Shared Decision Making in Mental Health

Shared Decision Making (SDM) is a practice which has great potentials to advance wellness and recovery among those experiencing mental health problems and their families. Enabling the client to be an indispensable partner in their care embraces the fundamental pillars of recovery and creates opportunity to advance its goals.

Traditional healthcare has historically practiced with an approach towards care which often oppressed clients, where the treatment choices and plan were often exclusively determined by the clinician and or the team providing the care. However, in more recent years, there has been strong evidence showing the benefits of SDM in the care being provided.

Stigma plays a strong role in the adoption of SDM within mental health care. An imbalance exists among the respect and considerations families receive with relatives experiencing a mental illness as opposed to a physical illness. Research has demonstrated positive client outcomes when families of those experiencing mental illness are informed and participate in the decision-making processes. It is important to recognize that the families of those with mental illness experience unique problems which are deserving of services themselves. At times mental health professionals may only see families as either liability or benefit to the client without further exploration and assessment.

Similarly, client participation in shared decision making needs to be part of everyday practice. Clients have voiced their preference to participate in decision making and receive information about their care. Research shows many benefits in having clients central to their care and partnering with the clinical teams. These benefits include increased client satisfaction, improved relationships between client and health care provider and health outcomes. Some improved health outcomes include following of treatment, satisfaction with treatment, biomedical outcomes and increased sense of empowerment and hope.

Despite the evidence of positive outcomes, there continues to be limited widespread implementation of SDM in mental health care. Is SDM not a basic human right? Would you as an individual receiving care not have expectations to participate in decision making processes? Some barriers identified are concerns about the capacity of persons with mental illness to make informed decisions, experience of discomfort by mental health provider of the shift in roles required by SDM, apprehension on the part of the mental health client with respect to their ability to take the responsibilities offered through SDM, and the lingering stigma surrounding those experiencing mental illness.

SDM provides opportunity to further advance recovery in mental health care at the direct care level. Living the values of recovery places clients and families at the centre of care as partners. This promotes both well-being and recovery. It is time to break down the barriers and advocate for this human right.