Shared Decision Making and Peer Support: New Directions for Research and Practice

Peer support and shared decision making (SDM) in mental health care have increasingly been framed as central to high-quality treatment of mental health conditions.Peer support interventions and SDM have some conceptual similarities; both intervention areas evolved in response to a history of coercion in psychiatric care, along with narrow treatment options, limited opportunity for self-determination, and little real choice of treatments and services.Peer support and SDM emphasize person-centered support, better person-defined outcomes, and autonomy and recovery as major goals.Therefore, integration of peer support and SDM within psychiatric services, in the form of peer-facilitated decision support interventions, is seen as a best practice.However, outcomes of peer-facilitated decision support interventions have been largely confined to improved communication between client and provider.As a result, the uptake of these interventions has been limited (1), because, unlike clinical providers, peer support workers are not the ones involved in SDM regarding clinical treatments, which are the common form of contemporary SDM interventions and tools in mental health.The limited impact and infrequent use of peer-facilitated decision-support interventions can be attributed to the fundamental differences between peer support and SDM.These differences are often overlooked or misunderstood in research and practice.In this commentary, we discuss the challenges of using contemporary peer-facilitated decision support interventions to achieve SDM.We also offer new directions for incorporating peer support workers in SDM that will enhance their value as independent advocates via future peer-led SDM interventions for social prescribing of nonclinical services.