Key issues in the process of implementing shared decision making (DM) in mental health practice (original) (raw)

Abstract

Although SDM is seen as a favourable approach in mental health settings, its routine use in everyday practice is low. Implementation is judged to be the test of the intention to use SDM because of its value base and its potential to improve mental health practice, across medical, psychological and social interventions carried out by multidisciplinary providers, including peer support workers. Successful implementation is achieved by enhancing the incorporation of understanding SDM as based on different types of knowledge (scientific and experiential)and leading to decisions more acceptable to service users than only to clinicians, thus enabling a more genuine working partnership between the key stakeholders in mental health services. Purpose: This review article will look at internationally existing publications in the English language on mental health SDM implementation of a variety of interventions, including different methodologies and research methods, age groups and countries. We will aim to provide an overview of: process, degree, and outcomes of implementation; barriers and facilitators; perspectives on implementation by different stakeholders; analysis of the process of implementation in mental health services through the lenses of the Normalisation Process Theory (NPT) Design: Following a targeted literature search the data was analysed in order to provide an overview of methodologies and methods applied in the articles, as well as of the variables listed above. Three different types of information were included: a content analysis of key issues, reflective understanding coming out of participating in implementation of an SDM project in the form of two narratives written by two key participants in an SDM pilot project, and an NPT analysis of the process of implementation. Findings: Only a minority of mental health SDM research focuses on implementation in everyday practice. It is possible and often desirable to achieve SDM in mental health services; it requires a low level of technology, it can save time once routinized, and it is based on enhancing therapeutic alliance, as well as service users' motivation. Implementation requires an explicit policy decision, a clear procedure, and regular adherence to the aims and methods of implementation by all participants. These necessary and sufficient conditions are rarely met, due to the different levels of commitment to SDM and its process by the different key stakeholders, as well as due to competing providers' objectives and the time allocated to achieving them. Implications: The review indicates both the need to take into account the complexity of SDM, as well as future strategies for enhancing its implementation in everyday mental health practice. Perhaps because applying SDM reflects a major cultural change in mental health practice, current value attached to SDM among clinicians and service managers would need to be more positive, prominent, and enduring to enable a greater degree of implementation.

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