From Treatment Adherence to Advanced Shared Decision Making: New Professional Strategies and Attitudes in Mental Health Care

Giuseppe      Tibaldi; Luis      Salvador-Carulla; Juan      Carlos Garcia-Gutierrez

Abstract

Treatment adherence is related to “self-regulation” of prescribed drugs. Patients organise their drug intake around their own priorities, which may be very different from prescribers' priorities, since most of the patients value their personal concerns and/or their social roles more than the benefits of a prescribed treatment. A gap exists between patients' and professionals' views. This gap is mainly related to patients' health beliefs and physicians' attitudes. A number of strategies can help professionals overcome gaps between their treatment options for depression and schizophrenia and the “real world” alternatives shared by the lay public, patients, their relatives, and political stakeholders. These strategies include integrated care and recovery, family engagement, and the development of a mutualistic patient/physician relationship with the adoption of advance directives and appropriate guidelines that incorporate the patient's choices. The effective implementation of these combined strategies within the person-centred care model empowers patients to collaborate with mental health professionals and their families in making complex health care choices. Barriers to this process include factors affecting the control, contact and communication facets of the patient/physician relationship.

Keywords: Mental health, treatment adherence, person-centred medicine, shared decision making, depression, schizophrenia, antipsychotic, antiepileptic drugs, Psychotherapy, self-regulatio