Shared Decision-Making: An Autoethnography About Service User Perspectives in Making Choices About Mental Health Care and Treatment

Abstract

Shared decision-making (SDM) between mental health medication prescribers and service users is a central pillar in the recovery approach, because it supports people experiencing mental ill-health to explore their care and treatment options to promote their well-being and to enable clinicians to gain knowledge of the choices the service user prefers. SDM is receiving increasing recognition both in the delivery of physical and mental health services; and as such, is of significance to current practice. As an expert-by-experience with over 30 years of receiving mental health treatment, I have made many choices about taking medication and accessing other forms of support. The experiences of SDM have been variable over my career as a service user: both encounters when I have felt utterly disempowered and interactions when I have led decision-making process based on my expertise-by-experience. In this article, I recount two experiences of exploring care and treatment options: firstly, a discharge planning meeting; and secondly, the choice to take medication over the long-term, despite the side effects. The article will explore both opportunities and barriers to effective shared decision-making, as well as skills and processes to facilitate this approach. The need to balance power between service users and professionals in this interaction is highlighted, including the need to respect expertise built on lived experience, alongside that of clinical expertise. This narrative is framed within an autoethnographic approach which allows me to contextualize my personal experiences in the wider environment of mental health care and support.

Autoethnographic Reflections on Mental Distress and Medication Management: Conceptualising Biomedical and Recovery Models of Mental Health

“…I am a social work academic and an expert-byexperience (Fox, 2016); I have been accepted in that world as such. My professional expertise as a social work academic has given me an intellectual space to write extensively about how I have used mental health services (Fox, 2016(Fox, , 2021a(Fox, , 2021c as a consumer.…”

“…I worry more widely that such representations have reduced this service user led radical construct (Coleman, 1999;Deegan, 1996) to a professional framework of service provision. I have viewed myself to be a consumer of mental health services, taking control of my medication regime with the support of mental health prescribers (Fox, 2021a). Medication is often effective in reducing distress, improving coping skills and ameliorating social and occupational functioning in people who have been diagnosed with schizophrenia (Ceraso et al, 2020;Huhn et al, 2019).…”

“…Despite many professionals' commitment to the importance of medication in maintaining mental wellbeing (Fleming et al, 2021), increasingly, methods of shared decisionmaking (SDM) in medication management (Fox, 2021a;Ramon et al, 2021) have been advocated to respect service users as experts in their own care. This is a process which breaks down the medical model of care, that views the professional as the expert, and reinforces the importance of coproduction in mental health services (DH, 2019/2020).…”

“…Moreover, the symptoms of mental ill health, their severity and the outcomes people have, are hugely variable; thus, this narrative is based on my own lived encounters. Moreover, the way I have used medication, and experienced support from professionals, are also unique (Fox, 2021a). This article combines reflexive narratives shifting between perspectives of theory, story and practice, drawing upon autoethnography to frame this discussion.…”

Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care

“…Also, to be put in the role of “medication monitor” can create distrust between patient and family (Bradley & Green, 2017 ), specifically when there is a discrepancy between the self-reported medication adherence and the true situation (Ali et al, 2015 ; Patel et al, 2008 ). Conversely, some clinicians fear that engaging patients in decisions may lead to non-adherence to medication (Fox, 2021 ; Morant et al, 2016 ).…”