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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2013 APA Gold Award: Amplifying the voices of individuals who use mental health services: A commitment to shared decision making: Decision Support Centers, Community Care Behavioral Health Organization, Pittsburgh, Pennsylvania. (2013). Psychiatric Services, 64(10), e7–e9.
Adams, J. R., & Drake, R. E. (2006). Shared decision-making and evidence-based practice. Community Mental Health Journal, 42(1), 87–105.
Adams, J. R., Drake, R. E., & Wolford, G. L. (2007). Shared decision-making preferences of people with severe mental illness. Psychiatric Services, 58(9), 1219–1221.
Ahmed, A. O., Birgenheir, D., Buckley, P. F., & Mabe, P. A. (2013). A psychometric study of recovery among Certified Peer Specialists. Psychiatry Research, 209(3), 721–731.
Ahmed, A. O., Buckley, P. F., & Mabe, P. A. (2012). Latent structure of psychotic experiences in the general population. Acta Psychiatrica Scandinavica, 125(1), 54–65.
Alegria, M., Polo, A., Gao, S., Santana, L., Rothstein, D., Jimenez, A., et al. (2008). Evaluation of a patient activation and empowerment intervention in mental health care. Medical Care, 46(3), 247–256.
American Psychiatric Association & American Association of Community Psychiatrists. (2011). Psychiatry and recovery-oriented practice: A situational analysis. Washington, DC: Author.
Angermeyer, M. C., & Matschinger, H. (2003). The stigma of mental illness: Effects of labelling on public attitudes towards people with mental disorder. Acta Psychiatrica Scandinavica, 108(4), 304–309.
Barratt, A. (2008). Evidence based medicine and shared decision making: The challenge of getting both evidence and preferences into health care. Patient Education and Counseling, 73(3), 407–412.
Bedregal, L. E., O’Connell, M., & Davidson, L. (2006). The recovery knowledge inventory: Assessment of mental health staff knowledge and attitudes about recovery. Psychiatric Rehabilitation Journal, 30(2), 96–103.
Benbassat, J., Pilpel, D., & Tidhar, M. (1998). Patients’ preferences for participation in clinical decision making: A review of published surveys. Behavioral Medicine, 24(2), 81–88.
Bond, G. R., Drake, R. E., & Becker, D. R. (2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal, 31(4), 280–290.
Boyd, J. E., Katz, E. P., Link, B. G., & Phelan, J. C. (2010). The relationship of multiple aspects of stigma and personal contact with someone hospitalized for mental illness, in a nationally representative sample. Social Psychiatry and Psychiatric Epidemiology, 45(11), 1063–1070.
Buckley, P. F., & Ahmed, A. O. (2013). Principles and practices of medication management for people with schizophrenia: Evolution within a recovery-based framework of care. In K. Yeager, D. Cutler, D. Svendsen, & G. Sills (Eds.), Modern community mental health: An interdisciplinary approach. New York: Oxford University Press.
Buckley, P. F., Schooler, N. R., Goff, D. C., Hsiao, J., Kopelowicz, A., Lauriello, J., et al. (2015). Comparison of SGA oral medications and a long-acting injectable SGA: The PROACTIVE study. Schizophrenia Bulletin, 41(2), 449–459.
Bunn, M. H., O’Connor, A. M., Tansey, M. S., Jones, B. D., & Stinson, L. E. (1997). Characteristics of clients with schizophrenia who express certainty or uncertainty about continuing treatment with depot neuroleptic medication. Archives of Psychiatric Nursing, 11(5), 238–248.
Burns, T., & Kendrick, T. (1997). The primary care of patients with schizophrenia: A search for good practice. British Journal of General Practice, 47(421), 515–520.
Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science and Medicine, 44(5), 681–692.
CommonGround. (2015). Retrieved on 5/25/15 from https://www.patdeegan.com/commonground
Conus, P., Lambert, M., Cotton, S., Bonsack, C., McGorry, P. D., & Schimmelmann, B. G. (2010). Rate and predictors of service disengagement in an epidemiological first-episode psychosis cohort. Schizophrenia Research, 118(1–3), 256–263.
Corrigan, P. W., Rafacz, J. D., Hautamaki, J., Walton, J., Rüsch, N., Rao, D., et al. (2010). Changing stigmatizing perceptions and recollections about mental illness: The effects of NAMI’s in our own voice. Community Menalt Health Journal, 46(5), 517–522.
Corrigan, P. W., River, L. P., Lundin, R. K., Penn, D. L., Uphoff-Wasowski, K., Campion, J., et al. (2001). Three strategies for changing attributions about severe mental illness. Schizophrenia Bulletin, 27(2), 187–195.
Corry, P., Hogman, G., & Sandamas, G. (2001). That’s just typical. London, UK: National Schizophrenia Fellowship.
Cousin, G., Schmid Mast, M., Roter, D. L., & Hall, J. A. (2012). Concordance between physician communication style and patient attitudes predicts patient satisfaction. Patient Education and Counseling, 87(2), 193–197.
Deegan, P. E., & Drake, R. E. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services, 57(11), 1636–1639.
Deegan, P. E., Rapp, C., Holter, M., & Riefer, M. (2008). Best practices: A program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatric Services, 59(6), 603–605.
Diamond, R. J. (2006). Recovery from a psychiatrist’s viewpoint. Postgraduate Medicine, 54–62.
DiMatteo, M. R., Giordani, P. J., Lepper, H. S., & Croghan, T. W. (2002). Patient adherence and medical treatment outcomes: A meta-analysis. Medical Care, 40(9), 794–811.
Doyle, R., Turner, N., Fanning, F., Brennan, D., Renwick, L., Lawlor, E., & Clarke, M. (2014). First-episode psychosis and disengagement from treatment: A systematic review. Psychiatric Services, 65(5), 603–611.
Drake, R. E., & Deegan, P. E. (2009). Shared decision making is an ethical imperative. Psychiatric Services, 60(8), 1007.
Drapalski, A. L., Medoff, D., Unick, G. J., Velligan, D. I., Dixon, L. B., & Bellack, A. S. (2012). Assessing recovery of people with serious mental illness: Development of a new scale. Psychiatric Services, 63(1), 48–53.
Elwyn, G., Edwards, A., Kinnersley, P., & Grol, R. (2000). Shared decision making and the concept of equipoise: The competences of involving patients in healthcare choices. British Journal of General Practice, 50(460), 892–899.
Fenton, W. S., Blyler, C. R., & Heinssen, R. K. (1997). Determinants of medication compliance in schizophrenia: Empirical and clinical findings. Schizophrenia Bulletin, 23(4), 637–651.
Flynn, K. E., Smith, M. A., & Vanness, D. (2006). A typology of preferences for participation in healthcare decision making. Social Science and Medicine, 63(5), 1158–1169.
Godolphin, W. (2009). Shared decision-making. Healthcare Quarterly, 12 Spec No Patient, e186–e190.
Gordon, G. H., Joos, S. K., & Byrne, J. (2000). Physician expressions of uncertainty during patient encounters. Patient Eduucation and Counseling, 40(1), 59–65.
Hamann, J., Cohen, R., Leucht, S., Busch, R., & Kissling, W. (2007). Shared decision making and long-term outcome in schizophrenia treatment. Journal of Clinical Psychiatry, 68(7), 992–997.
Hamann, J., Kruse, J., Schmitz, F. S., Kissling, W., & Pajonk, F. G. (2010). Patient participation in antipsychotic drug choice decisions. Psychiatry Research, 178(1), 63–67.
Hamann, J., Langer, B., Winkler, V., Busch, R., Cohen, R., Leucht, S., & Kissling, W. (2006). Shared decision making for in-patients with schizophrenia. Acta Psychiatrica Scandinavica, 114(4), 265–273.
Hamann, J., Mendel, R., Cohen, R., Heres, S., Ziegler, M., Bühner, M., & Kissling, W. (2009). Psychiatrists’ use of shared decision making in the treatment of schizophrenia: Patient characteristics and decision topics. Psychiatric Services, 60(8), 1107–1112.
Hansson, L., Jormfeldt, H., Svedberg, P., & Svensson, B. (2013). Mental health professionals’ attitudes towards people with mental illness: Do they differ from attitudes held by people with mental illness? International Journal of Social Psychiatry, 59(1), 48–54.
Huhn, M., Tardy, M., Spineli, L. M., Kissling, W., Förstl, H., Pitschel-Walz, G., et al. (2014). Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: A systematic overview of meta-analyses. JAMA Psychiatry, 71(6), 706–715.
Improving the Quality of Health Care for Mental and Substance-Use Conditions. (2006). Improving the quality of health care for mental and substance-use conditions: Quality chasm series. Washington, DC: National Academic Press.
Kingdon, D., Sharma, T., & Hart, D. (2004). What attitudes do psychiatrists hold towards people with mental illness? The Psychiatrist, 28(11), 401–406.
Kreyenbuhl, J., Nossel, I. R., & Dixon, L. B. (2009). Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: A review of the literature. Schizophrenia Bulletin, 35(4), 696–703.
Kriston, L., Scholl, I., Hölzel, L., Simon, D., Loh, A., & Härter, M. (2010). The 9-item shared decision making questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. Patient Education and Counseling, 80(1), 94–99.
Levinson, W., Kao, A., Kuby, A., & Thisted, R. A. (2005). Not all patients want to participate in decision making. A national study of public preferences. Journal of General and Internal Medicine, 20(6), 531–535.
Link, B. G., & Phelan, J. C. (2001). Conceptualizing Stigma. Annual Review of Sociology, 27, 363–385.
Llewellyn-Thomas, H. A. (1995). Patients’ health-care decision making: A framework for descriptive and experimental investigations. Medical Decision Making, 15(2), 101–106.
Loh, A., Simon, D., Hennig, K., Hennig, B., Harter, M., & Elwyn, G. (2006). The assessment of depressive patients’ involvement in decision making in audio-taped primary care consultations. Patient Education and Counseling, 63(3), 314–318.
Makoul, G., & Clayman, M. L. (2006). An integrative model of shared decision making in medical encounters. Patient Education and Counseling, 60(3), 301–312.
Malm, U., Ivarsson, B., Allebeck, P., & Falloon, I. R. (2003). Integrated care in schizophrenia: A 2-year randomized controlled study of two community-based treatment programs. Acta Psychiatrica Scandinavica, 107(6), 415–423.
Masand, P. S., Roca, M., Turner, M. S., & Kane, J. M. (2009). Partial adherence to antipsychotic medication impacts the course of illness in patients with schizophrenia: A review. Prim Care Companion Journal of Clinical Psychiatry, 11(4), 147–154.
Maslach, C. (1982). Burnout: The cost of caring. New York: Prentice Hall.
Mistler, L. A., & Drake, R. E. (2008). Shared decision making in antipsychotic management. Journal of Psychiatric Practice, 14(6), 333–344.
Noordsy, D. L., Torrey, W. C., Mead, S., Brunette, M., Potenza, D., & Copeland, M. E. (2000). Recovery-oriented psychopharmacology: Redefining the goals of antipsychotic treatment. Journal of Clinical Psychiatry, 61(Suppl 3), 22–29.
Nordt, C., Rössler, W., & Lauber, C. (2006). Attitudes of mental health professionals toward people with schizophrenia and major depression. Schizophrenia Bulletin, 32(4), 709–714.
O’Connor, A. M. (2001). Using patient decision aids to promote evidence-based decision making. EMP Notebook, Vol. 6, July/August.
O’Brien, A., Fahmy, R., & Singh, S. P. (2009). Disengagement from mental health services. A literature review. Social Psychiatry and Psychiatric Epidemiology, 44(7), 558–568.
Ottawa Hospital Research Institute. (2015). Retreived from https://decWoSonaid.ohri.ca/
Ottawa Personal Decision Guide for People Facing Tough Health or Social Decisions. (2011). Retrieved on January 6, 2015 from http://med.dartmouth-hitchcock.org/documents/OPDG_2pg.pdf
Patel, S. R., Bakken, S., & Ruland, C. (2008). Recent advances in shared decision making for mental health. Current Opinion in Psychiatry, 21(6), 606–612.
Peebles, S. A., Mabe, P. A., Fenley, G., Buckley, P. F., Bruce, T. O., Narasimhan, M., et al. (2009). Immersing practitioners in the recovery model: An educational program evaluation. Community Menalt Health Journal, 45(4), 239–245.
Priebe, S., McCabe, R., Bullenkamp, J., Hansson, L., Lauber, C., Martinez-Leal, R., et al. (2007). Structured patient-clinician communication and 1-year outcome in community mental healthcare: Cluster randomised controlled trial. British Journal of Psychiatry, 191, 420–426.
Priebe, S., Watts, J., Chase, M., & Matanov, A. (2005). Processes of disengagement and engagement in assertive outreach patients: Qualitative study. British Journal of Psychiatry, 187, 438–443.
Roberts, L. W., & Dyer, A. R. (2003). Caring for “difficult” patients. FOCUS, 1(4), 453–458.
Robinson, A., & Thomson, R. (2001). Variability in patient preferences for participating in medical decision making: Implication for the use of decision support tools. Quality Health Care, 10(Suppl 1), i34–i38.
Rossi, A., Amaddeo, F., Sandri, M., Marsilio, A., Bianco, M., & Tansella, M. (2008). What happens to patients seen only once by psychiatric services? Findings from a follow-up study. Psychiatry Research, 157(1–3), 53–65.
Rüsch, N., Angermeyer, M. C., & Corrigan, P. W. (2005). Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20(8), 529–539.
Schauer, C., Everett, A., del Vecchio, P., & Anderson, L. (2007). Promoting the value and practice of shared decision-making in mental health care. Psychiatric Rehabilitation Journal, 31(1), 54–61.
Schaufeli, W. B., & Enzmann, D. (1998). The burnout companion to study and practice: A critical analysis. London, UK: Taylor & Francis.
Schrank, B., Bird, V., Rudnick, A., & Slade, M. (2012). Determinants, self-management strategies and interventions for hope in people with mental disorders: Systematic search and narrative review. Social Science and Medicine, 74(4), 554–564.
Schulze, B. (2007). Stigma and mental health professionals: A review of the evidence on an intricate relationship. International Review of Psychiatry, 19(2), 137–155.
Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions. (2010). HHS Publication No. SMA-09-4371. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.
Simon, D., Schorr, G., Wirtz, M., Vodermaier, A., Caspari, C., Neuner, B., et al. (2006). Development and first validation of the shared decision-making questionnaire (SDM-Q). Patient Education and Counseling, 63(3), 319–327.
Stacey, D., Legare, F., Bennett, C. L., Barry, M. J., Eden, K. B., Homles-Rovner, M., et al. (2014). Decision aids to help people who are facing health treatment or screening decisions. Retreived on September 5, 20115 from http://www.cochrane.org/CD001431/COMMUN_decision-aids-to-help-people-who-are-facing-health-treatment-or-screening-decisions
Stewart, M., Brown, J. B., Weston, W. W., McWhinney, I. R., McWilliam, C. L., & Freeman, T. R. (2003). Patient-centered medicine: Transforming the clinical method (2nd ed.). Abingdon, UK: Radcliffe Medical Press.
Stowkowy, J., Addington, D., Liu, L., Hollowell, B., & Addington, J. (2012). Predictors of disengagement from treatment in an early psychosis program. Schizophrenia Research, 136(1–3), 7–12.
Street, R. L., Gordon, H. S., Ward, M. M., Krupat, E., & Kravitz, R. L. (2005). Patient participation in medical consultations: Why some patients are more involved than others. Medical Care, 43(10), 960–969.
Towle, A., & Godolphin, W. (1999). Framework for teaching and learning informed shared decision making. British Medical Journal, 319(7212), 766–771.
Valenstein, M., Blow, F. C., Copeland, L. A., McCarthy, J. F., Zeber, J. E., Gillon, L., et al. (2004). Poor antipsychotic adherence among patients with schizophrenia: Medication and patient factors. Schizophrenia Bulletin, 30(2), 255–264.
Van Os, J., Altamura, A. C., Bobes, J., Gerlach, J., Hellewell, J. S., Kasper, S., et al. (2004). Evaluation of the two-way communication checklist as a clinical intervention. Results of a multinational, randomised controlled trial. British Journal of Psychiatry, 184, 79–83.
Van Os, J., Altamura, A. C., Bobes, J., Owens, D. C., Gerlach, J., Hellewell, J. S., et al. (2002). 2-COM: An instrument to facilitate patient-professional communication in routine clinical practice. Acta Psychiatrica Scandinavica, 106(6), 446–452.
Woolf, S. H., Chan, E. C., Harris, R., Sheridan, S. L., Braddock, C. H., Kaplan, R. M., et al. (2005). Promoting informed choice: Transforming health care to dispense knowledge for decision making. Annals of Internal Medicine, 143(4), 293–300.
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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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