Cited by 129Patient-Provider Communication in HealthcareMental Health and Patient InvolvementHealthcare Decision-Making and Restraints

Shared decision making for psychiatric medication management: beyond the micro‐social

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Morant, Nicola, Kaminskiy, Emma, Ramon, Shulamit·2016·Health Expectations

Abstract

Background: Mental health care has lagged behind other health‐care domains in developing and applying shared decision making ( SDM ) for treatment decisions. This is despite compatibilities with ideals of modern mental health care such as self‐management and recovery‐oriented practice, and growing policy‐level interest. Psychiatric medication is a mainstay of mental health treatment, but there are known problems with prescribing practices, and service users report feeling uninvolved in medication decisions and concerned about adverse effects. SDM has potential to produce better tailoring of psychiatric medication to individuals' needs. Objectives: This conceptual review argues that several aspects of mental health care that differ from other health‐care contexts (e.g. forms of coercion, questions about service users' insight and disempowerment) may impact on processes and possibilities for SDM . It is therefore problematic to uncritically import models of SDM developed in other health‐care contexts. We argue that decision making for psychiatric medication is better understood in a broader way that moves beyond the micro‐social focus of a medical consultation. Contextualizing specific medication‐related consultations within longer term relationships, and broader service systems enables recognition of the multiple processes, actors and agendas that shape how psychiatric medication is prescribed, managed and used, and which may facilitate or impede SDM . Conclusion: A broad conceptualization of decision making for psychiatric medication that moves beyond the micro‐social can account for why SDM in this domain remains a rarity. It has both conceptual and practical utility for evaluating research evidence, identifying future research priorities and highlighting fruitful ways of developing and implementing SDM in mental health care.

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  1. [23]NICE. Medicines Adherence: Involving Patients in Decision about Prescribed Medicines and Supporting Adherence. London: NICE, 2009. 21834197

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Authors
Morant, N., Kaminskiy, E., & Ramon, S.
Affiliations
  • University College London (GB)
  • Anglia Ruskin University (GB)
Corresponding author
Morant, Nicola
Venue
Health Expectations
Publisher
Wiley
Published
2015-08-10
Volume
19
Issue
5
Pages
1002-1014
ISSN
  • 1369-6513 (ISSN-L)
  • 1369-7625
OpenAlex
W2130169597
Cited by
129
References
67
Citations by year
2026: 9 · 2025: 9 · 2024: 10 · 2023: 10 · 2022: 7 · 2021: 22 · 2020: 11 · 2019: 19 · 2018: 10 · 2017: 19 · 2016: 2
FWCI
1.87
Type
journal article
Language
en
Open access
Locations
  • Health Expectations (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Anglia Ruskin Research Online (Anglia Ruskin University) (submittedVersion)
  • University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
National Institute for Health Research (PB‐PG‐0909‐20054)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
Keywords
shared decision-making, psychiatric medication, mental health services, prescribing patterns, service user involvement, coercion in mental health care, insight, disempowerment, recovery-oriented care, self-management, adverse drug reactions, service systems
MeSH terms
Mental Disorders, Decision Making, Humans, Patient Participation, Professional-Patient Relations

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