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Handbook of Recovery in Inpatient Psychiatry pp 99–123Cite as

Shared Decision-Making

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Part of the book series: Evidence-Based Practices in Behavioral Health ((EBPBH))

Abstract

Providing treatment to people with severe mental illnesses on an inpatient unit is fraught with challenges. Many patients are acutely ill and may be experiencing very severe symptoms that coexist with poor insight, emotional dysregulation, impulsivity, aggression, and severe disability. Moreover, many patients are involuntarily hospitalized and may be less cooperative with inpatient treatment. Some civilly committed patients may view their hospital tenure as needlessly lengthy and forced medications as impinging on their civil rights, while longing for less restrictive environments. For many practitioners, these are clinical challenges that adversely impact treatment adherence and ultimately positive treatment outcomes. There is accumulating evidence that the traditional model of decision making is insufficient in psychiatric care and may play a significant role in the reluctance of individuals who need mental health care to seek it and sustain their efforts in it. Shared decision-making, in contrast, provides a viable system of enhancing the engagement of care recipients in treatment and is an essential component of recovery-oriented practice. Inasmuch as it represents a change from the paternalistic model of traditional care, shared decision-making requires a shift in perspective and skill for both the provider and for the individual receiving mental health services. This chapter presents the concept of shared decision-making, explores provider attitudes, expectations and beliefs that may serve as barriers to its implementation, and provides practical strategies to facilitate effective shared decision-making in clinical care.

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Authors and Affiliations

  1. Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997 St. Sebastian Way, Augusta, GA, USA

    Gina N. Duncan, P. Alex Mabe, Brian Anderson & Michael Rollock

  2. Department of Psychiatry, Weill Cornell Medical College, Cornell University, 21 Bloomingdale Road, White Plains, NY, USA

    Anthony O. Ahmed

  3. College of Social Work, University of South Carolina, 902 Sumter Street, Columbia, SC, USA

    Gareth Fenley

Authors
  1. Gina N. Duncan
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  2. Anthony O. Ahmed
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  3. P. Alex Mabe
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  4. Brian Anderson
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Correspondence to Gina N. Duncan .

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Editors and Affiliations

  1. Department of Psychiatry and Health Behavior, Augusta University Medical College of Georgia, Augusta, Georgia, USA

    Nirbhay N. Singh

  2. Virginia Department of Behavioral Health and Developmental Services , Richmond, Virginia, USA

    Jack W. Barber

  3. Medical College of Georgia, Augusta University Medical College of Georgia, Augusta, Georgia, USA

    Scott Van Sant

An Illustrative Case of Shared Decision-Making

An Illustrative Case of Shared Decision-Making

Brian Anderson, CPS

Do consumers want to participate in shared decision making?

Yes. As a person that was diagnosed with Clinical Depression and Addictive Disease, I can tell you how important it was for me to have a voice in my recovery. Before shared decision in my treatment, I felt like a robot, following every command to the letter. I remember not trusting myself because I had failed over and over again, and there was an abundance of evidence to support my belief. It was not until I met someone who had been through what I was going through that I realized I had a voice in my own recovery, I had developed GREAT insight on the problem and solution. The power that came from my voice was a life changer; I felt alive again.

Are consumers able to participate in shared decision-making?

Yes. I have worked in the field of Mental Health over 25 years, in group homes, mental hospitals, medical centers, etc. I ‘have literally seen the “light” come back on when clients started participating in their recovery, advocating for themselves. Given the chance, I have seen clients go back to school and get degrees, become employed, get married, facilitate recovery groups, put on workshops at mental health conferences, and reconnect with their families. All because a clinician, a staff member, a peer, took time to listen to them, their wants, needs, and desires.

Is it important for mental health professionals to be able to view through the lens of the consumer?

Absolutely. What a wonderful world it would be if all mental health workers did this one act for every encounter. We want only the best for ourselves—the best treatments, the best relationships, to be treated with respect and dignity—we all need that. That is why I live by this one statement: “I give what I need the most.”

Personal story

After 28 days in inpatient treatment, I can recall being eager and yet terrified of going back to my hometown. In 28 days, I had been diagnosed, put on medication, gone through withdrawal and intense treatment. I was put on a treatment plan as a part of my release, and one of the “most important” steps I was ordered to take was to attend 90 NA meetings in 90 days. Then, out the doors of safety and back to reality I went. I immediately located the day treatment center and the NA meetings I was ordered to attend. Night after night I went to the NA for about two weeks meetings before something went wrong. (I must stop here and tell you that when I was in treatment for those 28 days on the inpatient unit, I reconnected with the God of my understanding and with the belief that ALL THINGS ARE MADE NEW WHEN YOU RETURN TO HIM). Back to the story, during every NA meeting, there’s a statement that is repeated by everyone in attendance. I had to say, “My name is Brian Anderson, and I’m an addict.” That statement left me very uncomfortable, feeling like an addict, and remembering all my addict ways, because once again I repeated it over and over and over again. I was in a fight. One of these statements was going to win, either ALL THINGS ARE MADE NEW WHEN YOU RETURN TO HIM or My name is Brian Anderson, and I am an addict. I decided to talk to my father and one of my favorite clinicians at the day treatment center and WE decided (with great input from me) that I would finish my 90 meetings at my Dad’s church revival. Now this worked for me—this was my “individual plan of action.” NA has worked miracles for many people and I would not dare say that everyone should follow my lead. What I will tell you is that with the help of a GREAT clinician, my dad, and myself, WE worked it out. Shared decision-making at its finest!

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Duncan, G.N., Ahmed, A.O., Mabe, P.A., Anderson, B., Fenley, G., Rollock, M. (2016). Shared Decision-Making. In: Singh, N., Barber, J., Van Sant, S. (eds) Handbook of Recovery in Inpatient Psychiatry . Evidence-Based Practices in Behavioral Health. Springer, Cham. https://doi.org/10.1007/978-3-319-40537-7_5

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