Shared Risk Taking: Shared Decision Making in Serious Mental Illness

Abstract

Shared decision making (SDM) is an interpersonal health communication model that is underutilized with people with serious mental illness. Although research has emphasized the role of patient capacity-, clinician-, and system-related barriers in SDM underutilization, the risk taking that affects SDM with people with mental illness is less often discussed. This Open Forum presents a reconceptualization of SDM as a process of shared risk taking that often occurs during different phases of illness management and recovery. The concepts of intersubjectivity, meaning making, and metacognition are offered to inform clinical interventions needed to address risk in SDM.

Shared Decision Making in Primary Care Based Depression Treatment: Communication and Decision-Making Preferences Among an Underserved Patient Population

“…In sum, this study offers novel, in-depth insight into how patients prefer to approach discussions around depression treatment, highlighting areas where both decisional authority and partnership is desired ( 57 ). Through these in-depth interviews, respondents highlighted several strategies that can inform providers' efforts to encourage patient's to actively engage in conversations about depression treatment, and guide flexible and responsive applications of SDM that are most aligned with the needs of individuals seeking depression care.…”

NICE shared decision making guidelines and mental health: challenges for research, practice and implementation

“…It dismisses a priori evidence for rich SDM research with individuals with SMI, 3,[6][7][8] and enhances stigmatic beliefs about the ability of individuals with SMI and other concerns regarding capacity to engage in an SDM process, an assumption that is not yet evidence-based. 9,10 As a result, the NICE recommendations for effectiveness approaches and activities to increase engagement in SDM (Evidence Document A) are based on only eight quantitative studies of SDM in mental health and ten qualitative studies. Of the included quantitative studies, only six [11][12][13][14][15][16] are relevant to SMI and addressed SDM in community mental health settings (the others focused on primary care or patients with behavioural health issues 17 or patients with dementia 18 ).…”

“…Of the included quantitative studies, only six [11][12][13][14][15][16] are relevant to SMI and addressed SDM in community mental health settings (the others focused on primary care or patients with behavioural health issues 17 or patients with dementia 18 ). Only one quantitative study measuring recovery, 16 a primary goal and outcome in mental health that is associated with SDM, [19][20][21] was included. Of the included qualitative studies, [22][23][24][25][26][27][28][29][30][31] only four [24][25][26]28 involved the perspectives and attitudes of patients or individuals with mental health conditions on SDM (the rest addressed providers' perspectives [22][23][24][25][27][28][29][30][31] ), and most of these qualitative studies were valued by the NICE as having a high 22,27,28 to moderate 23,24,26 risk of bias.…”

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

“…A similar initiative may be applicable for patients with schizophrenia. A recent open forum suggested a new conceptualization, shared risk-taking, to facilitate the implementation of SDM ( 30 ). The clinician and patient should explicitly conduct a risk assessment of a decision, its safety implications, and the patient's capacity to be involved in the decision-making process.…”

“…While there is ample evidence indicating its benefits, SDM implementation for patients with serious mental illness has been relatively less successful than for other groups of patients ( 30 ). Individuals with schizophrenia, among all the patients with mental illnesses, experience the lowest SDM ( 20 ).…”