From treatment adherence to advanced shared decision making: New professional strategies and attitudes in mental health care

Treatment adherence is related to "self-regulation" of prescribed drugs. Patients organise their drug intake around their own priorities, which may be very different from prescribers' priorities, since most of the patients value theirpersonal concerns and/or their social roles more than the benefits of a prescribed treatment. A gap exists between patients'and professionals' views. This gap is mainly related to patients' health beliefs and physicians' attitudes. A number ofstrategies can help professionals overcome gaps between their treatment options for depression and schizophrenia and the"real world" alternatives shared by the lay public, patients, their relatives, and political stakeholders. These strategiesinclude integrated care and recovery, family engagement, and the development of a mutualistic patient/physicianrelationship with the adoption of advance directives and appropriate guidelines that incorporate the patient's choices. Theeffective implementation of these combined strategies within the person-centred care model empowers patients tocollaborate with mental health professionals and their families in making complex health care choices. Barriers to thisprocess include factors affecting the control, contact and communication facets of the patient/physician relationship.