Shared decision making for psychiatric medication management: a summary of its uptake, barriers and facilitators.

The model of shared decision making with mental health patients and clinicians (doctors and pharmacists) harnesses the benefits of patients becoming partners in their own recovery through improved communication and greater self-advocacy. Shared decision making in mental health services is an emerging model of care which has not been well investigated, however it is seen as the way forward to achieving improved health outcomes for non-pharmacological and pharmacological therapy. Successful implementation of this model requires supporting the process through provision of information and training, use of decision aids, coaching in communication skills and inclusion of family and carers in the decision making process. This summary examines the application of the shared decision making model for psychiatric medication management, including barriers and facilitators.

Development of the My Medicines and Me (M3Q) side effect questionnaire for mental health patients: a qualitative study.

OBJECTIVE: The objective of this study was to assess the acceptability, content validity and usability of the My Medicines and Me (M3Q) self-report side effect questionnaire. METHODS: Eight focus groups consisting of mental health patients, carers, general practitioners, psychiatrists, mental health nurses and pharmacists were conducted, involving 78 participants. Two researchers independently examined the transcriptions and analysed the data thematically using an inductive method. RESULTS: The findings supported changes to the formatting, length and phrasing of questions in the original version of the questionnaire. Although the groups provided differing views on the usability of the M3Q in clinical practice, the patient and carer groups were unconditionally in favour of such a tool to be used systematically to describe patients' subjective experiences with side effects. CONCLUSION: The differing contribution made by all groups involved in the administration and completion of the M3Q assisted with content validity of the questionnaire. The acceptability and usability of this novel side effect questionnaire was also explored, with many participants agreeing it was a necessary tool for a patient centred approach to treatment. Following implementation of the changes to the current format of the questionnaire, investigation into the uptake and use in clinical practice should be carried out.

A clinical communication tool for the assessment of psychotropic medication side effects.

The primary aim was to assess usability of the My Medicines and Me Questionnaire (M3Q) as a self-reported questionnaire for mental health patients to subjectively express side effects experienced with their psychotropic medications. The secondary aim was to evaluate patients' attitudes towards treatment and psychotropic medications following dialogue with their clinicians about side effects. Questionnaires were administered at six adult mental health facilities. A total of 205 participants were divided into intervention (facilitated dialogue) and non-intervention groups (no facilitated dialogue). The mean completion time for the M3Q was 15min (SD=6.5) with only 11 (5%) patients requiring assistance. The most commonly reported side effect was sedation (77%) and weight gain was ranked as the most bothersome (23%). The previously validated M3Q provided patients with the opportunity to express the impact these effects had on their lives. Side effects were the most common reason given for non-adherence. There were no significant changes in patient attitudes towards treatment and medications in the intervention group, mainly due to the logistical challenges in the clinicians' ability to view the questionnaire for the subsequent meeting with the patient. The M3Q demonstrated its usability in allowing patients to easily express their subjective experiences with side effects.

Construction and validation of the My Medicines and Me Questionnaire for assessment of the self-reported side effects of psychotropic medication.

We aimed to construct and assess the psychometric properties of the My Medicines and Me Questionnaire (M3Q), a self-report side-effect questionnaire for mental health patients. Thirty individuals taking a psychotropic medication completed the M3Q side-effect checklist along with the Liverpool University Neuroleptic Side Effect Rating Scale. Thirty healthy comparison individuals also completed the M3Q checklist. Data were analyzed using factorial analysis. Psychometric evaluations including validity and reliability testing were carried out on the questionnaire's checklist. The original 54-item checklist of the M3Q was shortened to include only those items found to be significant in the factorial analysis. The revised 32-item checklist of the M3Q was found to be valid and reliable. The M3Q is a simple, valid and reliable questionnaire that can be used routinely in clinical practice for detecting bothersome side effects of a range of psychotropic medications. This will provide a platform for improved communication between the clinician and the patient.

A review of self-report medication side effect questionnaires for mental health patients.

Side effects of psychotropic medications are important determinants of adherence to treatment. Discussion between the patient and clinician facilitated through the use of a side effect self-report questionnaire (SRQ) could lead to improved communications and treatment adherence. The aim of this review was to 1) identify all currently available side effect SRQs used in the assessment of mental health patients' subjective experiences, 2) evaluate the characteristics of the studies and 3) assess the psychometric properties of each of the questionnaires. Eight electronic databases were searched for peer-reviewed published articles. Six side effect SRQs were identified. Two independent reviewers assessed the quality of the study designs and psychometric properties of the identified SRQs. All questionnaires consisted of closed questions relating to antipsychotic side effects and completion times ranged from 5 to 20 min. Five questionnaires had undergone some form of psychometric testing, ranging from basic to comprehensive. There is a need in everyday clinical practice for a side effect communication tool applicable to all psychotropic medications, which allows the patient to express their subjective beliefs about their medications. This could provide an important contribution to the working relationship between patients and clinicians leading to informed decision-making and improved adherence.

The use of Enhancing Quality Use of Medication Self-Reported Questionniare (EQUIM-SRQ) among mental health consumers: a pilot study.

OBJECTIVE: To assess the applicability, interpretability and potential limitations of an adverse event screening questionnaire (the Enhancing Quality Use of Medication Self-Reported Questionnaire [EQUIM-SRQ]) in an Australian mental health outpatient population. METHOD: Questionnaires were distributed amongst two Australian adult mental health clinics for completion either at the clinic (onsite), or externally (postal option), during March-May 2011. Assistance was offered to participants completing the questionnaire onsite. Clients who were visited in their homes by clinic staff were invited to participate as external participants. RESULTS: Of 160 questionnaires distributed, 29 (18%) were completed. Of those, 22 were completed onsite, and seven were completed externally. Of the questionnaires completed onsite, 11 were fully completed, with 4 participants requiring assistance. A further 11 questionnaires were partially completed, with 2 participants requiring assistance. Of the questionnaires completed externally, 5 were fully completed. CONCLUSION: Although the response rate was low, the EQUIM-SRQ was applicable, interpretable and acceptable when completed or partially completed questionnaires were assessed. The potential exists to apply the EQUIM-SRQ in further research, and thereafter, clinical practice.

Are consumers on community treatment orders informed of their legal and human rights? a West Australian study.

The human and legal rights under the Western Australian Mental Health Act (1996) of involuntary patients on community treatment orders (CTOs) include being provided with information by clinicians about the treatment expectations of the order, the procedure for review of status by the Mental Health Review Board, access to the Council of Official Visitors, and the opportunity for a second opinion about their psychiatric condition. To date, there has been no specific research in this area. This paper presents the findings of a study conducted in Western Australia where consumers on CTOs were asked to provide feedback as to whether they were informed of these legal rights. A questionnaire was distributed which asked eight questions related to being informed of these rights. The results indicated that from the consumer's perspective, the process of providing them with information about their rights was only partially met. Most consumers were informed about first appointments, their right to a review by the Mental Health Review Board, and provided with the appropriate legal form. However, in relation to what it means to be on a CTO, access to the Council of Official Visitors and the right to a second opinion, information was not being provided to the majority of consumers. The findings suggest that mental health clinicians need to make significant improvements in providing information to consumers. This level of consumer engagement could have beneficial results for the development of therapeutic relationships which in turn may lead to improved compliance with the CTO and better health outcomes for the consumer.