Shared Decision Making in Psychiatry: Dissolving the Responsibility Problem

Abstract

Person centered care (PCC) invites ideas of shared responsibility as a direct result of its shared decision making (SDM) process. The intersection of PCC and psychiatric contexts brings about what I refer to as the responsibility problem, which seemingly arises when SDM is applied in psychiatric settings due to (1) patients’ potentially diminished capacities for responsibility, (2) tension prompted by professional reasons for and against sharing responsibility with patients, as well as (3) the responsibility/blame dilemma. This paper aims to do away with the responsibility problem through arguing for a functional approach to mental illness, a blameless responsibility ascription to the person with mental illness, as well as a nuanced understanding of SDM as part of an emancipation-oriented PCC model.

REalist Synthesis Of non-pharmacologicaL interVEntions for antipsychotic-induced weight gain (RESOLVE) in people living with severe mental illness

“…Rather than a diagnosis-dependent approach to care decisions, shared responsibility represents what information individuals need at any point in time, to engage in making decisions about their mental, physical and social care needs. 145 Recovery-oriented treatment for individuals with SMI and weight gain reinforces the starting point of our programme theory and CMOCs-the therapeutic relationship. When primary care practitioners focus on the quality of their relationships with individuals with SMI and weight gain, care planning and follow-through for individuals is greatly enhanced, 144 and ongoing participation of individuals and families in goal-setting and decision-making is associated with sustained, positive behaviour changes.…”

Exploring the nurse-patient relationship in caring for the health priorities of older adults: qualitative study

“…This necessitates a care approach that transcends traditional medical treatment to embrace a more holistic view, recognizing the importance of psychological, social, and spiritual well-being alongside physical health [ 13 ]. PCC, in this context, demands a shift from a one-size-fits-all model to a more nuanced and individualized care strategy [ 14 ]. This approach not only aims to manage the medical aspects of care but also to address the broader dimensions of health, ensuring that the care plans for older adults are tailored to their specific needs, preferences, and life circumstances [ 15 ].…”