Collaborative decision making is tailored for populations like people with SMI and other groups who experience chronic and complex symptoms, along with power imbalances within health systems. We highlight these barriers and propose that a novel paradigm, collaborative decision making, will offer conceptual and practical solutions at the systemic and patient/clinician level. As a result, current levels of shared decision making are low. Shared decision making in mental health is a priority for stakeholders, but faces significant implementation barriers, particularly in settings intended to serve people with serious mental illnesses (SMI). (PsycINFO Database Record (c) 2019 APA, all rights reserved). Consumer self-advocacy is also important, given that providers often see themselves as lacking agency to make changes. Additional training and education may help to close this gap. Although many obstacles were system-level, providers themselves also contributed to the gap between ideal and real treatment planning. Providers identified several obstacles to enacting best practices.
However, actual treatment planning processes rarely live up to those principles. These results indicate that providers have a strong understanding of evidence-based principles of treatment decision-making. Real treatment planning was described as directed by institutional and regulatory needs, resulting in treatment plans that were not personalized and not communicated to frontline staff or the consumer. Providers described the ideal treatment planning process as dynamic and collaborative, including thorough assessment and inclusion of all stakeholders including the consumer, providers, and family members. Analysis revealed 6 primary themes with 23 subthemes. Content analysis of the transcription from the dialogue was used to identify major themes and subthemes. Twelve mental health providers completed a participatory dialogue focused on discussing perceptions of ideal and real treatment planning processes.
In this study, we used qualitative methods to increase understanding of typical treatment planning practices. It is unclear how well treatment planning practices in usual care settings for SMI adhere to best practices guidelines. Treatment planning processes are a fundamental component of evidence-based practice in mental health for people with serious mental illness (SMI), who often present with complex concerns and require an interdisciplinary treatment team.
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