Implementing shared decision making in routine mental health care

Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains...

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Main Author: Slade, Mike
Format: Article
Published: Wiley 2017
Subjects:
Online Access:https://eprints.nottingham.ac.uk/33117/
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author Slade, Mike
author_facet Slade, Mike
author_sort Slade, Mike
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description Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non-maleficence. It is argued that SDM is “polyvalent”, a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high-quality decision support tools; integrating SDM with other recovery-supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes – social marketing and the hospitality industry – are identified.
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spelling nottingham-331172020-05-04T19:57:10Z https://eprints.nottingham.ac.uk/33117/ Implementing shared decision making in routine mental health care Slade, Mike Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non-maleficence. It is argued that SDM is “polyvalent”, a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high-quality decision support tools; integrating SDM with other recovery-supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes – social marketing and the hospitality industry – are identified. Wiley 2017-06 Article PeerReviewed Slade, Mike (2017) Implementing shared decision making in routine mental health care. World Psychiatry, 16 (2). pp. 146-153. ISSN 2051-5545 Shared decision making; Mental health care; Ethics; Implementation; Routine outcome monitoring; Social marketing http://onlinelibrary.wiley.com/doi/10.1002/wps.20412/full doi:10.1002/wps.20412 doi:10.1002/wps.20412
spellingShingle Shared decision making; Mental health care; Ethics; Implementation; Routine outcome monitoring; Social marketing
Slade, Mike
Implementing shared decision making in routine mental health care
title Implementing shared decision making in routine mental health care
title_full Implementing shared decision making in routine mental health care
title_fullStr Implementing shared decision making in routine mental health care
title_full_unstemmed Implementing shared decision making in routine mental health care
title_short Implementing shared decision making in routine mental health care
title_sort implementing shared decision making in routine mental health care
topic Shared decision making; Mental health care; Ethics; Implementation; Routine outcome monitoring; Social marketing
url https://eprints.nottingham.ac.uk/33117/
https://eprints.nottingham.ac.uk/33117/
https://eprints.nottingham.ac.uk/33117/