Shared Decision-Making (SDM):Making Recovery Real in Mental Health Care
Substance Abuse and Mental Health Services Administration (SAMHSA)Center for Mental Health Services (CMHS)
About Shared Decision-Making
Shared decision-making is an interactive and collaborative process between individuals and their health carepractitioners about decisions pertinent to the individual’s treatment, services, and ultimately their personalrecovery. The practitioner brings expertise about disorders, treatment options, risks and benefits. Individualsbring their lived experience, knowledge, values, and preferences.
An optimal decision is one that is informed, consistent with personal values, and acted upon. Participants aresatisfied with the process used to make the decision.
Shared decision-making is particularly relevant when there is uncertainty about a particular decision.Uncertainty may stem from multiple or competing options each with advantages and disadvantages,incomplete or inconclusive scientific outcome evidence, or individual factors such as personal values andbeliefs, a limited knowledge about the options, or lack of support to make a clear choice.
Effective shared decision-making requires both informed and involved consumers, and practitioners who arewilling to enter into meaningful dialogue with the person about the decision to be made.
In general health care, people are increasingly recognized as key decision-makers about their own healthcare.For example, the Institute of Medicine (IOM) Report,
Crossing the Quality Chasm,
calls for health care to bepatient-centered with individual preferences, needs, and values guiding clinical decisions. The IOM’s follow-upreport,
Improving the Quality of Health Care for Mental and Substance Abuse Conditions,
expands theprinciples of informed, patient-centered treatment, and shared decision-making to mental health andsubstance abuse treatment services.
Decision Aids and Decision Support
are tools that help provide information and provide a structured process for making decisionsabout a particular concern. They may be presented in any number of formats, such as paper-pencil,audio/visual, computer-assisted or web-based interactive technologies. Regardless of format, decision aidscontain four primary elements: (1) Information; (2) Values clarification; (3) Recognition of social pressures ondecision-maker; and (4) Resources required to act on decision.
: Processes for helping individuals gather information, assess risks/benefits, and use decisionaids and other resources to come to a decision that aligns with personal values and goals. May includepreparation for communicating and implementing a decision.
The Ottawa Health Research Institute maintains the Ottawa Health Decision Centre
which has an inventory of many decision aides for physical health care, many of which are available on line.The Dartmouth-Hitchcock Medical Center Decision Support Center, with funding from the Foundation for Informed Medical Decision Making and Health Dialog, Inc., has established an on-site decision-support center for patients and also provides limited on-line resources