Decision making in recovery-oriented mental health care.
Open accessAbstract
OBJECTIVE: Patient-centered communication has been linked to patient satisfaction, treatment adherence and outcomes. Shared decision making (SDM) has been advocated as an important and ethically essential aspect of patient-centered care, but SDM has received relatively little attention in mental health care, despite studies indicating that consumers want to be involved in making decisions. This is particularly important in a recovery-oriented system, where consumers are active participants in their treatment and rehabilitation. Because medication management is a key component of recovery from severe mental illnesses, this study explores how consumers and providers make decisions in medication management consultations. METHODS: Four providers (3 psychiatrists, 1 nurse practitioner) and 40 consumers with severe mental illness (10 consumers per provider) were recruited from a community mental health center with a recovery-oriented focus. We directly observed 40 medication management appointments. Observations were audio recorded and transcribed. We used emergent thematic analysis to characterize decision making processes. RESULTS: Providers initiated most decisions, although they often invited consumers to participate in decision making. Decisions initiated by consumers elicited a greater degree of discussion and disagreement, but also frequently resulted in consumers' preferences prevailing. Consultations generally exhibited more characteristics of person-centeredness than SDM. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: While we observed a high degree of person-centeredness, SDM was not prevalent. Interventions helping consumers to take greater initiative when working with service providers may be helpful. For example, programs using tools such as peer instruction, Internet-based software, and individual case-manager instruction all have shown promise for enhancing SDM in mental health treatment. Further research is needed to determine the degree of SDM in other settings (e.g., with case managers) and the impact of SDM on consumers' recovery.
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SDM has a positive impact on patients' satisfaction and adherence to treatments, as well as on quality of life and empowerment.
“studies have demonstrated that it has a positive impact on the patient’s levels of satisfaction and adherence to treatments, as well as on his/her quality of life and empowerment [7].”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [7]
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- Authors
- Matthias, M. S., Salyers, M. P., Rollins, A. L., & Frankel, R. M.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- Regenstrief Institute (US)
- Health Services Research & Development (US)
- Venue
- Psychiatric Rehabilitation Journal
- Published
- 2012
- Volume
- 35
- Issue
- 4
- Pages
- 305-314
- ISSN
- 1095-158X (ISSN-L)
- 1559-3126
- PMC
- PMC3980461
- OpenAlex
- W2035267805
- Cited by
- 105
- References
- 45
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 11 · 2023: 8 · 2022: 5 · 2021: 14 · 2020: 4 · 2019: 11 · 2018: 5 · 2017: 8 · 2016: 6 · 2015: 6 · 2014: 12 · 2013: 5 · 2012: 1
- FWCI
- 13.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatric Rehabilitation Journal (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs
- National Institute of Mental Health (R24MH074670)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- shared decision-making, severe mental illness, medication management, patient-centered care, person-centeredness, pharmaceutical consultation
- MeSH terms
- Adult, Mental Disorders, Community Mental Health Services, Decision Making, Female, Humans, Male, Middle Aged, Patient Participation, Pilot Projects, Professional-Patient Relations, Patient-Centered Care, Qualitative Research
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