Topic: This article reviews the literature on shared decision making in health and mental health and discusses tools in general health that are proposed for adapta- tion and use in mental health. Purpose: To offer findings from literature and a product development process to help inform/guide those who wish to create or implement materials for shared decision making in mental health. Sources used: Published literature and research on issues related to shared decision making in health and mental health, focus groups, and product testing. Conclusions: Structured shared decision making in mental health shows promise in supporting service user involvement in critical decision making and provides a process to open all treatment and service decisions to informed and respectful dialogue. Keywords: choice, person centered planning, recovery-oriented care, shared decision making The doctors basically thought they knew what was best for me and I started be- lieving that they did. They kept giving me medicine after medicine and I just wasn’t getting any better. My life was falling apart while they tried to find a perfect medicine. –Barbara, a person who uses mental health services Background Sadly, Barbara’s story is all too com- mon. Even with longstanding values of self-determination within psychiatric rehabilitation (Cohen, Farkas, Cohen, & Unger, 1991; USPRA, 2009; Deegan, this issue), many people who use men- tal health services do not see them- selves as equal partners or feel empowered to make decisions about their mental health treatment and serv- ices. Studies find that people typically want more involvement in their health and mental health treatment decisions than they often experience (Klein, Rosenberg, & Rosenberg, 2007). People using mental health services have a strong desire to be involved in decisions about their medications, an arena often considered the sole purview of the physician (Roe, Goldblatt, Baloush-Klienman, Swarbrick, & Davidson, 2009). The process of mental health recovery hinges on individuals taking personal responsibility for their lives, including making decisions about how medica- tions, treatment, and other services fit into their recovery plan (Schauer, 14 Psychiatric Rehabilitation Journal 2010, Volume 34, No. 1, 14–22 Copyright 2010 Trustees of Boston University DOI: 10.2975/34.1.2010.14.22 Pushing the Envelope: Shared Decision Making in Mental Health ▼ Laurie C. Curtis Advocates for Human Potential, Inc., Montpelier, VT Susan Milstrey Wells Advocates for Human Potential, Inc., Waterford, NY Darby J. Penney Advocates for Human Potential, Inc., Albany, NY Sushmita Shoma Ghose Westat, Appleton, WI Lisa A. Mistler Dartmouth College, Medical School Irma H. Mahone University of Virginia, School of Nursing Miriam Delphin-Rittmon Yale University Paolo del Vecchio and Stacey Lesko SAMHSA, CMHS, Rockville, MD Acknowledgement This article was developed under contract number HHSS 283200700038I (Shared Decision Making: Making Recovery Real in Mental Health Care) from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessari- ly reflect those of SAMHSA or HHS. Special Section