title: Shared decision making in public mental health care: perspectives from consumers living with severe mental illness.
abstract: OBJECTIVE
  Most theoretical and empirical work regarding decision making in mental health suggests that mental health consumers have better outcomes when their preferences are integrated into quality of life decisions. A wealth of research, however, indicates that providers have difficulty predicting what their clients' priorities are. This study investigates consumer decision-making preferences and understanding of construction of decisions in community mental health.
  
  
  METHODS
  People living with severe mental illness being treated in the public mental health care system (N=16) participated in qualitative interviews regarding case management decision making as a part of a larger study investigating a decision support system to facilitate shared decision making. Interviews were transcribed, coded, and cross-case thematic analyses were conducted.
  
  
  RESULTS
  Mental health consumers generally endorse a "shared" style of decision making. When asked what "shared" means, however, consumers describe a two-step process which first prioritizes autonomy, and if that is not possible, defers to case managers' judgment. Consumers also primarily focused on the relationship and affective components of decision making, rather than information-gathering or deliberating on options. Finally, when disagreements arose, consumers primarily indicated they handled them.
  
  
  CONCLUSIONS
  Mental health consumers may have a different view of decision making than the literature on shared decision making suggests. Mental health consumers may consciously decide to at least verbally defer to their case managers, and remain silent about their preferences or wishes.
authors.affiliation: VA Ann Arbor Health Care System, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48113-0170, USA. ewoltman@umich.edu
authors.forename: Emily M
authors.initials: EM
authors.lastname: Woltmann
authors.forename: Rob
authors.initials: R
authors.lastname: Whitley
mesh_terms: D000328:Adult; D019090:Case Management; D032921:Consensus; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D026706:Paternalism; D010347:Patient Care Planning; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D026684:Personal Autonomy; D011618:Psychotic Disorders / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life