Interventions to Facilitate Service User Decisions Around Medication Use for Mental Health Difficulties

Abstract

Individuals experiencing mental health difficulties are frequently prescribed medication as a core component of treatment. Practice guidelines encourage collaboration around treatment decisions and service users often wish to actively participate in the process. The current thesis aimed to explore interventions to facilitate service user decisions around medication use for mental health difficulties and comprises three separate papers that have been prepared for publication. Paper one is a systematic review of interventions to facilitate shared decision-making (SDM) regarding neuroleptic medication use for people experiencing psychosis. It aimed to identify existing SDM interventions; assess the quality of the evidence; and summarise their effect on outcomes. Fourteen randomised control trials met the inclusion criteria. Three types of SDM interventions were identified; training, communication tools and decision aids. Eleven of the included studies found at least one significant outcome favourable for the intervention condition. However, limitations in the methodological quality of all studies were found Paper two is a case series evaluating the feasibility and acceptability of a psychological intervention (Method of Levels; MOL) for medication decision-making. Five participants, who reported ambivalence around psychotropic medication use, received MOL and outcome variables were collected pre-, during- and post-intervention. A qualitative interview was also completed. The findings suggested it is feasible to offer and evaluate MOL in this context and it appeared acceptable to participants. Interpretation of the potential impact of the intervention is limited by the research design but would support the benefit of further research. Paper three is critical reflection of the work completed for the thesis and is not intended for publication. The decisions made throughout the research process are reviewed, and the strengths and limitations are highlighted. The implications for clinical practice and future research are discussed.

Date of Award	31 Dec 2019
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Richard Brown (Supervisor)