Supported Decision-Making: The Expectations Held by People With Experience of Mental Illness

Abstract

Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people's ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants' conceptualization of mental health expertise, their own experiences and sense of agency, and their varying needs for dependence and independence influenced their relationships with mental health practitioners. These factors in turn shaped their expectations about SDM. Four narrative positions emerged: the "Inward Expert," the "Outward Entrustor," the "Self-Aware Observer," and the "Social Integrator." These positionings influenced the type or style of support that participants expected and considered most useful. Our findings are relevant to developing effective approaches to SDM that take into account service users' needs and preferences.

Service users' experiences and views of support for decision‐making

“…Participants identified a wide range of experiences in terms of the support they either needed or received in making decisions. As Knight et al () had found, people may have different positions on support and these may overlap and change over time. Support included the opportunity to access information, review pros and cons and get feedback from others.…”

“…A number of empirical studies have documented the experiences of individuals and supporters in the supported decision‐making process. One of the key findings has been that ‘decision‐making is a dynamic and interactional process’ (Knox, Douglas, & Bigby, , p. 15) and that the subjective relationships between the individual, supporter and the context is at the heart of the process (Knox et al, ; Jamieson, Theodore, & Raczka, ; Knight et al, ). Other studies have also discussed the relationship between the individual and the supporter, particularly focusing on the individual's feeling of powerlessness if there was not a good working relationship between them (McDaid & Delaney, ; Jamieson, Theodore, & Raczka, ; People First (Scotland), ).…”

‘I’m proud of how far I’ve come. I’m just ready to work’: mental health recovery narratives within the context of Australia’s Disability Employment Services

“…Narrative inquiry has been previously used to explore various lived experiences of phenomena (e.g. disability, supported-decision making, unemployment) [63][64][65][66][67]. Ridgway [68] for example used first person narratives to explore lived experiences of recovery of women with long-term psychosocial disability, describing how these narratives could inform recovery-orientated practice.…”

Unravelling subjectivity, embodied experience and (taking) psychotropic medication

“…Such work, as well as broader scholarship within the social sciences, has increasingly revealed the ontological instability of divisions between things; between clinical category and personal accounts; between ‘abnormality’ and side effects of achieving ‘normality’. For example, drawing on an ethnography with people who have experienced psychiatric care and psychotropic medication, several studies have unpacked the complexities of decision-making, often highlighting the role of side effects, negotiations and relations of power (e.g., Knight et al, 2018; Angell and Bolden, 2015; Seale et al, 2007, 2006; Rogers et al, 1998). In addition, concepts of phenomenology and embodiment have been harnessed to shed light on the complex effects of drugs (e.g., Morrison et al, 2015; McCann and Clark, 2004; Parnas and Handest, 2003; Usher, 2001).…”