Community Mental Health Journal

, Volume 46, Issue 5, pp 433–440 | Cite as

Practicing Shared Decision Making in the Outpatient Psychiatric Care of Adults with Severe Mental Illnesses: Redesigning Care for the Future

  • William C. TorreyEmail author
  • Robert E. Drake
Original Paper


Psychiatrist outpatient office visits have the potential to support the recovery of adults with severe mental illnesses by engaging them in a collaborative process of evaluating, selecting, and trying individually-tailored therapeutic options. Evidence-informed shared decision making is difficult for psychiatrists to offer within the framework of care as it is delivered today: it requires time, easy access to relevant scientific information, and extensive communication between patients and psychiatrists. In this paper, we describe the current structural obstacles to collaborative psychiatric care and envision a redesigned office visit process that facilitates active informed patient involvement.


Shared decision making Evidence-based practice Quality improvement Severe mental illness Schizophrenia Recovery 


  1. Adams, J. R., & Drake, R. E. (2006). Shared decision-making and evidence-based practice. Community Mental Health Journal, 42, 87–105.CrossRefPubMedGoogle Scholar
  2. Adams, J. R., Drake, R. E., & Wolford, G. L. (2007). Shared decision-making preferences of people with severe mental illness. Psychiatric Services, 58, 1219–1221.CrossRefPubMedGoogle Scholar
  3. Carpenter, W., Gold, J. M., Lahti, A. C., et al. (2000). Decisional capacity for informed consent in schizophrenia research. Archives of General Psychiatry, 57, 533–538.CrossRefPubMedGoogle Scholar
  4. Cimpean, D., Bartels, S., Merrens, M., Drake, R. E., & Garrity, W. (2009). Summer institute in evidence-based psychiatry and mental health. Academic Psychiatry, 33, 327–330.CrossRefPubMedGoogle Scholar
  5. Committee on Quality Healthcare in America, Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.Google Scholar
  6. Committee on Quality in Health Care in America. (2006). Improving the quality of health care for mental and substance-use conditions: Quality chasm series. Washington, DC: Institute of Medicine, National Academy Press.Google Scholar
  7. Deegan, P. E., & Drake, R. E. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services, 57, 1636–1639.CrossRefPubMedGoogle Scholar
  8. Deegan, P. E., Rapp, C., Holter, M., et al. (2008). A program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatric Services, 59, 603–605.CrossRefPubMedGoogle Scholar
  9. Drake, R. E., Cimpean, D., & Torrey, W. C. (2009). Shared decision making in mental health care. Dialogues in Clinical Neuroscience (in press).Google Scholar
  10. Drake, R. E., Teague, G. B., & Gersing, K. (2005). State mental health authorities and informatics. Community Mental Health Journal, 41, 365–370.CrossRefPubMedGoogle Scholar
  11. Elwyn, G., & Charles, C. (2009). Shared decision-making: From conceptual models to implementation in clinical practice. In A. Edwards & G. Elwyn (Eds.), Shared decision-making health care: Achieving evidence-based patient choice (2nd ed., pp. 117–121). Oxford: Oxford University Press.Google Scholar
  12. Fraenkel, L., & McGraw, S. (2007). What are the essential elements to enable patient participation in medical decision making? Journal of General Internal Medicine, 22, 614–619.CrossRefPubMedGoogle Scholar
  13. Goss, C., Moretti, F., Mazzi, M. A., et al. (2008). Involving patients in decisions during psychiatric consultations. The British Journal of Psychiatry, 193, 416–421.CrossRefPubMedGoogle Scholar
  14. Gravel, K., Legare, F., & Graham, I. D. (2006). Barriers and facilitators to implementing shared decision-making in clinical practice: A systematic review of health professionals’ perceptions. Implementation Science, 1, 16.CrossRefPubMedGoogle Scholar
  15. Grisso, T., & Applebaum, P. S. (1995). The MacArthur treatment competence study. III. Abilities of patients to consent to psychiatric and medical treatments. Law Human Behavior, 19, 149–174.CrossRefGoogle Scholar
  16. Joosten, E. A., DeFuentese-Merillas, L., de Weert, G. H., et al. (2008). Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics, 77, 219–226.CrossRefPubMedGoogle Scholar
  17. Miller, A. L., Chiles, J. A., Chiles, J. K., et al. (1999). The Texas Medication Algorithm Project (TMAP) schizophrenia algorithms. Journal of Clinical Psychiatry, 60, 649–657.CrossRefPubMedGoogle Scholar
  18. Miller, A. L., Crismon, M. L., Rush, A. J., et al. (2004). The Texas Medication Algorithm Project: Clinical results for schizophrenia. Schizophrenia Bulletin, 30, 627–647.PubMedGoogle Scholar
  19. Mueser, K. T., Goodman, L. B., Trumbetta, S. L., et al. (1998). Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 66, 493–499.CrossRefPubMedGoogle Scholar
  20. O’Connor, A. M., Bennett, C. L., Stacey, D., et al. (2003). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, Issue 1. Art. No. CD001431. DOI:  10.1002/14651858.CD001431.
  21. O’Connor, A. M., & Edwards, A. (2009). The role of decision aids in promoting evidence-based patient choice. In A. Edwards & G. Elwyn (Eds.), Shared decision-making in health care: Achieving evidence-based patient choice (2nd ed., pp. 191–200). Oxford: Oxford University Press.Google Scholar
  22. O’Connor, A. M., Rostom, A., Fiset, V., et al. (1999). Decision aids for patients facing health treatment or screening decisions: Systematic review. British Medical Journal, 319, 731–734.PubMedGoogle Scholar
  23. Rimondini, M., Del Piccolo, L., Goss, C., et al. (2006). Communication skills in psychiatric residents—how do they handle patient concerns? An application of sequence analysis to interviews with simulated patients. Psychotherapy and Psychosomatics, 75, 161–169.CrossRefPubMedGoogle Scholar
  24. Say, R. E., & Thomson, R. (2003). The importance of patient preferences in treatment decisions—challenges for doctors. BMJ, 327, 542–545.CrossRefPubMedGoogle Scholar
  25. Simon, D., Wills, C. E., & Harter, M. (2009). Shared decision-making in mental health. In A. Edwards & G. Elwyn (Eds.), Shared decision-making in health care: Achieving evidence-based patient choice (2nd ed., pp. 269–276). Oxford: Oxford University Press.Google Scholar
  26. Stacey, D., Bennett, C., Saarimaki, A., et al. (2009). How effective are patient decision aids? In A. Edwards & G. Elwyn (Eds.), Shared decision-making in Health Care: Achieving Evidence-Based Patient Choice (2nd ed., pp. 201–208). Oxford: Oxford University Press.Google Scholar
  27. Stroup, S., Appelbaum, P., Swartz, M. S., et al. (2005). Decision-making capacity for research participation among individuals in the CATIE schizophrenia trial. Schizophrenia Research, 80, 1–8.CrossRefPubMedGoogle Scholar
  28. Suppes, T., Rush, A. J., Dennehy, E. B., et al. (2003). Texas Medication Algorithm Project, phase 3 (TMAP-3): Clinical results for patients with a history of mania. Journal of Clinical Psychiatry, 64, 370–382.CrossRefPubMedGoogle Scholar
  29. Thorton, H. (2009). Evidence-based health care: What roles for patients? In A. Edwards & G. Elwyn (Eds.), Shared decision-making in health care: Achieving evidence-based patient choice (2nd ed., pp. 37–41). Oxford: Oxford University Press.Google Scholar
  30. Torrey, W. C., Green, R., & Drake, R. E. (2005a). Psychiatry and psychiatric rehabilitation. Journal of Psychiatric Practice, 11, 1–6.CrossRefGoogle Scholar
  31. Torrey, W. C., Rapp, C. A., Van Tosh, L., et al. (2005b). Recovery principles and evidence-based practice: Essential ingredients of service improvement. Community Mental Health Journal, 41, 91–100.CrossRefPubMedGoogle Scholar
  32. Trivedi, M. H., Rush, A. J., Crismon, M. L., et al. (2004). Clinical results for patients with major depressive disorder in the texas medication algorithm project. Archives of General Psychiatry, 61, 669–680.CrossRefPubMedGoogle Scholar
  33. Wagner, E. H., Austin, B. T., Davis, C., et al. (2001). Improving chronic illness care: translating evidence into action. Health Aff (Millwood), 20, 64–78.CrossRefGoogle Scholar
  34. Wolford, G., Rosenberg, S. D., Rosenberg, H. J., et al. (2008). A clinical trial comparing interviewer and computer-assisted assessment among clients with severe mental illness. Psychiatric Services, 59, 769–775.CrossRefPubMedGoogle Scholar
  35. Young, A. S., Mintz, J., Cohen, A. B., et al. (2004). Using information systems to improve care for persons with schizophrenia. Psychiatric Services, 55, 253–255.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Dartmouth Medical SchoolHanoverUSA
  2. 2.Department of PsychiatryLebanonUSA

Personalised recommendations