SAMHSA’s Shared Decision-Making (SDM):

Making Recovery Real in Mental Health Care Project

About Shared Decision-Making

• Shared decision-making is an interactive and collaborative process between individuals and their health care
practitioners about decisions pertinent to the individual’s treatment, services, and ultimately their personal
recovery. An optimal decision is one that is informed, consistent with personal values, and acted upon.
Participants are satisfied 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 and beliefs, 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 are
willing 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 be
patient-centered with individual preferences, needs, and values guiding clinical decisions. The IOM’s follow-up
report, Improving the Quality of Health Care for Mental and Substance Abuse Conditions, expands the
principles of informed, patient-centered treatment, and shared decision-making to mental health and substance
abuse treatment services.
• The Ottawa Health Research Institute maintains the Ottawa Health Decision Centre (http://decisionaid.ohri.ca)
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 (http://www.dhmc.org).

About Shared Decision-Making in Mental Health

• There is growing understanding and interest in how approaches to shared decision-making emerging in the
physical health arena may be adapted to mental health field. Currently there is very little research and few
decision-aides or other material on shared decision-making specific to the mental health context.
• Dr. Patricia Deegan has pioneered an innovative approach to helping mental health consumers to participate in
shared decision-making about the use of psychiatric medication. This program, currently being piloted, includes
peer-to-peer workshops, an interactive software program available to patients in a clinical waiting-room setting,
and training for practitioners to help clients navigate decisional conflict related to medication use. Dr. Deegan is
a lead member of the SAMHSA/CMHS SDM project.
• SAMHSA/CMHS is interested in promoting and supporting SDM in mental health for a number of reasons
o SDM is consistent with recovery-based transformation and the foundation values of choice, self-
determination, and empowerment.
o SDM is a means of enhancing involvement of consumers in mental health care, which has recognized
benefits for positive treatment outcomes.
o Mental health consumers have an active desire to participate in decisions about their care and are
capable of doing so.
About the SAMHSA/CMHS Project:
Shared Decision-Making: Making Recovery Real in Mental Health

Purpose
• The project is intended to identify existing proven decision-making technologies from general healthcare or
other sources, and then adapt and pilot test them for use by mental health care practitioners and consumers.
• SDM is a very new approach for mental health services and it is expected that this project will develop interest
and provide a foundation for future development in the field.

Method for Development

• The SAMHSA/CMHS SDM project is being developed under a contract with Advocates for Human Potential,
Inc. (AHP) and Westat, with an experienced team of staff, consultants, and subcontractors to design, develop and
pilot test SDM products.
• The work plan for the SDM project calls for regular input and feedback from a Planning Team, an advisory
group of researchers, policy-makers, consumers, family members, and practitioners. The responsibilities of the
Planning Team are to:
o Take an active role in guiding the SDM work group in determining priorities and identifying resources
and potential technologies that may be adapted to mental health context,
o Raise critical issues and questions,
o Address potential barriers, and
o Review and comment on the documents and materials developed through this initiative.
• Audience testing will be an active part of product development as well as of field evaluation of draft products.

Timeframe and Products

• The SAMHSA/CMHS SDM project is a 3-year initiative that began in 2007. SDM information and decision
support tools are being developed in three areas for consumers and mental health providers and administrators
and will include informational documents, videos, CD-ROMs, and web-based materials. The first product line
will provide information about SDM. The second will focus on a general decision support tool to be used by
consumers with their providers. The last product line will focus on information and decision tools related to
medication.

For further information contact:

Paolo del Vecchio
Associate Director for Consumer Affairs
(240) 276-1946
paolo.delvecchio@samhsa.hhs.gov