1 Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia.
2 Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2018 Sep;52(9):826-833. doi: 10.1177/0004867418784177. Epub 2018 Jun 28.
Supporting the decision-making of mental health service users fulfils professional, ethical and moral obligations of mental health practitioners. It may also aid personal recovery. Previous research on the effectiveness of supported decision-making interventions is limited.
The study aims to explore from several perspectives the barriers and facilitators to supported decision-making in an Australian context. Supported decision-making was considered in terms of interpersonal experiences and legal supported decision-making mechanisms.
In all, 90 narrative interviews about experiences of supported decision-making were conducted and analysed. Participants were mental health service users who reported diagnoses of schizophrenia, psychosis, bipolar disorder and severe depression; family members supporting them and mental health practitioners, including psychiatrists. The data were analysed thematically across all participants.
Negative interpersonal experiences in the mental health care system undermined involvement in decision-making for people with psychiatric diagnoses and family carers. Mental health practitioners noted their own disempowerment in service systems as barriers to good supported decision-making practices. All groups noted the influence of prevailing attitudes towards mental health service users and the associated stigma and discrimination that exist in services and the broader community. They believed that legal supported decision-making mechanisms facilitate the participation of mental health service user and their family supporters in supported decision-making.
Enabling supported decision-making in clinical practice and policy can be facilitated by (1) support for good communication skills and related attitudes and practices among mental health practitioners and removing barriers to their good practice in health and social services and (2) introducing legal supported decision-making mechanisms.
为心理健康服务使用者的决策提供支持，既是心理健康从业者的专业、道德和伦理义务，也有助于个人康复。关于支持性决策干预措施的有效性的先前研究有限。
本研究旨在从几个角度探讨在澳大利亚背景下支持性决策的障碍和促进因素。从人际体验和法律支持决策机制两个方面考虑支持性决策。
共进行了 90 次关于支持性决策体验的叙事访谈和分析。参与者是报告被诊断为精神分裂症、精神病、双相情感障碍和重度抑郁症的精神健康服务使用者；支持他们的家庭成员和精神健康从业者，包括精神科医生。对所有参与者的数据进行了跨主题分析。
精神卫生保健系统中负面的人际体验破坏了精神疾病诊断患者和家庭照顾者参与决策的能力。精神健康从业者指出，他们自己在服务系统中的无能为力是良好支持性决策实践的障碍。所有群体都注意到对精神健康服务使用者的态度以及在服务和更广泛的社区中存在的相关耻辱和歧视的影响。他们认为，法律支持性决策机制有利于精神健康服务使用者及其家庭支持者参与支持性决策。
通过（1）支持精神健康从业者的良好沟通技巧和相关态度和实践，并消除他们在卫生和社会服务中的良好实践障碍，以及（2）引入法律支持性决策机制，可以促进临床实践和政策中的支持性决策。
