['Shared Steps & Checks': A pragmatic model for shared decision making in mental health care]

Although shared decision making (SDM) is considered the standard within mental health care, literature shows that its implementation remains limited. The lack of practical guidelines how to implement SDM in psychiatric practice may contribute to this gap.

To develop a pragmatic model for SDM in psychiatric practice and training purposes.

We conducted a literature review of existing SDM models. We examined which psychiatry-specific elements were missing from these models, while also considering didactic aspects. The resulting model was further refined through interdisciplinary focus groups with five different panels consisting of healthcare professionals, patients, relatives and students (n=48).

We opted for a linear stepwise model incorporating aspects characteristic of mental health care, such as the explicit formulation of treatment goals, the establishment of a ‘decision team’, assessment of decision-making capacity, and risk evaluation. Given that psychiatric care requires a stable and trusting therapeutic relationship, we also included an explicit evaluation of the collaboration between patient and clinician.

We present an initial pragmatic and didactic SDM model (‘Shared Steps & Checks’) that explicitly addresses the complexity of shared decision-making in mental health care. The model is designed for application in psychiatric clinical practice as well as for educational purposes within mental health services.