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Structured shared decision making in mental health shows promise in supporting service user involvement in critical decision making and provides a process to open all treatment and service decisions to informed and respectful dialogue.

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This study examined medication decision making by 84 persons with serious mental illness, specifically examining relationships among perceived coercion, decisional capacity, preferences for involvement and actual participation, and the outcomes of medication adherence and QoL. Multiple and logistic regression analysis were used in this cross-sectional, descriptive study, controlling for demographic, socio-economic and utilization variables. Appreciation was positively related to medication adherence behaviors for the past six months. Females, older individuals and those living independently were more likely to have taken all their medications over the past six months. Neither client participation, preference, nor preference-participation agreement was found to be associated with better medication adherence or QoL.

Clients with schizophrenia require maintenance treatment with antipsychotic medication and psychosocial therapy to maintain symptom control. Rates of medication adherence or follow-through are low in clients with schizophrenia. This increases the risk of relapse and contributes to poor quality of life. As educators and advisers, psychiatric nurses can collaborate with clients to improve adherence and other outcomes using shared decision-making techniques and tools that engage and empower clients to actively participate in decisions about their treatment. This article outlines effective strategies used by psychiatric nurses to improve outcomes in clients with schizophrenia and uses a case example for demonstrating this strategy in a client with schizophrenia.