Shared Decision Making: From the Patient’s Perspective David L. Shern, Ph.D. Mental Health America February 14, 2011 Legislative Briefing

Patient Engagement Issues Amplified for Severe Psychiatric Illnesses Traditionally, patients not thought to be competent to assist in planning Led to  Objectification  Lack of engagement  Full participation in planning Poor Quality Care

The Problem High rates of failure to engage, disengagement, and non-adherence Less than 5% of people with severe mental illnesses receive most evidence-based services Important reasons include lack of information, inattention to the person’s goals, failure to empower the person, and failure to provide effective services

Decision Support Systems Address these Problems through A structured approach to  defining one’s goals,  obtaining information on effective service options,  choosing services,  participating in developing treatment plans,  on-going assessment of one’s progress, and  reviewing treatment decisions

Outcomes of Shared Decision Making for Persons with Severe Mental Illnesses Have been demonstrated in randomized trials to  Increase knowledge and participation in planning  Enhance patient satisfaction with care  Reduce unmet needs  Improve adherence and quality of life  Decrease symptoms of depression and alcohol abuse Practitioners  Increased insight into patient preferences  Improved efficiency of care  Some age and discipline related reluctance to participate

Conclusions SDM reflects patients’  Desire for more, trusted and organized information for treatment decisions  Enhanced sense of real participation in treatment  Overall sense of empowerment and better adherence to treatment plans If efficiently designed, providers report  More efficiency in care provision  New insights into patient preferences and goals