How included are mental health service users in decisions about their medication?

Date08 August 2016
Published date08 August 2016
AuthorSue Holttum
How included are mental health service
users in decisions about their medication?
Sue Holttum
Sue Holttum is a Senior
Lecturer at the Salomons
Centre for Applied Psychology,
Canterbury Christ Church
University, Southborough, UK.
Purpose The purpose of this paper is to consider four recent articles relating to how included service users
are in decision making about their medication in mental health services.
Design/methodology/approach One article describes conversations between a psychiatrist and service
users about medication. The second paper describes a study in which young people were supported with
the aim of developing their confidence to challenge medication decisions. The third paper reports on
interviews with both professionals and service users about medication decisions. The fourth paper presents a
theory of how the wider context can affect medication decision making in mental health.
Findings The first paper shows how a psychiatrist can persuade service users to accept medication
decisions. The second paper shows how some young people can challenge medication decisions if they
have the right support. The third paper illustrates how both professionals and service users may doubt
service usersability to decide about medication, and pessimistically suggests that shared decision making
may be unrealistic. In contrast to this, the fourth paper offers hope of changing how mental health services are
organised in order to enable service users to be more empowered about medication decisions.
Originality/value A model of shared decision making is being imported into mental health from physical
health. These four papers illustrate problems with a simple transfer from physical to mental health.
The present paper points to differences in apparent awareness of different clinical researchers of the
need to tackle service usersdisempowerment in mental health care, showing how some researchers are
tackling this.
Keywords Empowerment, Mental health service users, Medication, Coercion, Psychiatrists
Paper type Viewpoint
In this review I discuss four papers concerning decisions about medication in mental health
services. Three papers mention shared decision-makingand one uses an empowerment
framework. Even so, thefirst paper (Angell and Bolden, 2015) seems to show how mental health
service userscan be disempowered in a meetingwith a psychiatrist who appearsto be taking their
concerns into account. The second paper (Delman et al., 2015) suggests how young people in
mental healthcare can begin to have more say as theyget older but also shows what standsin the
way of this. The thirdpaper (Mikesell et al., 2016) shows how serviceusers and professionals both
have dilemmasabout shared decision making, and seemsto conclude that things cannotchange
much. The fourth paper (Morant et al., 2015) helps explain why the shared decision-making
model does not transfer easily from physical to mental health care. Professionals, they suggest,
need to address the problem of disempowerment and stigmatising of service users in mental
health care, as wellas the wider organisational constraints, changing the organisation if necessary.
What happens when a psychiatrist and a service user meet to talk about
Angell and Bolden (2015) describe medication as a cornerstone of treatmentin psychiatry
(p. 44). However, prescribing happens behind closed doors. It was not clear how much
DOI 10.1108/MHSI-05-2016-0015 VOL. 20 NO. 3 2016, pp. 141-148, © Emerald Group Publishing Limited, ISSN 2042-8308
PAG E 14 1

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