The balance of involvement between staff and service user in clinical decision making can be conceptualized as a continuum from paternalistic or passive through shared to informed or active. There is some evidence suggesting that shared decisionmaking contributes to better treatment outcomes. People with mental illness want a say in their care and it has been shown that sharing medical decisions is possible, even with people with severe and acute mental illness. However, despite shared decision making being increasingly recommended in treatment guidelines, paternalistic decision-making remains common. Especially psychiatrists seem to be skeptical and hesitant to integrate principles of shared decision making in their daily practice.

Research so far has mainly focused on how to help patients make decisions, or on how to understand the degree of involvement in decision making desired by the patient, but not on vital aspects of decision-making in routine care. This presentation will give a practice-oriented overview of research on decision making in mental health care including a discussion of the reasons for the lack of adoption of shared decision making in daily practice.