Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr;27(2):e14001.
doi: 10.1111/hex.14001.

Supported decision-making interventions in mental healthcare: A systematic review of current evidence and implementation barriers

Cathy J Francis  1 , Amanda Johnson  2 , Rhonda L Wilson  1   3
Affiliations

Supported decision-making interventions in mental healthcare: A systematic review of current evidence and implementation barriers

Cathy J Francis et al. Health Expect. 2024 Apr.

Abstract

Background: There is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In-principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice.

Objectives: We conducted a systematic review of quantitative, qualitative and mixed-method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation.

Methods: Seven databases were searched and 5137 articles were screened. Articles were included if they reported on an intervention for adult service users, were published between 2008 and October 2023 and were in English. Evidence in the 140 included articles was synthesised according to the JBI guidance on Mixed Methods Systematic Reviews.

Results: Research in this field remains exploratory in nature, with a wide range of interventions investigated to date but little experimental replication. Overarching barriers to shared and supported decision-making in mental health treatment planning were (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health-related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians).

Conclusions: On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programs, the designing of new tools and for clinicians seeking to practice shared and supported decision-making in the healthcare they offer.

Patient or public contribution: This systematic review has been guided at all stages by a researcher with experience of mental health service use, who does not wish to be identified at this point in time. The findings may inform organisations, researchers and practitioners on implementing supported decision-making, for the greater involvement of people with mental ill health in their healthcare.

Keywords: UNCRPD; mental health; person-centred care; shared decision-making; supported decision-making.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart.
See this image and copyright information in PMC

References

    1. United Nations . Convention on the rights of persons with disabilities. 2022. Accessed December 7, 2022. https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-r...
    1. Kokanovic R, Brophy L, McSherry B, et al. Options for supported decision‐making to enhance the recovery of speople experiencing severe mental health problems. Melbourne: Melbourne Social Equity Institute, University of Melbourne. 2017.
    1. Lovell K, Bee P, Brooks H, et al. Embedding shared decision‐making in the care of patients with severe and enduring mental health problems: the EQUIP pragmatic cluster randomised trial. PloS one. 2018;13:e0201533. - PMC - PubMed
    1. Nicaise P, Lorant V, Dubois V. Psychiatric Advance Directives as a complex and multistage intervention: a realist systematic review. Health Soc Care Community. 2013;21:1‐14. - PubMed
    1. Slade M. Implementing shared decision making in routine mental health care. World Psychiatry. 2017;16:146‐153. - PMC - PubMed

Publication types

LinkOut - more resources