Implementing shared decision making in routine mental health care

Slade, Mike

Abstract

Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non-maleficence. It is argued that SDM is “polyvalent”, a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high-quality decision support tools; integrating SDM with other recovery-supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes – social marketing and the hospitality industry – are identified.

• Journal Article Type: Article
• Acceptance Date: Feb 20, 2016
• Online Publication Date: May 12, 2017
• Publication Date: Jun 1, 2017
• Deposit Date: May 5, 2016
• Publicly Available Date: May 12, 2017
• Journal: World Psychiatry
• Electronic ISSN: 2051-5545
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 16
• Issue: 2
• Pages: 146-153
• DOI: https://doi.org/10.1002/wps.20412
• Keywords: Shared decision making; Mental health care; Ethics; Implementation; Routine outcome monitoring; Social marketing
• Public URL: https://nottingham-repository.worktribe.com/output/968784
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1002/wps.20412/full
• Additional Information: This is the peer reviewed version of the following article: Slade, M. (2017), Implementing shared decision making in routine mental health care. World Psychiatry, 16: 146–153, which has been published in final form at http://dx.doi.org/10.1002/wps.20412. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.