, and the outcomes of this step are insufficiently looked at in existing research. We aim to include articles on original research describing completed and running SDM projects that we can learn from and advance the development of SDM and its implementation. Examples for relevant topics are research that: • Explores creatively yet methodically at least one key issue of SDM in mental health. • Applies in an evaluated way SDM across a whole mental health service. • Identifies barriers to implementing SDM and attempts systematically and ethically to devise ways of overcoming the barriers. • Uses facilitators, such as peer support workers and/or the strengths approach, to enhance the implementation of SDM in mental health in a systematic way. • Pays attention to reducing the power differential between service users and clinicians, considering ways of increasing more equal collaboration within the research design. • Addresses SDM with minority populations