The Montgomery ruling, individual values and shared decision-making in psychiatry

This article starts with a brief review of the UK Supreme Court’s decision in the Montgomery case. Although much of the focus in discussing the case has been on the disclosure of risk, an important aspect of the model of consent contained in the judgment is that of dialogue. The model of informed consent set out in Montgomery suggests shared decision-making as the norm. Central to shared decision-making, however, is an awareness of values and of how values can vary between people. We introduce values-based practice as an approach that is entirely in keeping with the precepts of the Montgomery judgment. We go on to review how values-based practice and shared decision-making are relevant to psychiatric practice, using as examples recovery practice and compulsory detention under the Mental Health Act 1983.

LEARNING OBJECTIVES
• Appreciate that a new test of consent has been established as of a result of the UK Supreme Court’s Montgomery ruling
• Learn about the role of values-based practice as a partner to evidence-based practice in implementing Montgomery
• Understand how values-based practice and Montgomery together support shared decision-making in psychiatry