Perceived Barriers and Enablers to Shared Decision-Making in Assessment and Management of Risk: A Qualitative Interview Study with Mental Health Professionals

BackgroundInvolving service users in decisions about their care is essential to delivering recovery-orientated mental health services. Research shows, however, that service users often are not involved in the assessment and management of the risk component of their care. This paper explores mental health professionals perceptions of the barriers and enablers to shared decision-making in risk assessment and management. MethodsWe conducted semilJstructured interviews with fifteen mental health professionals working within either a community mental health or an early intervention service in the United Kingdom. Data collection and analysis were guided by the Theoretical Domains Framework for behaviour change, which encompasses fourteen domains identified as influencing behaviour. ResultsThe findings show that staff are motivated to work collaboratively but experience a complex range of barriers that hinder the implementation of shared decision-making, including challenges related to the individuals mental capacity and level of engagement, managing disagreements, type and level of risk, quality of therapeutic relationships, fear of causing distress or disengagement, and environmental constraints such as time, resources and place of meeting. Enabling factors included a supportive multi-disciplinary team, training they received as part of education and practice, clinical experience providing them with skills, and a belief that equipping individuals with knowledge and understanding of their risk and safety could help them to manage it more effectively. ConclusionThe findings of this study may inform future intervention design to enhance collaboration in the assessment and management of risk and support current clinical practice in this area.