The Institute of Medicine ( 1 ) has found the quality chasm framework to be applicable to health care for people with mental health and substance use disorders, and it cites shared decision making as one of the top ten rules to guide the redesign of health care. Shared decision making has been defined as a collaborative process between a client and a practitioner, both of whom recognize one another as experts and work together to exchange information and clarify values in order to arrive at health care decisions ( 2 , 3 ).

Decision aids for practitioners and clients have been developed in general health care to support the shared decision-making process ( 4 ). Decision aids are particularly helpful in reducing decisional conflict associated with making challenging choices in which there are benefits and risks associated with treatment or when empirical evidence is inconclusive or incomplete ( 5 ). Deegan and Drake ( 6 ) have argued that shared decision making and the use of decision aids related to medication management in psychiatry is an ethical imperative, is consistent with the long-standing tradition of building therapeutic alliances in treatment collaboration, and is a superior approach to medical paternalism and insistence on medication compliance.

In this column, we describe a 12-month pilot program to begin to identify best practices for shared decision making in an outpatient psychiatric medication clinic. The primary intervention was the transformation of a typical waiting area in an urban, midwestern psychiatric medication clinic into a peer-run Decision Support Center (DSC). Services at the DSC included establishing peer-specialist protocols to support a welcoming environment, offering a healthy snack and beverage, assisting clients in completing a one-page computer-generated report for use in the medication consultation, giving clients access to health-related information via the Internet, providing informal peer support, and providing support with completing decision aids for helping clients address areas of decisional conflict related to medication use. Medication appointments were redefined to include 30 minutes of work in the DSC before meeting with a physician or nurse.