Balancing power in mental healthcare: Why supported decision-making matters

Jasim Alhayki

Jasim is a library and information studies professional with expertise in integrating technology and innovative services into modern library systems.

Imagine being given a powerful medication that can change your mood, thoughts, or even your sense of self, without anyone ever asking you what you truly want or what is important to you. For many people undergoing mental health treatment, especially those on antipsychotics, this is still the reality.

Supported Decision-Making (SDM) aims to shake things up. It is not just a trendy term; it is about ensuring patients have a genuine say in their treatment, especially when the medications can significantly affect their quality of life. However, despite strong ethical and clinical reasons supporting SDM, it is still not consistently applied in mental health care.

SDM: A right, not a privilege

SDM shifts away from a one-sided approach to care and embraces partnerships, allowing patients to shape their treatment actively. Studies indicate that when patients are involved in decision-making, it not only boosts adherence but also eases worries about side effects and aligns with international human rights standards, such as the UN Convention on the Rights of Persons with Disabilities, which advocates for autonomy and informed consent in healthcare (Slade et al., 2017; Morant et al., 2023; Stavert, 2025). However, challenges within the system remain.

Three key barriers to SDM

1. Unreadable information: Patient Information Leaflets (PILS) can often be overwhelming with all the technical jargon, which tends to obscure important risks, such as metabolic side effects. Research by Sustersic et al. (2017) shows that many patients misunderstand these leaflets, which can result in unnecessary worry or sudden medication stops.
2. Clinicians in control: It is still the case that many clinicians tend to steer the conversations. When patients bring up feelings of emotional numbness or mention side effects such as weight gain, they often get brushed off, although platforms like PatientsLikeMe constantly shine a light on these concerns.
3. The digital divide: While websites like MindBalance are great for helping patients keep tabs on their symptoms, the reality is that not everyone has the same access to technology. This, combined with a lack of proper integration into clinical practices, means that marginalised groups often get left out in the cold.

Real stories, real solutions

Online forums such as Bluelight and Mumsnet highlight the shortcomings of traditional care. For instance, a user on Mumsnet talked about how their dissociative symptoms were overlooked by specialists, which led them to look for peer-recommended options like hypnotherapy. These personal stories do not replace clinical data; they provide important context, illuminating the pressing need for empathy and a more personalised approach to care.

3 Ways to bridge the gap

1. Traffic-light risk guides: Colour-coded visuals—where red indicates high risk and green signals low risk—make it easier to understand complex data. This helps patients focus on what matters, like balancing weight gain with managing their symptoms.
2. Symptom-priority rankings: Tools that allow patients to prioritise their needs, like choosing “minimise sedation” over “rapid symptom relief”—help to give them back a sense of control.
3. Digital trackers: Platforms like MindBalance help patients prepare for their appointments by tracking their daily experiences and blending personal insights with clinical evidence.

Clinicians: partners, not authorities

Training clinicians in SDM helps to cut down on paternalism. In trials conducted in Australia, there was a remarkable 40% decrease in dismissive attitudes after workshops that taught doctors how to acknowledge and validate the side effects reported by patients. Even minor adjustments, such as setting aside 20-minute consultation slots specifically for SDM, can go a long way in building trust between doctors and patients (Hormazábal-Salgado et al., 2024; Francis et al., 2024).

Policy changes for lasting impact

SDM is fundamentally a human rights concern. Reforms must elevate patient voices in legislation surrounding informed consent and involuntary treatment. Ghana is making strides to enhance the readability of Patient Information Leaflets (PILS) due to the concerning levels of anxiety and discontinuation among patients. This effort underscores the importance of including patient feedback, especially insights gathered from forums. Similarly, international programs like clinician SDM training in Australia and Canada show that structured methods can help lessen paternalism and foster trust between patients and healthcare providers (Owusu et al., 2020; Hormazábal-Salgado et al., 2024; Francis et al., 2024).

Conclusion: building a future of partnership

Proper mental healthcare is more than just managing symptoms; it is about dignity and collaboration. SDM plays a crucial role by offering clear information, empowering patients, and fostering collaboration with clinicians. Initiatives like Ghana’s patient-informed leaflets and SDM training in other countries such as Canada and Australia are promising steps forward, but real, lasting change hinges on legal reforms that protect patients’ rights. Integrating these rights into policy can create a foundation for the more expansive, sustainable adoption of patient-centred practices.