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

45IntroductionThe consumer-driven recovery movement and informed shared decision-making(SDM) are of central contemporary interest for quality improvement in mental healthinterventions and services. It is increasingly recognized that the active engagement ofconsumers in the treatment and the recovery process is essential to achieving highqualityoutcomes. This interest has led to a number of key national reports in recentyears emphasizing the essential role of consumers in achieving positive outcomes.For example, the final report of the President’s New Freedom Commission on MentalHealth (2003) and two Institute of Medicine (IOM) reports, Crossing the QualityChasm (2001) and Improving the Quality of Health Care for Mental and Substance-Use Conditions (2006), emphasize a goal of understanding and honoring consumers’preferences and supporting fully shared decision-making with service providers todevelop person-centered plans of care to foster improved satisfaction, better meetingof needs, and meaningful recovery. Federal agencies that support research on healthclinical interventions have also highlighted the importance of a person-centered approachand shared decision-making to achieve high-level recovery (Schauer, Everett,del Vecchio, & Anderson, 2007). For example, patient-provider decision-making isidentified as a key research priority for the Primary Care Research Program by theNational Institute of Mental Health (National Institute of Mental Health, 1999). TheSubstance Abuse and Mental Health Services Administration (SAMHSA) conveneda National Consensus Conference on Mental Health Recovery and Mental HealthSystems Transformation in 2004, in which 10 fundamental components of recoveryhighlighted the role of individual preferences and active participation in decisionmaking(SAMHSA, 2004). Three of the ten identified fundamental components ofrecovery—self-direction, individualized and person-centered, and empowerment—describe the importance of consumer choice, control, preferences, and active participationin decision-making. SAMHSA has set forth principles and characteristics ofconsumer- and family-driven care that emphasize the control of decision-making byfamilies and individuals (SAMHSA, 2006).In the mental health interventions and services literature, consumers also are increasinglyacknowledged as full partners in SDM with their health care providers as socialperspectives evolve regarding mental illness treatment and meaningful recovery(Deegan & Drake, 2006; Wills & Holmes-Rovner, 2006). SDM is being advocatedas a promising health care reform paradigm for the improvement of mental healthservices via recognition and provision of support for consumers to be equal partnerswith their health care providers in health-related decision-making. This shift in perspectiveto support and better appreciate the consumer’s role comes from the recognitionthat well-achieved SDM can avoid some significant limitations of the traditionalmedical (paternalistic) model and the unsupported informed choice modelof care that have often resulted in suboptimal care processes and outcomes (Deegan& Drake, 2006; Hamann, Leucht, & Kissling, 2003). Effective approaches forShared Decision-Making in Mental Health Care:Practice, Research, and Future Directions