Background So far, shared decision-making has found its way into mental health care to a limited extent only and especially “challenging” patients (e.g. those with limited insight or reduced decisional capacity) do not benefit from this development.

Aim To describe an integrative approach (SDM-PLUS) that fosters shared-decision making in the very acute mental health settings and for patient groups suffering from severe mental illnesses.

Discussion The basic idea is an empowerment strategy addressing both patients and mental health care providers. While patients need to be empowered to become more active, self-confident and better skilled (regarding health literacy and communication) mental health care professionals need to be trained in analysing decisional situations and empowered to have more communicative strategies at hand, to optimise the environment of decisional processes and to be more confident regarding their communicative skills consequently resulting in their increased ability to share more decisions with their patients.