“I Would Like Someone to Hear Me”: Understanding Stakeholder Perceptions in Pursuit of Improving Collaborative Decision-Making among People with Serious Mental Illness

Objective: Collaborative decision-making is valued by people with serious mental illnesses and associated with important outcomes like treatment engagement and satisfaction, but levels of collaboration remain low. We developed a skills training manual to increase consumer ability to initiate and engage in collaborative decision-making in the hopes of facilitating higher levels of collaboration. Our study included two aims: 1) to understand stakeholder perception of collaborative decision-making, and 2) to gain feedback from stakeholders regarding the skills training manual to inform manual revisions.Methods: Eleven consumers with serious mental illness and eleven providers of mental health treatment were recruited. Each participant received a copy of the skills training manual and engaged in one of two mixed participatory dialogues with eleven participants each.Results: Stakeholders reported having a positive perception of collaborative decision-making, but also reported concern about a number of barriers that may inhibit collaborative interactions. Participants believed that increases in collaboration would have to come from consumer self-advocacy despite provider resistance. Stakeholders responded positively overall to the skills training manual, but made a number of suggestions to improve it, leading to 10 revisions.Conclusions and Implications for Practice: Stakeholders’ response emphasizes the desirability and importance of improving CDM, and suggests that a consumer-led intervention is a promising method to do so. Participatory dialogues were not only an effective method to gather data for this study, but also provided a structured and supportive space for consumers to speak to and with providers, including responding directly to stigma among providers.