Purpose: The values of client voice and empowerment in service and treatment have been promoted in public mental health services for years. Putting these principles into practice has been linked with positive outcomes and is considered a key indicator of quality recovery-oriented services. At the same time, most public mental health services do not yet fully practice these values. Recognizing that shared decision-making (SDM) technologies have the potential to support and promote more effective communication and collaboration, SAMHSA contracted with Advocates for Human Potential, Inc. (AHP) to develop resources applicable to public mental health services and the people who use them. We report on field tests from one of these resources, a decision aid for consumers considering use of antipsychotic medication.
Method: After conducting an extensive literature review and analysis of decision aids and decision support materials relevant to public mental health, we conducted consumer and provider needs assessments to guide development. Based on the needs assessment, we constructed a 7-module consumer-centered decision aid that follows the IPDAS standardsfor decision aids. We then field tested the prototype with a select group of consumers available to the team.
Result: Audience responses to the concept of SDM have been mixed. This response has implications for successful implementation in the public mental health arena. For example, focus group participants who use public mental health services perceive the term “shared” as a step backward in their personal autonomy and rights. Providers, in particular psychiatrists, also express concerns about “sharing” treatment decisions with clients.
Conclusion: Adapting shared decision-making concepts and technologies to public mental health settings has unique challenges. Traditional assumptions about the competency and capacity of people diagnosed with mental health problems have resulted in a long history of oppression and provider-dominated decision-making. These assumptions are being challenged on many fronts, but are still a powerful force in the field. Shared decision-making concepts and tools may support positive changes, but may also highlight existing values conflicts within the public mental health field.
Candidate for the Lee B. Lusted Student Prize Competition