It is increasingly recognised that shared decision making should be routine in all areas of health care. However, although evidence of its effectiveness is emerging, it is not yet standard practice. Reactions from participants in a study of shared decision making for medicines management in mental health care were positive. This way of working is supported by providing good quality information about medicines and alternative treatments, implementing structures that enable the service user’s preferences to be recorded and valued, and acknowledging power differentials and reluctance to change current practice.