Shared decision making has found its way into mental health care to a limited extent only, and especially "challenging" patients do not benefit from this approach. The authors describe barriers to shared decision making among mental health professionals and among patients. They propose an integrative approach-SDM-PLUS-that fosters shared decision making in mental health settings. SDM-PLUS empowers both patients and mental health care providers. Patients are empowered to become more active and self-confident and to acquire greater skills in regard to health literacy and communication. Providers are trained in analyzing decisional situations and are empowered to use a wider array of communication strategies to optimize patient participation.