Shared decision making for psychiatric medication management: a summary of its uptake, barriers and facilitators


The model of shared decision making with mental health patients and clinicians (doctors and pharmacists) harnesses the benefits of patients becoming partners in their own recovery through improved communication and greater self-advocacy. Shared decision making in mental health services is an emerging model of care which has not been well investigated, however it is seen as the way forward to achieving improved health outcomes for non-pharmacological and pharmacological therapy. Successful implementation of this model requires supporting the process through provision of information and training, use of decision aids, coaching in communication skills and inclusion of family and carers in the decision making process. This summary examines the application of the shared decision making model for psychiatric medication management, including barriers and facilitators.

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  1. 1.

    Australian institute of health and welfare. Mental health-related prescriptions. Mental health services in Australia; 2019.

  2. 2.

    Australian Health Ministers Advisory Council. A national framework for recovery-orientated mental health services: guide for practitioners and providers. Canberra: Commonwealth of Australia; 2013.

    Google Scholar 

  3. 3.

    Deegan PE. The lived experience of using psychiatric medication in the recovery process and a shared decision-making program to support it. Psychiatr Rehabil J. 2007;31(1):62–9.

    Article  Google Scholar 

  4. 4.

    Adams JR, Drake RE, Wolford GL. Shared decision-making preferences of people with severe mental illness. Psychiatr Serv. 2007;58(9):1219–21.

    Article  Google Scholar 

  5. 5.

    Morant N, Kaminskiy E, Ramon S. Shared decision making for psychiatric medication management: beyond the micro-social. Health Expect. 2015;19(5):1002–14.

    Article  Google Scholar 

  6. 6.

    Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681–92.

    CAS  Article  Google Scholar 

  7. 7.

    Shepherd A, Shorthouse O, Gask L. Consultant psychiatrists’ experiences of and attitudes towards shared decision making in antipsychotic prescribing, a qualitative study. BMC Psychiatry. 2014;14:127.

    Article  Google Scholar 

  8. 8.

    Bradley E, Green D. Involved, inputting or informing: “Shared” decision making in adult mental health care. Health Expect. 2018;21(1):192–200.

    Article  Google Scholar 

  9. 9.

    Finnerty MT, Layman DM, Chen Q, Leckman-Westin E, Bermeo N, Ng-Mak DS, et al. Use of a web-based shared decision-making program: impact on ongoing treatment engagement and antipsychotic adherence. Psychiatr Serv. 2018;69(12):1215–21.

    Article  Google Scholar 

  10. 10.

    Haddad PM, Brain C, Scott J. Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient Related Outcome Measures. 2014;5:43–62.

    Article  Google Scholar 

  11. 11.

    McGrath P. ‘A very individual thing’: findings on drug therapy in psychiatry from the perspective of Australian consumers. Australian e-J Adv Mental Health. 2007;6(3):1.

    Google Scholar 

  12. 12.

    Nosè M, Maria M, Eleonora E, Marco B, Paola P, Giovanni O, et al. Adverse effects of antipsychotic drugs: survey of doctors’ versus patients’ perspective. Soc Psychiatry Psychiatr Epidemiol. 2012;47(1):157–64.

    Article  Google Scholar 

  13. 13.

    Thompson L, McCabe R. The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC Psychiatry. 2012;12(1):87.

    Article  Google Scholar 

  14. 14.

    Perez-Revuelta J, Villagran-Moreno JM, Moreno-Sanchez L, Pascual-Pano JM, Gonzalez-Saiz F. Patient perceived participation in decision making on their antipsychotic treatment: evidence of validity and reliability of the COMRADE scale in a sample of schizophrenia spectrum disorders. Patient Educ Couns. 2018;101(8):1477–82.

    Article  Google Scholar 

  15. 15.

    Alguera-Lara V, Dowsey MM, Ride J, Kinder S, Castle D. Shared decision making in mental health: the importance for current clinical practice. Australas Psychiatry. 2017;25(6):578–82.

    Article  Google Scholar 

  16. 16.

    Miller R, Pavlo AJ. Two experts, one goal: collaborative deprescribing in psychiatry. Curr Psychiatry Rev. 2018;14(1):12–8.

    Article  Google Scholar 

  17. 17.

    Dahlqvist Jonsson P, Schon UK, Rosenberg D, Sandlund M, Svedberg P. Service users’ experiences of participation in decision making in mental health services. J Psychiatr Ment Health Nurs. 2015;22(9):688–97.

    CAS  Article  Google Scholar 

  18. 18.

    Delman J, Clark JA, Eisen SV, Parker VA. Facilitators and barriers to the active participation of clients with serious mental illnesses in medication decision making: the perceptions of young adult clients. J Behav Health Serv Res. 2015;42(2):238–53.

    Article  Google Scholar 

  19. 19.

    Jorgensen K, Rendtorff JD. Patient participation in mental health care-perspectives of healthcare professionals: an integrative review. Scand J Caring Sci. 2018;32:490–501.

    Article  Google Scholar 

  20. 20.

    Patel SR, Bakken S, Ruland C. Recent advances in shared decision making for mental health. Curr Opin Psychiatry. 2008;21(6):606–12.

    Article  Google Scholar 

  21. 21.

    Légaré F, Thompson-Leduc P. Twelve myths about shared decision making. Patient Educ Couns. 2014;96(3):281–6.

    Article  Google Scholar 

  22. 22.

    Mistler LA, Drake RE. Shared decision making in antipsychotic management. Journal of Psychiatric Practice. 2008;14(6):333–44.

    Article  Google Scholar 

  23. 23.

    Fukui S, Salyers MP, Rapp C, Goscha R, Young L, Mabry A. Supporting shared decision making beyond consumer-prescriber interactions: initial development of the commonGround fidelity scale. Am J Psychiatr Rehabil. 2016;19(3):252–67.

    Article  Google Scholar 

  24. 24.

    Paudel S, Sharma N, Joshi A, Randall M. Development of a shared decision making model in a community mental health center. Community Ment Health J. 2018;54(1):1–6.

    Article  Google Scholar 

  25. 25.

    Stein BD, Kogan JN, Mihalyo MJ, Schuster J, Deegan PE, Sorbero MJ, et al. Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence. Community Ment Health J. 2013;49(2):185–92.

    Article  Google Scholar 

  26. 26.

    Ashoorian D, Davidson R, Rock D, Dragovic M, Clifford R. A clinical communication tool for the assessment of psychotropic medication side effects. Psychiatry Res. 2015;230(2):643–57.

    Article  Google Scholar 

  27. 27.

    Deegan PE, Carpenter-Song E, Drake RE, Naslund JA, Luciano A, Hutchison SL. Enhancing clients’ communication regarding goals for using psychiatric medications. Psychiatr Serv. 2017;68(8):771–5.

    Article  Google Scholar 

  28. 28.

    Hamann J, Kruse J, Schmitz FS, Kissling W, Pajonk FG. Patient participation in antipsychotic drug choice decisions. Psychiatry Res. 2008;178(1):63–7.

    Article  Google Scholar 

  29. 29.

    Crickard EL, O’Brien MS, Rapp CA, Holmes CL. Developing a framework to support shared decision making for youth mental health medication treatment. Community Ment Health J. 2010;46(5):474–81.

    Article  Google Scholar 

  30. 30.

    Tibaldi G, Salvador-carulla L, Carlos G-G. From treatment adherence to advanced shared decision making: new professional strategies and attitudes in mental health care. Curr Clin Pharmacol. 2011;6(2):91–9.

    Article  Google Scholar 

  31. 31.

    Slade M. Implementing shared decision making in routine mental health care. World J Psychiatry. 2017;16(2):146–53.

    Article  Google Scholar 

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The authors acknowledge NGO group, Consumers of Mental Health WA, for their ongoing support in raising awareness of SDM and encouraging the development of this document.


This work was carried out independently with no external funding.

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Correspondence to Deena M. Ashoorian.

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Key points to consider with implementing SDM model for mental health patients.

Benefits include:

  • Improved symptoms and decreased hospitalisation rates

  • Improved treatment adherence

  • Improved satisfaction with medical care

  • Improved self-esteem

Barriers include:

  • Lack of confidence and assertiveness

  • Limited access to information

  • Patient lack of trust and awareness of rights

  • Poor communication by all or either party

  • Misperceptions about patient’s decisional ability

  • Lack of positive experiences with medications and illness symptoms

Facilitators include:

  • Use of Decision Aids

  • Specific clinician training

  • Specific patient/carer training

  • Involvement of family and carers

  • Development of an implementation strategy

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Ashoorian, D.M., Davidson, R.M. Shared decision making for psychiatric medication management: a summary of its uptake, barriers and facilitators. Int J Clin Pharm (2021).

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  • Clinicians
  • Medications
  • Mental health patients
  • Recovery
  • Shared decision making
  • Treatment