Decision making in recovery-oriented mental health care.

Marianne Matthias, Michelle P. Salyers, Angela L. Rollins, Richard Frankel

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Patient-centered communication has been linked to patient satisfaction, treatment adherence and outcomes. Shared decision making (SDM) has been advocated as an important and ethically essential aspect of patient-centered care, but SDM has received relatively little attention in mental health care, despite studies indicating that consumers want to be involved in making decisions. This is particularly important in a recovery-oriented system, where consumers are active participants in their treatment and rehabilitation. Because medication management is a key component of recovery from severe mental illnesses, this study explores how consumers and providers make decisions in medication management consultations. Four providers (3 psychiatrists, 1 nurse practitioner) and 40 consumers with severe mental illness (10 consumers per provider) were recruited from a community mental health center with a recovery-oriented focus. We directly observed 40 medication management appointments. Observations were audio recorded and transcribed. We used emergent thematic analysis to characterize decision making processes. Providers initiated most decisions, although they often invited consumers to participate in decision making. Decisions initiated by consumers elicited a greater degree of discussion and disagreement, but also frequently resulted in consumers' preferences prevailing. Consultations generally exhibited more characteristics of person-centeredness than SDM. While we observed a high degree of person-centeredness, SDM was not prevalent. Interventions helping consumers to take greater initiative when working with service providers may be helpful. For example, programs using tools such as peer instruction, Internet-based software, and individual case-manager instruction all have shown promise for enhancing SDM in mental health treatment. Further research is needed to determine the degree of SDM in other settings (e.g., with case managers) and the impact of SDM on consumers' recovery.

Original languageEnglish
Pages (from-to)305-314
Number of pages10
JournalPsychiatric Rehabilitation Journal
Volume35
Issue number4
DOIs
StatePublished - Mar 2012
Externally publishedYes

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Decision Making
Mental Health
Delivery of Health Care
Referral and Consultation
Community Mental Health Centers
Patient-Centered Care
Nurse Practitioners
Patient Satisfaction
Internet
Psychiatry
Appointments and Schedules
Software
Rehabilitation
Communication
Therapeutics
Research

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Rehabilitation
  • Health Professions (miscellaneous)

Cite this

Decision making in recovery-oriented mental health care. / Matthias, Marianne; Salyers, Michelle P.; Rollins, Angela L.; Frankel, Richard.

In: Psychiatric Rehabilitation Journal, Vol. 35, No. 4, 03.2012, p. 305-314.

Research output: Contribution to journalArticle

Matthias, Marianne ; Salyers, Michelle P. ; Rollins, Angela L. ; Frankel, Richard. / Decision making in recovery-oriented mental health care. In: Psychiatric Rehabilitation Journal. 2012 ; Vol. 35, No. 4. pp. 305-314.
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