Shared Decision-Making in Mental Health Care - SAMHSA Store ...

5outpatient commitment (Holmes-Rovner et al., Supplement 3), and was reported byfocus groups of mental health consumers convened through SAMHSA’s Eliminationof Barriers Initiative (Schauer et al., 2007). In its report, Improving the Quality ofHealth Care for Mental and Substance-Use Conditions, the IOM strongly rebuttedthis belief, stating that “many people with mental illness, indeed, many with severemental illnesses, are not incompetent on most measures of competency” (IOM,2006, p. 112).“A clear majority of mental health consumers are fully capable of makingdecisions about their care.” —A. Kathryn Power, CMHS DirectorPerson-centered CarePerson-centered care describes the effort to ensure that mental health care is centeredon the needs and desires of the consumer. It means that consumers set theirown recovery goals and have choices in the services they receive, and they can selecttheir own recovery support team. For mental health providers, person-centered caremeans assisting consumers in achieving goals that are personally meaningful.Self-directed Care and Personal MedicineSelf-directed care, on the other hand, focuses primarily on the rights and responsibilitiesof the consumer to “assess their needs, establish an individual plan of care,budget funds to meet their needs, choose how and by whom these needs will be met,and monitor the quality of services they receive” (SAMHSA, 2005, p. 5). In this case,collaboration by the provider is not explicitly required, although providers are identifiedas sources of information and services.Deegan (2007) coined the term “personal medicine” to describe self-taught, nonpharmaceuticalstrategies that persons with mental illnesses use, often in combinationwith psychiatric medication, to advance their recovery and improve their lives.As an example, Deegan shared the story of a man with bipolar disorder who usedmath problems to help himself get to sleep and thus avoid a manic episode. Shenotes, “there seem to be as many types of personal medicine as there are individuals:fishing, parenting, repairing airplanes, walking, diet, caring for pets, friendship, driving.. .” (Deegan, 2007, p. 65).The concepts of self-directed care and personal medicine are important to a considerationof shared decision-making because, in Deegan’s words, “Personal medicinereminds us that there are many ways to change our body’s biochemistry and that,within the task of recovery, pill medicine must complement and support personalmedicine, or the things that give one’s life purpose and meaning” (Deegan, 2007,p. 65).Shared Decision-Making in Mental Health Care:Practice, Research, and Future Directions