The Neglected Constructs of Health Literacy, Shared Decision-Making, and Patient-Centered Care in Behavioral Health: An Integrated Model

Abstract

Behavioral health costs have continued to escalate in the United States, with 36.2 million Americans paying a total of $57.5 billion in 2006 for behavioral health services (National Institute of Mental Health (2006) Mental healthcare cost data for all Americans (2006). Retrieved from National Institute of Menal Health. https://www.nimh.nih.gov/health/statistics/cost/mental-healthcare-cost-data-for-all-americans-2006.shtml). This increased expense has led to the proposal of a number of possible solutions to reign in the escalating cost of both medical and behavioral health treatments. Among these proposals are three important, and what will be argued interrelated, concepts: behavioral health literacy, shared decision-making, and patient-centered care. While these constructs are frequently mentioned as possible avenues to reduce healthcare costs and generally improve the quality and experience of care, the terms themselves are ill-defined, and consequently poorly measured, and inconsistently implemented. Despite the lack of agreed-upon definitions, several methods of defining and measuring these three constructs have been developed, but it raises the question about what these constructs and measures are capturing. What follows is a critical review of the existing definitions of each construct, with the intent of developing a more useful, adequate definition for each construct. Additionally, methods of adapting each construct to behavioral health applications will be proposed. Finally, guidelines of how an integrated construct comprising of the three constructs might be implemented in the behavioral health setting will be presented.