Overcoming Obstacles to Shared Mental Health Decision Making

Area of Science:

• Mental Health Practice
• Clinical Ethics
• Psychiatric Disability Care

Background:

• Shared decision making (SDM) is an ethical ideal in patient-clinician relationships.
• Implementing SDM in mental health settings presents significant challenges.
• The discrepancy between SDM's ideal and practice warrants clinical and ethical examination.

Purpose of the Study:

• To explore clinician-identified obstacles to implementing SDM with psychiatric disability patients.
• To argue that identified obstacles can often be overcome.
• To reaffirm the importance of pursuing SDM in mental health.

Main Methods:

• Qualitative exploration of clinician perspectives on SDM barriers.
• Identification and categorization of specific obstacles.
• Ethical and clinical argumentation for overcoming barriers.

Main Results:

• Four primary obstacles to SDM were identified: patient capacity, insight, clinician pessimism/dislike, and conflicting recovery goals.
• These obstacles are not insurmountable and can be addressed.
• Continued dedication to attempting SDM is feasible and necessary.

Conclusions:

• Clinician-perceived barriers to SDM in mental health are significant but manageable.
• Overcoming these obstacles is crucial for ethical practice and therapeutic alliance.
• Efforts to implement SDM should persist, involving patients, clinicians, and caregivers.