Supported Decision Making in Serious Mental Illness
Making decisions is central to the exercise of control over one's well-being. Many individuals with serious mental illness (SMI) experience limitations in their decision-making capacity. These individuals have often been placed under legal guardianship and substitute decision makers have been a...
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Published in | Psychiatry (Washington, D.C.) Vol. 81; no. 1; pp. 28 - 40 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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United States
01.01.2018
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Abstract | Making decisions is central to the exercise of control over one's well-being. Many individuals with serious mental illness (SMI) experience limitations in their decision-making capacity. These individuals have often been placed under legal guardianship and substitute decision makers have been appointed to make decisions on their behalf. More recently, supported decision making (SDM) has emerged as a possible alternative in some cases. SDM involves recruitment of trusted supports to enhance an individual's capacity in the decision-making process, enabling him or her to retain autonomy in life decisions. This overview examines issues associated with decision-making capacity in SMI, frameworks of substitute decision making and SDM, and emerging empirical research on SDM.
This is an overview of the medical and legal literature on decision making capacity and supported decision making for persons with SMI.
Many but not all individuals with SMI exhibit decrements in decision-making capacity and skill, in part due to cognitive impairment. There are no published data on rates of substitute decision making/guardianship or SDM for SMI. Only three empirical studies have explored SDM in this population. These studies suggest that SDM is viewed as an acceptable and potentially superior alternative to substitute decision making for patients and their caretakers.
SDM is a promising alternative to substitute decision making for persons with SMI. Further empirical research is needed to clarify candidates for SDM, decisions in need of support, selection of supporters, guidelines for the SDM process, integration of SDM with emerging technological platforms, and outcomes of SDM. Recommendations for implementation of and research on SDM for SMI are provided. |
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AbstractList | Making decisions is central to the exercise of control over one's well-being. Many individuals with serious mental illness (SMI) experience limitations in their decision-making capacity. These individuals have often been placed under legal guardianship and substitute decision makers have been appointed to make decisions on their behalf. More recently, supported decision making (SDM) has emerged as a possible alternative in some cases. SDM involves recruitment of trusted supports to enhance an individual's capacity in the decision-making process, enabling him or her to retain autonomy in life decisions. This overview examines issues associated with decision-making capacity in SMI, frameworks of substitute decision making and SDM, and emerging empirical research on SDM.
This is an overview of the medical and legal literature on decision making capacity and supported decision making for persons with SMI.
Many but not all individuals with SMI exhibit decrements in decision-making capacity and skill, in part due to cognitive impairment. There are no published data on rates of substitute decision making/guardianship or SDM for SMI. Only three empirical studies have explored SDM in this population. These studies suggest that SDM is viewed as an acceptable and potentially superior alternative to substitute decision making for patients and their caretakers.
SDM is a promising alternative to substitute decision making for persons with SMI. Further empirical research is needed to clarify candidates for SDM, decisions in need of support, selection of supporters, guidelines for the SDM process, integration of SDM with emerging technological platforms, and outcomes of SDM. Recommendations for implementation of and research on SDM for SMI are provided. OBJECTIVEMaking decisions is central to the exercise of control over one's well-being. Many individuals with serious mental illness (SMI) experience limitations in their decision-making capacity. These individuals have often been placed under legal guardianship and substitute decision makers have been appointed to make decisions on their behalf. More recently, supported decision making (SDM) has emerged as a possible alternative in some cases. SDM involves recruitment of trusted supports to enhance an individual's capacity in the decision-making process, enabling him or her to retain autonomy in life decisions. This overview examines issues associated with decision-making capacity in SMI, frameworks of substitute decision making and SDM, and emerging empirical research on SDM.METHODThis is an overview of the medical and legal literature on decision making capacity and supported decision making for persons with SMI.RESULTSMany but not all individuals with SMI exhibit decrements in decision-making capacity and skill, in part due to cognitive impairment. There are no published data on rates of substitute decision making/guardianship or SDM for SMI. Only three empirical studies have explored SDM in this population. These studies suggest that SDM is viewed as an acceptable and potentially superior alternative to substitute decision making for patients and their caretakers.CONCLUSIONSSDM is a promising alternative to substitute decision making for persons with SMI. Further empirical research is needed to clarify candidates for SDM, decisions in need of support, selection of supporters, guidelines for the SDM process, integration of SDM with emerging technological platforms, and outcomes of SDM. Recommendations for implementation of and research on SDM for SMI are provided. |
Author | Jeste, Dilip V Blanck, Peter Saks, Elyn R Palmer, Barton W Eglit, Graham M L Martinis, Jonathan G |
AuthorAffiliation | 5 Gould School of Law, Saks Institute for Mental Health Law, Policy, and Ethics, University of Southern California, Los Angeles, CA 1 Department of Psychiatry, University of California, San Diego, La Jolla, CA USA 2 Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA USA 3 Veterans Affairs San Diego Healthcare System, San Diego, CA USA 4 Burton Blatt Institute, Syracuse University, Syracuse, NY USA |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-2 Drs. Blanck and Saks are Co-Senior Authors. Drs. Jeste and Eglit are Co-First Authors. |
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Snippet | Making decisions is central to the exercise of control over one's well-being. Many individuals with serious mental illness (SMI) experience limitations in... OBJECTIVEMaking decisions is central to the exercise of control over one's well-being. Many individuals with serious mental illness (SMI) experience... |
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SubjectTerms | Decision Making Humans Mental Competency - psychology Mental Disorders - psychology |
Title | Supported Decision Making in Serious Mental Illness |
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