The rationale for shared decision making in mental health care: a systematic review of academic discourse

Abstract

Purpose: To identify and describe, in a systematic way, the various academic discourses on the rationale for SDM in mental health care, and so provide a comprehensive account of the ways in which this emerging field is being conceptualised in the research literature.Methodology: A systematic review of peer reviewed papers presenting a rationale for SDM in mental health. Relevant databases were searched from inception to July 2016. Data were analysed using a thematic analysis which aimed to identify and describe different discourses on the rationale for SDM in mental health care. Data were extracted into a standardised data extraction form which contained fields representing the developing thematic framework, study information and research methodology.Findings: Initial research returned 1616 papers, of which 175 were eligible for inclusion in this review. We developed ten distinct but interrelated themes which capture the various academic discourses on the rationale for SDM and represent some compelling arguments for SDM from a range of different perspectives including ethical, clinical, 'user' focussed, economic and political. Dominant narratives in the literature linked SDM to the recovery moment and person-centered care, and adherence and engagement with mental health services.Limitations: We are unable to make any conclusions about the strength of evidence for these rationales. Our review was restricted to peer reviewed publications, published in English.Implications: Our findings could be a useful framework to support the selection of outcome measures for SDM evaluations.Originality: There have been no systematic reviews published in this area previously.2

Exploring the potential use of patient and public involvement to strengthen Indonesian mental health care for people with psychosis: A qualitative exploration of the views of service users and carers

“…14,15 Such evidence has contributed to an increased emphasis on participatory approaches in mental health services internationally 16 and these principles becoming legal standards for medical care in some parts of the world. 17,18 Despite the ubiquity of involvement rhetoric within policy and practice ideologies across the world, current evidence suggests implementation remains far from optimal and service user and carer isolation and dissatisfaction persist. 10,[19][20][21][22][23][24] In a recent commentary, it was argued that true collaboration between people with mental health diagnoses and researchers, policy makers and health professionals cannot happen in environments which continue to perpetuate hierarchies and power imbalances albeit in a less transparent form.…”

“…At an individual level, reductions in symptom severity, positive impacts on personal recovery, individual rights, mental health literacy, confidence, hope and empowerment are all associated with increased involvement in mental health services . Such evidence has contributed to an increased emphasis on participatory approaches in mental health services internationally and these principles becoming legal standards for medical care in some parts of the world …”

Patients' perspectives on care pathways and informed shared decision making in the transition between psychiatric hospitalization and the community

“…Shared decision making promotes the use of research knowledge, and evidence‐based medicine asserts that the inclusion of patient preferences, along with scientific evidence and clinician skills, should underpin medical decision making . As care pathways are grounded in evidence‐based medicine and evidence‐based practice, clinical guidelines and best practice should intend to realize and integrate the best research evidence with clinical expertise as well as patients value to facilitate clinical decision making …”

“…52,53 Shared decision making promotes the use of research knowledge, and evidence-based medicine asserts that the inclusion of patient preferences, along with scientific evidence and clinician skills, should underpin medical decision making. [54][55][56] As care pathways are grounded in evidence-based medicine and evidence-based practice, clinical guidelines and best practice should intend to realize and integrate the best research evidence with clinical expertise as well as patients value to facilitate clinical decision making. [54][55][56] Being given the opportunity to decide on their care could also increase patients' self-esteem and thus sense of control during transitions between services, which can be stressful and experienced as paternalistic.…”

“…[54][55][56] As care pathways are grounded in evidence-based medicine and evidence-based practice, clinical guidelines and best practice should intend to realize and integrate the best research evidence with clinical expertise as well as patients value to facilitate clinical decision making. [54][55][56] Being given the opportunity to decide on their care could also increase patients' self-esteem and thus sense of control during transitions between services, which can be stressful and experienced as paternalistic. 39,42,57 The informants reported that having staff advocating for them and their perspectives strengthened their self-esteem.…”