The nature of SDM in mental health Emma Kaminskiy PhD Student Faculty of Health and Social Care

Today I will…. Give brief overview of model of shared decision making Explore critical considerations for SDM in mental health Explore obstacles and facilitators of SDM in mental health, focusing on two research studies.

Background research into medication management Medication management viewed in terms of compliance and clinical effectiveness. Medication management and its role in recovery and concordance Policy emphasis on shared decision making (SDM) and collaborative working (NICE, 2009, NPC, 2008). However, limited research has explored value and practice of SDM in mental health. Some research exploring views and experiences of service users, (Deegan, Drake, Read et al.) but less research exploring views and experience of wider stakeholder groups

Healthcare models of decision making SDM 1 2 participants Both physician and patient involved 2 Both parties share information 3 Take steps to build a consensus about preferred treatment 4 Agreement is reached on the treatment to implement 4 parts of shared decision making (Charles & Gafni 1997)

Critical considerations Does consensus need to be achieved? Few recommendations for how to go about achieving it Represent ‘ideal ethical practice’ – does this translate into practice? Ignores dynamic and complex nature of the process May not be applicable to all situations Judgement of competence (or insight) esp. relevant to medication management in psychiatry. Considerations of risk? Power imbalances?

Examples of studies : Seale et al 2006 (see printed articles) Background to consultations Commitment to patient centred practice A central dilemma: medication and adverse effects Conduct of consultations Building a therapeutic alliance Honesty and dishonesty Becoming directive or coercive Non compliance Themes from qualitative interviews with Psychiatrists, exploring SDM in Psychiatric medication management. Seale et al 2006

Example studies – Tees et al 2007 Mutual respect and building trust Communicating hope Holding but not controlling Valuing user’s role in life Belief in individual potential Promotion of independence Valuing SU as expert in their own mental health Shared risk assessment Being sensitive to the balance between dependency and autonomy Summary of the aspects of the encounter between SU and nurse which enhance partnership. Tees et al 2007.

Questions?