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Shared Decision Making:
Recent Research and Strategies

Shared decision making has long been identified as a guiding principle of mental health care and client-centered care. For the past several decades, researchers have focused on developing a model of health care that involves informed clients in decisions on their own care.

The client's participation in health care decisions represents one of the Institute of Medicine's proposed ten rules for redesigning the health care system for the 21st century. (Crossing the Quality Chasm: A New Health System for the 21st Century). People receiving care for mental health disorders have also shown some of the strongest interest in participation in their own care.

Despite the body of research evidence supporting the benefits and efficacy of shared decision making, obstacles still remain in its implementation. Most practitioners seek to employ shared decision making. However, time constraints, the multitude of clinical tasks clinicians take on during a consultation, and other practical considerations often make it difficult to incorporate it in their regular clinical practice.

The Dartmouth Psychiatric Research Center has focused recent research efforts into identifying strategies to address some of these difficulties. The following articles represent a sampling of the center's recent research findings on and support systems for shared decision making.

"Practicing Shared Decision Making in the Outpatient Psychiatric Care of Adults with Severe Mental Illness: Redesigning Care for the Future"
By William C. Torrey, Robert E. Drake.
Community Mental Health Journal
In this paper, Torrey and Drake describe current structural obstacles to employing collaborative psychiatric care in the outpatient setting, identifying a need for improved communications and access to research findings as central problems. As part of their conclusions, they propose redesigning the office visit as a means to better incorporated a shared decision-making process.

"The promise of shared decision making in mental health"
By Robert E. Drake, Patricia E. Deegan, Charles Rapp.
Psychiatric Rehabilitation Journal
An introduction to a section of research articles in the summer 2010 issue of Psychiatric Rehabilitation Journal, the authors provide a brief history of the emergence of shared decision making as an accepted clinical practical and describe current barriers to its full implementation.

"A web application to support recovery and shared decision making in psychiatric medication clinics"
By Patricia Deegan.
Psychiatric Rehabilitation Journal
Patricia Deegan identifies a process for incorporating shared decision making in client consultations and describes a web-based technology she is helping develop that is designed to provide information and decision supports to clients.

"Comprehensive Electronic Decision Support Systems"
By Robert E. Drake, Patricia E. Deegan, Emily Woltmann, William Haslett, Tyler Drake, and Charles A. Rapp.
Psychiatric Services
In this article, the authors describe their concept of a comprehensive electronic decision-support system and argue that this system could enhance and connect clinician skills and research evidence with client preferences.

Focus on Integrated Treatment:
This webinar provides an overview of FIT and explains its role in providing the tools and training needed to become certified to treat clients with co-occurring disorders.
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