(May 14, 2019) Shared decision-making, a clinical care approach where clinicians and patients discuss evidence together and make concerted choices about appropriate treatments, is a principle of quality healthcare that has become more prevalent in clinical guidelines for mental healthcare. However, in practice, caregiver or family member involvement in mental healthcare decision-making is rarely explicitly addressed.
A piece published in Psychiatric Services this month argues that family caregivers, in addition to patients themselves, should be involved in shared decision-making and are an integral component of any clinical practice. The authors summarize evidence demonstrating the benefits of caregiver involvement for improving clinical decision-making and outcomes for individuals with mental illness. Drawing conclusions from the evidence, they suggest that more work is needed to facilitate caregiver participation in mental healthcare decisions.
Caregiver involvement in clinical decision-making for severe mental illness
Research has shown that most families do not feel sufficiently engaged in treatment planning for their loved ones. In addition, mental health professionals may be hesitant to involve caregivers due to potential ethical conflicts, according to the authors. One of the greatest barriers to caregiver involvement is confidentiality concerns around sharing personal health information, despite evidence that family involvement can bridge communication gaps and allow for more effective information exchange between the clinician and the patient.
“People with severe mental illnesses often exhibit high levels of social impairment, unemployment, and isolation from society,” the authors write. “Many maintain close contact with informal caregivers (e.g., parents, partners, siblings, children, etc.) and perceive family support as critical. Informal caregivers therefore play an important role in the recovery process.”
The article makes a strong argument for expanding the principles of shared decision-making to mental healthcare and for including caregiver involvement as an essential element in clinical practice. The authors conclude that more research is needed to understand the specific skills required for caregivers to effectively participate in treatment decisions for their loved one with severe mental illness. They also suggest that a more practical framework should be developed to resolve conflicts between caregivers and patients, so as to avoid one party overruling the other.
References:
Elizabeth Sinclair
Director of Research
Treatment Advocacy Center
