Shared Decision Making for People with Severe and Persistent Mental Illness

Purpose

The proposed research will assess the decision making needs of people with SMI and their clinicians, and create a model decision aid that meets the local needs of clients and clinicians. This study will contribute to the development of interventions for persons with SMI by: 1) identifying decision support needs gaps; 2) identifying moderating variables of needs gaps; and 3) building and assessing the feasibility of decision aids to fill decision support needs gaps in this population.

Findings

Thirty clients were surveyed in the pilot study and 82 outpatient clients, 32 providers, and 30 self-help consumers in the primary study. Although decision making preferences spanned the spectrum from autonomous to passive, many clients expressed a greater desire to participate in psychiatric treatment decision-making than they currently experienced. In contrast, clients preferred passive roles in primary care. Self-reported executive functioning was related to a preference for a passive role, while other measured client characteristics did not. Desire for a computer-based medication value clarification tool was heterogeneous and related to personal ratings of the tool’s ease of use but did not relate to computer experience. The majority of clients reported being comfortable with computers and had used the internet to search for psychiatric health information. A quarter of consumers felt these tools would greatly enhance the desire to participate in treatment decision making and would significantly change the way they interacted with clinicians in the decision making process.

In contrast to attitudes towards general medical care, the majority of clients with severe mental illnesses express a preference for shared decision-making, particularly in relation to mental health care. Medication values clarification tools are an inexpensive way to promote shared decision making and are feasible to use with the majority of mental health consumers.