The Elephant in the Room: A Theoretical Examination of Power for Shared Decision Making in Psychiatric Medication Management.

Shared decision making (SDM) is an important tool for recovery-oriented practice in mental health services. It has been defined using narrow and broad conceptualizations. One overarching theme that merges the differing models is the emphasis on a rebalancing of power, with experiential knowledge holding equal weight in the encounter, alongside more traditional “medical” forms of knowledge. Nevertheless, the concept of power and how it is enacted and shared has received relatively little attention in the wider SDM literature. Yet, it is fundamental both to the principles and models of SDM more generally and to the recovery model within mental health services more specifically. This article explores the theoretical concept of power in the context of SDM for psychiatric medication management practice. It highlights the diverse structural components of the U.K. contemporary mental health system, their intersections, and the resultant opportunities for persons to take back control and enact their agency.