Psychiatrist Dr. Allen Dyer discusses his philosophy of engagement and approach to shared decision-making.
Treating a mental health condition is a partnership. Your patient depends on your empathy, knowledge and skill. You depend on your patient to give you complete and accurate information, work with you to develop a treatment plan and stay engaged and motivated. Shared decision-making is one technique for strengthening the partnership and providing better care.
In addition to its use in outpatient psychiatric treatment, which is the focus of this website, shared decision-making can be used in other kinds of mental health treatment, including hospital care, psychotherapy and case management. It can be used as well by providers and consumers of other mental health services.
Shared decision-making is a process that leads to a mutual decision by doctor and patient on what course of treatment to follow and what steps the patient needs to take to enact his or her plan.
There is no single, agreed-upon definition of shared decision-making. However, shared decision-making can be defined as "an interactive, collaborative process between providers and consumers that is used to make health care decisions, in which at least two individuals work together as partners with mutual expertise (professional and experiential) to exchange information and clarify values in relation to options and thereby arrive at a discrete decision."
As a process, shared decision-making begins with mutual education. The patient educates the doctor on symptoms, complaints, other health issues and their personal goals and preferences. The doctor educates the patient on diagnosis, treatment options and the risks and benefits of each option. Exploration follows: The patient discusses their reactions to the options offered and any concerns about them. The doctor provides additional information and recommendations based on the patient's input. Finally, doctor and patient arrive at a mutually agreed upon course of action by the patient and the next steps to be taken.
Shared decision-making recognizes that there are often several treatment approaches and options, that each one has potential risks and benefits, and that the patient's values, goals and preferences influence their choices. It also recognizes that patients are usually free to decide whether or not to follow a doctor's advice.
Shared decision-making has been described as model of medical care that falls between the traditional (paternalistic) model in which the doctor is the primary decider, and the informed choice model, in which the consumer actively controls the information exchange and decision-making.
Shared decision-making requires the willing participation of both doctor and patient. The doctor must be willing to involve the patient in decisions, consider their reservations and concerns and acknowledge their expertise about their own lives. The patient must want to take an active role in their own care and assume responsibility for choices. Thus, the process can place new and perhaps unaccustomed demands on both parties. It may not be appropriate or welcomed by all patients or by all physicians.
Shared decision-making should not be overwhelming. Exploring options, potential risks and benefits can happen over a series of visits as your patient learns more about their condition and treatment. Patients can educate themselves outside of appointment time through support groups, peer-run programs or the Internet.
 Shared Decision-making in Mental Health Care: Overview and Current Status. Celia E. Wills, Melody Reifer, Carole Schauer, and Paolo del Vecchio. In Shared Decision-Making in Mental Health Care: Practice, Research and Future Directions, p. 47. Substance Abuse and Mental Health Services Administration, 2007
 Ibid., p. 47.
 Ibid., p. 49.