Shared Decision-Making and Evidence-Based Practice: A Commentary

Excerpt

Attrition from care, irregular contact with mental health service providers, and medication non-adherence are common among individuals with severe and persistent mental disorders, as they are for individuals with other chronic diseases (Kessler et al., 2001; Regier et al., 1993; Wang et al., 2005). Each tends to be associated with poorer outcomes, each appears intractable, and each may be considered an example of unilateral decision-making on the part of the affected individual (patient, consumer, client). A burgeoning literature demonstrates the persistence as well of unilateral decision-making on the part of mental health providers and the desire on the part of consumers for involvement in treatment. In this context, efforts to promote and foster shared decision-making in care for the severely mentally ill are intuitively appealing. As noted in the review by Adams and Drake (2006) in this issue, however, the literature on shared decision-making in mental health is insufficient to make shared decision-making an evidence-based practice in mental health. We may expect, but do not have enough data to safely assume, that positive findings in other service settings will be replicated in mental health (Fenton, 2003). Adams and Drake highlight the promise and potential of shared decision-making, the range of research needed to address gaps in the existing research base, and many of the challenges facing researchers and practitioners in the field. The variety of research needed and its challenges warrant additional comment. …