“Work with me”: service users’ perspectives on shared decision making in mental health

DOIhttps://doi.org/10.1108/MHRJ-01-2017-0005
Pages166-178
Published date11 September 2017
Date11 September 2017
AuthorHeather Castillo,Shulamit Ramon
Subject MatterHealth & social care,Mental health
Work with me: service users
perspectives on shared decision
making in mental health
Heather Castillo and Shulamit Ramon
Abstract
Purpose While shared decision making (SDM) in general health has proven effectiveness, it has received far
less attention within mental health practice with a disconnection between policy and ideals. The purpose of
this paper to review existing developments, contemporary challenges, and evidence regarding SDM in
mental health with a particular focus on the perspectives of service users.
Design/methodology/approach This is a review of international papers analysed using narrative
synthesis of relevant data bases.
Findings The review shows significant barriers to the utilisation of SDM including ethical and legal
frameworks, accountability and risk. The medical model of psychiatry and diagnostic stigma also contributes
to a lack of professional acknowledgement of service user expertise. Service users experience an imbalance
of power and feel they lack choices, being done torather than worked with.
Practical implications The paper also presents perspectives about how barriers can be overcome, and
service users enabled to take back power and acknowledge their own expertise.
Originality/value Thisreview is the firstwith a particular focuson the perspectivesof service usersand SDM.
Keywords Mental health, Shared decision making, Barriers to shared decision making,
Narrative synthesis, Service usersperspectives
Paper type General review
Background
Shared decision making (SDM) aspires to be a collaborative process which allows patients and
providers to make health care decisions together (Charles et al., 1997). It aims to take into
account best scientific evidence together with service usersvalues and preferences, combining
experiential and scientific expertise. SDM in general health is supported in government policies
and guidance in the western world (Department of Health, 2012; Froch et al., 2011) and has
generated substantial research confirming effectiveness in treatment adherence and patient
satisfaction (Durand et al., 2014).
In the field of mental health SDM is a concept which has emerged as an alternative to
medical paternalism. It has been hailed as an aspect of health care reform which builds on
person-centred developments of previous decades and which enhances recovery-based
practice (Drake et al., 2010; Duncan et al., 2010). However, Morant et al. (2015) suggest
that SDM has received far less attention within mental health practice than it has in primary care,
and highlight the coercive history of mental health services, which has led to disconnection
between policy and ideals.
A key aspect of SDM concerns how it is conceptualised by service users and the degree to which
this may be in accord with or differ from professionalsviews. This and other challenges, barriers
and facilitators to achieving fruitful partnerships may offer insights into best practice concerning
SDM within the mental health field. This paper aims to review existing developments and
Received 18 January 2017
Revised 1 May 2017
7 June 2017
Accepted 14 June 2017
Heather Castillo is a Private
Consultant at Heather Castillo
Consultancy, Colchester, UK.
Shulamit Ramon is a Professor
at the School of Health and
Social Work, University of
Hertfordshire, Hatfield, UK.
PAGE166
j
MENTALHEALTH REVIEW JOURNAL
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VOL. 22 NO. 3 2017, pp. 166-178, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-01-2017-0005

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