Speaker 1: It takes 10 years, on average, for mental health treatment to begin after symptoms appear. If it even does begin, fewer than 1 in 3 receive minimally adequate treatment for mental health issues. Fewer than 1 in 10 receive evidence-based psychotherapies recommended as first-line treatments for issues like PTSD, anxiety, and insomnia. And many who do, drop out after a handful of visits. The unrealized promise of mental health care reflects a failure to engage patients in effective and personalized treatment. When patients begin mental health treatment, they often do so without an opportunity to choose and prepare for the treatment that's best for them. But there is hope for change, by changing the process from the start, by empowering people to see and choose a new path, even before treatment begins. This is Shared Decision Making, brought to the world of mental health care, and put into action in a brief intervention, known as the Shared Decision Making Session, for increasing treatment engagement and success among Veterans and others. Shared Decision Making is a process where the patient and provider work closely together to make decisions about treatment. The provider empowers the patient with information about different treatments and how they work. Armed with knowledge about options and their possibilities, the patient chooses the path forward that best fits them and their preferences. With the informed Veteran in the driver's seat, this provides for more personalized treatment and a more engaged, motivated, and prepared patient. Shared Decision Making is now often practiced in general health care settings, and research shows it's linked to many positive outcomes, including higher patient satisfaction, confidence, and participation in treatment, and even greater uptake of evidence-based psychological treatments among Vets. It's no surprise, then, that Shared Decision Making is strongly recommended for increasing Veteran engagement in evidence-based treatments for PTSD and other conditions. Now, as an exciting new approach, the SDM Session is bringing the principles and practices of Shared Decision Making to life in mental health care. It's a structured yet flexible process for empowering and engaging patients prior to treatment. And it goes beyond traditional Shared Decision Making, focusing more broadly on treatment motivation, readiness, and engagement. The SDM Session is being implemented in facilities throughout the VA health care system and in the community. The approach may be used in mental health, primary care, and other settings. And it's practical, usually requiring just a single session. The SDM Session is described in detail in a highly applied and free toolkit that includes in-session tools and interactive resources. The approach includes a dynamic, highly collaborative six-step process. Step 1. Connect. First impressions go a long way in life and treatment. Connection and trust are central to the commitment to change. In this initial step, the provider uses specific skills to connect closely with the patient's experience, presenting as a caring and concerned ally. Reflecting the session's primary goal of interpersonal engagement, the focus on connection doesn't end here. It continues throughout the session. Step 2. Motivate. Low motivation and ambivalence are common enemies to engagement and the specific focus of Step 2. The first part of this step involves assessing treatment motivation by exploring the patient's beliefs and assumptions about treatment. The next part focuses on increasing treatment motivation. Using open-ended questions, the provider helps the patient see how their life could be different. During this process, non-directive techniques are used to reinforce change talk and to respond to sustain talk, or a patient's reasons for maintaining the status quo. Step 3. Educate. Knowledge is power, especially when making treatment decisions. During the Educate step, the provider empowers the patient with information about treatment options to increase informed choice and agency. Interactive decision aids are used to tailor discussion of specific treatments, how they work, their benefits, and side effects. Animated, character-based videos may also help engage patients in learning about specific therapies. Through close discussion and active listening, the provider helps support understanding and personal meaning of information. Step 4. Explore. Values and preferences hold the key to person-treatment fit. In this step, the provider digs deep to explore what's important to the Veteran. This serves as a lens through which treatment options are then considered. In the Veteran's world, what lifestyle, cultural, or other personal factors are consistent or inconsistent with one or more treatment options? Using specific techniques, the provider helps the patient filter the treatment information through their identified values and preferences. Step 5. Set goals. Making the abstract real can be a powerful motivator and decider for treatment. In this step, the provider helps the patient identify potential treatment goals, both for increasing motivation and for facilitating the final treatment decision. By bringing treatment concepts down from the abstract to the Veteran's life, this step makes treatment more real and accessible. Step 6. Choose. In this final step of the collaborative journey, the provider guides the patient to select treatment or other next step. During this discussion, the provider elicits and provides summaries to tie together key points and discoveries from earlier steps. Aligning with the patient is important here for supporting where they are in their decision-making and for leaving lasting impressions of hope and trust. Once a decision is reached, the provider helps problem-solve and head off potential barriers to putting the plan into action. In some cases, a patient may not be ready to begin active treatment due to high stress or limited coping skills. For these situations, an optional Preparatory Skills Building, or PSB, protocol is included for increasing treatment readiness. PSB is an individualized process for teaching key coping skills in three areas. Reducing physiological arousal, increasing attentional focus and control, and addressing maladaptive thinking. Provider tip sheets offer scripts, apps, and other tools for teaching each skill. Included in the Evidence-Based Psychotherapy Shared Decision-Making Toolkit is a practical in-session guide for implementing the six steps of the SDM session. The toolkit also includes provider and patient handouts, case examples, and dialogue to support busy providers in delivering the SDM session and PSB protocol. Whether public or private system, local clinic or private practice, the All-in-One Toolkit brings the SDM session alive as an effective and practical approach for mental health patients. By empowering and engaging Veterans before treatment starts, we have an opportunity to truly realize the promise of mental health care. Bringing key ingredients of shared decision-making to mental health, the SDM session provides a structured, flexible, and feasible approach to increasing informed choice, motivation, and agency. Learn more about this exciting pretreatment intervention and free tools for empowering and activating your patients at Treatment Works for Vets.