‘Shared Steps & Checks’: A Shared Decision Making Model for Mental Health Care

Abstract

Background Although shared decision making (SDM) is the preferred choice in mental health care, the literature shows this patient-clinician communication approach is not widely implemented in this field of medicine. To promote its use in clinical practice and training, we introduce an SDM model that allows for all field-specific demands and teaching purposes. Methods We developed an elementary framework for sharing decisions during psychiatric consultations through an iterative process. After reviewing the literature on existing SDM models and assessing their appropriateness for further enrichment to meet the needs of mental health services, we integrated all requirements in our model, paying special attention to didactic aspects in communication courses. The resulting model was finetuned in a focus group- approach involving five different panels of health-care professionals, clients, informal caregivers and medical students. Results We chose to expand the initial 3-step models and later adaptations by Elwyn et al. and to devise a linear step model to meet clinical and requirement and didactic usability. The model incorporates aspects that are typical to mental health care such as explicit goal setting, setting up a ‘decision team’, assessing decision capacity and risk deliberation. As psychiatric care demands a stable and trustful therapeutic relationship, we added the element of the explicit pursuit of three core values: Be curious, collaborative and connected. Conclusions Comprising six steps and periodical core value checks, the Shared Steps & Checks approach presented here offers a pragmatic SDM framework for mental health practice and training serving all stakeholders involved in this complex, multidisciplinary field.