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A single conceptualization of mental health based on empirical research has yet to be adopted by researchers and practitioners. This paper aims to explore how diverse Americans define mental health. The aim of the study was to build a conceptualization of the term “mental health”, using qualitative and quantitative methods, on the basis of definitions provided by an ethnically diverse sample of lay-people and professionals.

Concept mapping methods, including multidimensional scaling and hierarchical cluster analysis, were applied to 146 statements generated by 125 participants of diverse American racial and ethnic groups. The resulting concept map was inspected visually, quantitatively and qualitatively.

Out of the 146 statements, 8 overarching themes emerged from multidimensional scaling and hierarchical cluster analysis. Themes include Well-being, balance, coping, adaptability, relational, self, lack of mental illness and physical. T-tests revealed statistically significant differences on ratings of importance for statements within the theme “Lack of Mental Illness” from those included in “Well-Being”, “Balance” and “Coping.” Statements included in the theme “Lack of Mental Illness” were rated least essential to the construct of mental health. The “Self” cluster appeared at the center of the data visualization, suggesting that Americans believe that self is essential to the construct in question.

This mixed-method study is consistent with prior evidence that mental health and mental illness might best be considered separate constructs (Westerhof and Keyes, 2010). A logical follow-up might examine why the concept of “Self” emerges centrally as it would help mental health practitioners and policymakers to focus their understanding of mental health to improve mental health interventions.

Understanding that the concept of “Self” is central to Americans’ conceptualizing of mental health may help mental health practitioners and policymakers to focus their efforts in delivering targeted mental health interventions.

Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context.

The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included.

The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce.

The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care.

The authors highlight several limitations and challenges for the measurement of SDM in mental health care.

Much of the existing literature on shared decision making (SDM) in mental health has focused on the use of decision aids (DAs). However, DAs tend to focus on information exchange and neglect other essential elements to SDM in mental health. The purpose of this paper is to expand the review of SDM interventions in mental health by identifying important components, in addition to information exchange, that may contribute to the SDM process in mental health.

The authors conducted a systematic literature search using the Ovid-Medline database with supplementary scoping search of the literature on SDM in mental health treatment. To be eligible for inclusion, studies needed to describe (in a conceptual work or development paper) or evaluate (in any type of research design) a SDM intervention in mental health. The authors included studies of participants with a mental illness facing a mental health care decision, their caregivers, and providers.

A final sample of 31 records was systematically selected. Most interventions were developed and/or piloted in the USA for adults in community psychiatric settings. Although information exchange was a central component of the identified studies, important additional elements were: eliciting patient preferences and values, providing patient communication skills training, eliciting shared care planning, facilitating patient motivation, and eliciting patient participation in goal setting.

The review indicates that additional elements, other than information exchange such as sufficient rapport and trusting relationships, are important and needed as part of SDM in mental health. Future SDM interventions in mental health could consider including techniques that aim to increase patient involvement in activities such as goal settings, values, and preference clarification, or facilitating patient motivation, before and after presenting treatment options.