The Role of Shared Decision-Making in Mental Health Nursing

Introduction

In the realm of mental health nursing, the preservation of patient safety is a paramount concern, as identified by Bowers (2014). This focus often leads to the creation of environments that, while safe, can be isolating, with seclusion used as a method of treatment and intervention. However, such approaches can potentially hinder social inclusion, independence, and communication, as argued by Clifton et al. (2017). As a response to these challenges, shared decision-making (SDM) has emerged as a vital model, promoting collaboration between clinicians and patients to make informed decisions based on the best available evidence and patient values (Stiggelbout et al.

, 2015; Chi, 2018). This essay explores the complexities of mental health care, emphasizing the importance of shared decision-making and the need for a holistic, patient-centered approach to enhance outcomes for service users.

Mental Health Nursing and Safety

Mental health professionals are tasked with balancing safety and patient autonomy. The Department of Health (1999) states that in cases of severe mental illnesses like psychosis, professionals must act as care coordinators under the Care Program Approach (DOH, 2008). This role is crucial for those with serious and enduring mental illness, as mandated by Lovell et al. (2018). The NMC Code (2015) further underscores the duty of mental health professionals to ensure safety, as outlined in the Mental Health Act (MHA, amended 2007), by providing care and protection to those at risk of harm (Scott, 2013). Decisions made during crises are thus oriented towards the patient's best interests (MCA, 2005).

The Mental Capacity Act (MCA) emphasizes that the MHA is applied when patients cannot be treated under the MCA and are non-compliant with treatment. Consequently, the SDM process is often restricted to information sharing among professionals and carers initially. An approved mental health professional (AMHP) coordinates assessments under the MHA, ensuring compliance with legislation and consulting with involved parties to determine the most appropriate course of action (DOH, 2008; Morris, 2016). It is imperative that AMHPs act independently and uphold the individual’s rights as per the Mental Health Act (2007), the Mental Capacity Act (2005), and the Human Rights Act (1998) (Gaag, 2016).

A Holistic Approach to Care

Reflecting on previous incidents, it is evident that earlier intervention might prevent subsequent crises. Understanding the roles and responsibilities of crisis teams and the importance of maintaining service user empowerment are crucial. Offering community support and employing the least restrictive strategies can enhance the assessment and treatment process, aligning with a holistic approach to care. Environmental and social factors are integral to an individual's recovery journey, and shared decision-making facilitates the inclusion of diverse perspectives from professionals, carers, and the service user. Effective information sharing across multi-agency networks is vital in delivering holistic care.

Positive risk-taking is a fundamental aspect of recovery-oriented practice. It involves managing risks to maintain individual independence and identity while avoiding isolative environments that can negatively impact mental well-being. Risk management is complex, intertwining with recovery and necessitating collaboration among experts to reach consensus on the best interest decisions. This approach can optimize care delivery and improve service user outcomes in mental health care settings.

Reflective Practice and Future Directions

Reflective practice is a cornerstone of mental health nursing, promoting continuous learning and improvement. A recent incident involving a suicide attempt highlighted the importance of considering environmental factors in recovery. Initially, my instinct was to detain the individual, but I realized that addressing environmental influences could facilitate a more therapeutic recovery. This experience underscored the value of positive risk-taking and empowering individuals with solution-focused strategies for suicide prevention.

This reflective process has informed my future practice, emphasizing evidence-based care and effective communication across professional agencies. Accurate record-keeping is essential in forming a holistic view of a patient's circumstances. By understanding various professional roles and engaging in continuous professional development, I have enhanced my competence in delivering person-centered care.

Conclusion

In conclusion, mental health nursing requires a delicate balance between ensuring patient safety and promoting autonomy. Shared decision-making, when effectively implemented, fosters collaboration and empowers patients, ultimately enhancing care outcomes. By adopting a holistic approach that considers environmental and social factors, mental health professionals can support recovery in community settings, minimizing the need for restrictive interventions. This essay has highlighted the importance of evidence-based practice, effective communication, and reflective learning in optimizing mental health care delivery. By focusing on these elements, mental health professionals can better navigate the complexities of care and support individuals on their recovery journeys.

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