# SAMHSA's Shared Decision-Making (SDM): 

# Making Recovery Real in Mental Health Care Project

## About Shared Decision-Making

-   Shared decision-making is an interactive and collaborative process
    between individuals and their health care practitioners about
    decisions pertinent to the individual's treatment, services, and
    ultimately their personal recovery. An optimal decision is one that
    is informed, consistent with personal values, and acted upon.
    Participants are satisfied with the process used to make the
    decision.

-   Shared decision-making is particularly relevant when there is
    uncertainty about a particular decision. Uncertainty may stem from
    multiple or competing options each with advantages and
    disadvantages, incomplete or inconclusive scientific outcome
    evidence; or individual factors such as personal values and beliefs,
    a limited knowledge about the options, or lack of support to make a
    clear choice.

-   Effective shared decision-making requires both informed and involved
    consumers, and practitioners who are willing to enter into
    meaningful dialogue with the person about the decision to be made.

-   In general health care, people are increasingly recognized as key
    decision-makers about their own healthcare. For example, the
    Institute of Medicine (IOM) Report, *Crossing the Quality Chasm,*
    calls for health care to be patient-centered with individual
    preferences, needs, and values guiding clinical decisions. The IOM's
    follow-up report, *Improving the Quality of Health Care for Mental
    and Substance Abuse Conditions,* expands the principles of informed,
    patient-centered treatment, and shared decision-making to mental
    health and substance abuse treatment services.

-   The Ottawa Health Research Institute maintains the Ottawa Health
    Decision Centre
    ([http://decisionaid.ohri.ca](http://decisionaid.ohri.ca/)) which
    has an inventory of many decision aides for physical health care,
    many of which are available on line. The Dartmouth-Hitchcock Medical
    Center Decision Support Center, with funding from the Foundation for
    Informed Medical Decision Making and Health Dialog, Inc., has
    established an on-site decision-support center for patients and also
    provides limited on-line resources
    ([http://www.dhmc.org](http://www.dhmc.org/)).

## About Shared Decision-Making in Mental Health

-   There is growing understanding and interest in how approaches to
    shared decision-making emerging in the physical health arena may be
    adapted to mental health field. Currently there is very little
    research and few decision-aides or other material on shared
    decision-making specific to the mental health context.

-   Dr. Patricia Deegan has pioneered an innovative approach to helping
    mental health consumers to participate in shared decision-making
    about the use of psychiatric medication. This program, currently
    being piloted, includes peer-to-peer workshops, an interactive
    software program available to patients in a clinical waiting-room
    setting, and training for practitioners to help clients navigate
    decisional conflict related to medication use. Dr. Deegan is a lead
    member of the SAMHSA/CMHS SDM project.

-   SAMHSA/CMHS is interested in promoting and supporting SDM in mental
    health for a number of reasons

    -   SDM is consistent with recovery-based transformation and the
        foundation values of choice, self-determination, and
        empowerment.

    -   SDM is a means of enhancing involvement of consumers in mental
        health care, which has recognized benefits for positive
        treatment outcomes.

    -   Mental health consumers have an active desire to participate in
        decisions about their care and are capable of doing so.

## About the SAMHSA/CMHS Project: 

## Shared Decision-Making: Making Recovery Real in Mental Health

### Purpose

-   The project is intended to identify existing proven decision-making
    technologies from general healthcare or other sources, and then
    adapt and pilot test them for use by mental health care
    practitioners and consumers.

-   SDM is a very new approach for mental health services and it is
    expected that this project will develop interest and provide a
    foundation for future development in the field.

### Method for Development

-   The SAMHSA/CMHS SDM project is being developed under a contract with
    Advocates for Human Potential, Inc. (AHP) and Westat, with an
    experienced team of staff, consultants, and subcontractors to
    design, develop and pilot test SDM products.

-   The work plan for the SDM project calls for regular input and
    feedback from a Planning Team, an advisory group of researchers,
    policy-makers, consumers, family members, and practitioners. The
    responsibilities of the Planning Team are to:

    -   Take an active role in guiding the SDM work group in determining
        priorities and identifying resources and potential technologies
        that may be adapted to mental health context,

    -   Raise critical issues and questions,

    -   Address potential barriers, and

    -   Review and comment on the documents and materials developed
        through this initiative.

-   Audience testing will be an active part of product development as
    well as of field evaluation of draft products.

### Timeframe and Products

-   The SAMHSA/CMHS SDM project is a 3-year initiative that began
    in 2007. SDM information and decision support tools are being
    developed in three areas for consumers and mental health providers
    and administrators and will include informational documents, videos,
    CD-ROMs, and web-based materials. The first product line will
    provide information about SDM. The second will focus on a general
    decision support tool to be used by consumers with their providers.
    The last product line will focus on information and decision tools
    related to medication.

#### For further information contact:

> *Paolo del Vecchio*
>
> *Associate Director for Consumer Affairs*
>
> *(240) 276-1946*
>
> *paolo.delvecchio@samhsa.hhs.gov*