Shared Decision Making and Medication Management in the Recovery Process

Abstract

Mental health professionals commonly conceptualize medication management for people with severe mental illness in terms of strategies to increase compliance or adherence. The authors argue that compliance is an inadequate construct because it fails to capture the dynamic complexity of autonomous clients who must navigate decisional conflicts in learning to manage disorders over the course of years or decades. Compliance is rooted in medical paternalism and is at odds with principles of person-centered care and evidence-based medicine. Using medication is an active process that involves complex decision making and a chance to work through decisional conflicts. It requires a partnership between two experts: the client and the practitioner. Shared decision making provides a model for them to assess a treatment's advantages and disadvantages within the context of recovering a life after a diagnosis of a major mental disorder.

Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts

“…In a SDM frame, neither clinicians (paternalistic model) nor clients (informed choice model) are singularly responsible for making decisions (Makoul & Clayman, 2006). Instead, decision making is characterized by the exchange of unbiased information (Drake et al, 2010), collaboration (Charles, Gafni & Whelan, 1999) and mutual respect for differing expertise (Deegan & Drake, 2006). Given the centrality of communication in mental health care, we believe the assumptions underlying SDM warrant critical examination.…”

“…Deegan and Drake (2006) discuss the importance of adopting new language (e.g., working alliance, informed choice) to replace more antiquated terms (e.g., medical authority, compliance) (p. 1638). While shifting the rhetoric surrounding a discipline may help reconceptualize it, it may not be sufficient to change beliefs grounded in everyday practice.…”

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

“…Desired outcomes may be broad in scope and encompass social and functional outcomes as well as symptomatic outcomes (Deegan and Drake 2006;Klein et al 2007). Inquiring about the patient's current quality of life and level of functioning can often serve as a starting point for discussing his or her overarching goals and preferences for achieving them.…”

“…They are not absolute but may shift with the clinical context or type of decision that is being made (Epstein and Gramling 2013). Fewer studies are available in psychiatric patients, but these also suggest individual variations in preferences (Deegan and Drake 2006;Klein et al 2007;Woltmann and Whitley 2010). Even for patients who are well informed and have high health literacy, shared decision making can sometimes impose an unrealistic burden on patients (Olthuis et al 2014).…”

Psykisk syke mangler rettssikkerhet

“…Kartlegging av behovet for kommunale tjenester 4 Kommunen bør gjennomføre en kartlegging av de individuelle behovene for hjelp ut fra pasientens/brukerens personlige mål, ressurser og livssituasjon.…”