User participation and shared decision-making in adolescent mental healthcare: a qualitative study of healthcare professionals’ perspectives

Abstract

Background: Most mental health problems occur in adolescence. There is increasing recognition of user participation and shared decision-making in adolescents' mental healthcare. However, research in this field of clinical practice is still sparse. The objective of this study was to explore healthcare professionals' perspectives on user participation, and opportunities for shared decision-making in Child and Adolescent Mental Health Service (CAMHS) inpatient units. Methods: Healthcare professionals at CAMHS inpatient units participated in three focus group interviews. Fifteen participants with experience with user participation and shared decision-making were recruited from five hospitals in Norway. Results: Five themes emerged: (1) involvement before admission; (2) sufficient time to feel safe; (3) individualized therapy; (4) access to meetings where decisions are made; and (5) changing professionals' attitudes and practices. Conclusion: User participation and shared decision-making require changes in workplace culture, and routines that allow for individualized mental health services that are adapted to adolescents' needs. This calls for a flexible approach that challenges clinical pathways and short-stay hospital policies. The results of this study may inform further work on strengthening user participation and the implementation of shared decision-making.

Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

“…We should be aware that the capacity to cope with a child with psychiatric problems is likely to differ between families, and that taking care of children with severe psychopathology and externalizing behaviour can be exhausting, even in the absence of other family problems. Finally, since we found the lack of motivation and compliance with medical treatment to be associated with a compulsory rather than voluntary admission, shared decision-making may be required to increase adolescents' participation in and adherence with psychiatric care [39].…”

Shared Decision-Making: An Autoethnography About Service User Perspectives in Making Choices About Mental Health Care and Treatment

“…The client needs to want to be involved in SDM and be trained how to engage in it, and the professional should be aware of SDM techniques and should place the therapeutic alliance with the patient at the center of the interaction, offering clear information and actively listening to the client's viewpoints. In support of this, it has been found that establishing effective relationships based on a personcentered and user participation model are more important in decision-making than following an established pathway with little consultation (30). Additionally, the three-talk model of SDM (9) highlights the need for active listening between the parties leading to discussion of possible options for the service user to make when facing a decision.…”

I’m not a diagnosis: Adolescents’ perspectives on user participation and shared decision-making in mental healthcare

“…Trust between patients and therapists has been described in previous studies ( 18 , 28 , 29 ). Routines for adolescents to participate in treatment meetings and selecting their treatment team should, according to our results, be established to facilitate shared decision-making ( 20 ). The significance of information is also highlighted in previous research ( 18 , 29 ).…”

“…The results also show a link between shared decision-making and workplace culture. Teamwork, positive clinicians, leadership support, and a culture that promotes user participation are key elements in the implementation of shared decision-making ( 20 , 28 , 31 ). Earlier research support an assertion that shared decision-making mobilizes adolescents to engage in therapy thus making it more likely that they will continue with treatment ( 8 , 18 ).…”

“…In addition, there is a lack of conceptual clarity in shared decision-making and a need for clarification of central aspects of shared decision-making in a clinical context ( 15 , 18 ). There is also a dearth of research in adolescent mental healthcare and adolescents’ perspectives ( 19 , 20 ). Previous qualitative research with adolescents highlights the importance of providing mental health services that incorporate individual expectations, needs, and goals ( 8 , 21 , 22 ).…”