Obstacles to Shared Decision-Making in Psychiatric Practice

The interactions involved in trying to achieve shared decision-making are relatively unexplored in psychiatric practice. This book brings together findings from three in-depth qualitative studies of psychiatric practice in the U.K. Particular attention is paid to how patients' choices about their treatment are facilitated or constrained by the actions of mental health professionals both in routine encounters (outpatient consultations) and crisis situations (assessments for compulsory admission to hospital and ward rounds in acute hospitals). In some psychiatric contexts the threat of compulsion is overt or barely concealed making the ideal of shared decision-making very difficult to achieve. The value of qualitative observational methods lies in their capacity to reveal the nuanced differences between decisions that are experienced by participants as real shared decisions and those experienced as a subtle form of manipulation. Clinically this is important because the positive effects of shared decision-making (e.g. adherence to prescribing) will be lost if shared decisions are not experienced as such by the service user involved.