A critical narrative analysis of shared decision-making in acute, in-patient mental health care.

Shared decision making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values Based Practice (VBP) framework which offers a theoretical and practical model to promote democratic interprofessional approaches to decision making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision making and examines to what extent decisions about patients’ care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users and carers. The data were analysed using the framework of critical narrative analysis proposed by Langdridge (2007). The findings of the study suggested each group constructed different identity positions which placed them as inside or outside of the decision making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM need to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.