User participation and shared decision-making in adolescent mental healthcare: a qualitative study of healthcare professionals’ perspectives

Bjønness, Stig Erlend; Viksveen, Petter; Johannessen, Jan Olav; Storm, Marianne

doi:10.1186/s13034-020-0310-3

Cited by 34 publications

(43 citation statements)

References 44 publications

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“…We should be aware that the capacity to cope with a child with psychiatric problems is likely to differ between families, and that taking care of children with severe psychopathology and externalizing behaviour can be exhausting, even in the absence of other family problems. Finally, since we found the lack of motivation and compliance with medical treatment to be associated with a compulsory rather than voluntary admission, shared decision-making may be required to increase adolescents' participation in and adherence with psychiatric care [39].…”

Section: Discussionmentioning

confidence: 95%

Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

Wierdsma

Kasius

et al. 2020

Eur Child Adolesc Psychiatry

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As hospital beds are scarce, and emergency admissions to a psychiatric ward are major life-events for children and adolescents, it is essential to have insight into the decision-making process that leads to them. To identify potentially modifiable factors, we, therefore, studied the contextual and clinical characteristics associated with the voluntary and compulsory emergency admission of minors. We used registry data (2008-2017) on 1194 outpatient emergencies involving children aged 6-18 who had been referred to the mobile psychiatric emergency service in two city areas in The Netherlands. Demographic and contextual factors were collected, as well as clinical characteristics including diagnoses, psychiatric history, Global Assessment of Functioning (GAF), and the Severity of Psychiatric Illness (SPI) scale. Logistic regression analyses were used to identify factors that predict voluntary or compulsory admission. Of 1194 consultations, 227 (19.0%) resulted in an admission, with 137 patients (11.5%) being admitted voluntarily and 90 (7.5%) compulsorily. Independently of legal status, the following characteristics were associated with admission: severity of psychiatric symptoms, consultation outside the patient's home, and high levels of family disruption. Relative to voluntary admission, compulsory admission was associated with more severe psychiatric problems, higher suicide risk, and prior emergency compulsory admission. Two potentially modifiable factors were associated with psychiatric emergency admission: the place where patients were seen for consultation, and the presence of family problems. Psychiatric emergency admissions may be reduced if, whenever possible, minors are seen in their homes and if a system-oriented approach is used.

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Section: Discussionmentioning

confidence: 95%

Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

Wierdsma

Kasius

et al. 2020

Eur Child Adolesc Psychiatry

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“…The client needs to want to be involved in SDM and be trained how to engage in it, and the professional should be aware of SDM techniques and should place the therapeutic alliance with the patient at the center of the interaction, offering clear information and actively listening to the client's viewpoints. In support of this, it has been found that establishing effective relationships based on a personcentered and user participation model are more important in decision-making than following an established pathway with little consultation (30). Additionally, the three-talk model of SDM (9) highlights the need for active listening between the parties leading to discussion of possible options for the service user to make when facing a decision.…”

Section: Discussionmentioning

confidence: 99%

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

Fox

2021

Front. Psychiatry

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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.

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“…Trust between patients and therapists has been described in previous studies ( 18 , 28 , 29 ). Routines for adolescents to participate in treatment meetings and selecting their treatment team should, according to our results, be established to facilitate shared decision-making ( 20 ). The significance of information is also highlighted in previous research ( 18 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…The results also show a link between shared decision-making and workplace culture. Teamwork, positive clinicians, leadership support, and a culture that promotes user participation are key elements in the implementation of shared decision-making ( 20 , 28 , 31 ). Earlier research support an assertion that shared decision-making mobilizes adolescents to engage in therapy thus making it more likely that they will continue with treatment ( 8 , 18 ).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there is a lack of conceptual clarity in shared decision-making and a need for clarification of central aspects of shared decision-making in a clinical context ( 15 , 18 ). There is also a dearth of research in adolescent mental healthcare and adolescents’ perspectives ( 19 , 20 ). Previous qualitative research with adolescents highlights the importance of providing mental health services that incorporate individual expectations, needs, and goals ( 8 , 21 , 22 ).…”

Section: Introductionmentioning

confidence: 99%

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I’m not a diagnosis: Adolescents’ perspectives on user participation and shared decision-making in mental healthcare

Bjønness

Grønnestad

Storm

2020

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: Adolescents have the right to be involved in decisions affecting their healthcare. More knowledge is needed to provide quality healthcare services that is both suitable for adolescents and in line with policy. Shared decision-making has the potential to combine user participation and evidence-based treatment. Research and governmental policies emphasize shared decision-making as key for high quality mental healthcare services. Objective: To explore adolescents' experiences with user participation and shared decision-making in mental healthcare inpatient units. Method: We carried out ten in-depth interviews with adolescents (16-18 years old) in this qualitative study. The participants were admitted to four mental healthcare inpatient clinics in Norway. Transcribed interviews were subjected to qualitative content analysis. Results: Five themes were identified, representing the adolescents' view of gaining trust, getting help, being understood, being diagnosed and labeled, being pushed, and making a customized treatment plan. Psychoeducational information, mutual trust, and a therapeutic relationship between patients and therapists were considered prerequisites for shared decision-making. For adolescents to be labeled with a diagnosis or forced into a treatment regimen that they did not initiate or control tended to elicit strong resistance. User involvement at admission, participation in the treatment plan, individualized treatment, and collaboration among healthcare professionals were emphasized. Conclusion: Routines for participation and involvement of adolescents prior to inpatient admission is recommended. Shared decision-making has the potential to increase adolescents' engagement and reduce the incidence of involuntary treatment and re-admission to inpatient clinics. In this study, shared decision-making is linked to empowerment and less to standardized decision tools. To be labeled and dominated by healthcare professionals can be a barrier to adolescents' participation in treatment. We suggest placing less emphasis on diagnoses and more on individualized treatment.

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User participation and shared decision-making in adolescent mental healthcare: a qualitative study of healthcare professionals’ perspectives

Cited by 34 publications

References 44 publications

Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

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

I’m not a diagnosis: Adolescents’ perspectives on user participation and shared decision-making in mental healthcare

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