Psychiatric Advance Directives, a Possible Way to Overcome Coercion and Promote Empowerment (original) (raw)
Related papers
Psychiatric advance directives and reduction of coercive crisis interventions
Journal of Mental Health, 2008
Background: Psychiatric advance directives are intended to enable self-determined treatment for patients who lose decisional capacity, and thus reduce the need for coercive interventions such as police transport, involuntary commitment, seclusion and restraints, and involuntary medications during mental health crises; whether PADs can help prevent the use of these interventions in practice is unknown. Aims: This study examined whether completion of a Facilitated Psychiatric Advance Directive (F-PAD) was associated with reduced frequency of coercive crisis interventions. Method: The study prospectively compared a sample of PAD completers (n ¼ 147) to non-completers (n ¼ 92) on the frequency of any coercive interventions, with follow-up assessments at 6, 12, and 24 months. Repeated-measures multiple regression analysis was used to estimate the effect of PADs. Models controlled for relevant covariates including a propensity score for initial selection to PADs, baseline history of coercive interventions, concurrent global functioning and crisis episodes with decisional incapacity. Results: F-PAD completion was associated with lower odds of coercive interventions (adjusted OR ¼ 0.50; 95% CI ¼ 0.26-0.96; p 5 0.05). Conclusions: PADs may be an effective tool for reducing coercive interventions around incapacitating mental health crises. Less coercion should lead to greater autonomy and self-determination for people with severe mental illness.
2007
Psychiatric advance directives (PADs) are legal tools that allow competent individuals to declare preferences for future mental health treatment when they may not be capable of doing so as a result of a psychiatric crisis. PADs allow individuals to maintain self-determination during times when they are most vulnerable to loss of autonomy and in need of assistance to make their preferences known and honored. This article describes the content of twenty-eight open-ended, semi-structured qualitative interviews of adults with PADs who have experienced psychiatric crises. The qualitative analysis revealed three major themes from the interviews: (1) PADs as tools for empowerment and self-determination, (2) limited knowledge of PADs among service providers; and (3) difficulties communicating PADs to inpatient staff. In general, many participants expressed enthusiasm of the implementation of PADs but concern regarding clinicians' general lack of awareness about them. Additionally, some consumers discussed discomfort in even mentioning that they had a PAD to clinicians for fear of a negative response from them, or some type of involuntary treatment during their hospitalization. However, participants consistently viewed PADs as a positive tool to promote autonomy with the potential to facilitate stronger patient-provider relationships. Therefore, when working with individuals in psychiatric crisis who have a PAD, and who have never before experienced a sense of control over their own treatment, clinicians must recognize the potential troubling disequilibrium this sense of control may engender. In sum, though the most significant challenges facing the implementation of PADs involve clinicians' familiarity with and education about PADs, much promise for the future growth of PADs lies in the benefits perceived by the patients. Kim et al.
Commentary: Psychiatric advance directives as tools for enhancing treatment of the mentally ill
The journal of the American Academy of Psychiatry and the Law, 2006
In this issue of the Journal, Swanson et al. explore the demand for and utilization of psychiatric advance directives (PADs), and discuss some of the barriers to their greater acceptance. This author suggests that PADs may be more widely accepted and utilized if they are viewed as tools for maximizing individual autonomy, with an emphasis on optimizing rather than merely restricting care.
Advance directives for psychiatric patients? Balancing paternalism and autonomy
Wiener medizinische Wochenschrift (1946), 2003
Advance directives contain wishes and values, fears and refusals of competent lay people regarding medical interventions in future situations when they might lack communicative and decision-making capacities. However, these advance directives for medical, psychiatric and care interventions can very well be used to improve the care for patients in psychiatry and gerontopsychiatry and to provide individualized care and treatment. The development and use of advance-care documents in psychiatry, and the clinical and ethical appreciation and recognition of the wishes and values of those patients, represent a particularly difficult challenge to medical paternalism.
Psychology, Public Policy, and Law, 2007
Statutes on psychiatric advance directives (PADs) allow competent individuals to document instructions for future mental health treatment in the event of an incapacitating crisis. PADs are aimed at promoting a stronger sense of patient self-determination, considered a central tenet of psychosocial rehabilitation and recovery; however, it is unknown what factors (if any) lead psychiatric patients with PADs to experience this benefit long term. The current study involves examination of 1 year effects on perceived treatment self-determination among 125 people with mental disorders who completed PADs via a 1-on-1 facilitated PAD intervention. Descriptive analyses showed participants documented medically relevant information that would assist doctors in a crisis and participants reported a high level of satisfaction with the facilitated PAD intervention. Multivariate analyses demonstrated that increased sense of autonomy at 1 year was predicted by race, understanding PADs, and verbal memory. Results provide useful guidance for administrators and clinicians, suggesting that PADs show promise in helping empower people with mental illness, especially African-American clients. Further, findings indicate that optimal implementation of PADs will be achieved when facilitated intervention assists people with mental illness to better understand what PADs are and to remember they have a PAD at the time they are experiencing a psychiatric crisis.
Psychiatric advance directives: A tool for consumer empowerment and recovery
Psychiatric Rehabilitation Journal, 2007
Individuals with psychiatric disabilities identify choice and self-direction as central elements of recovery. During times of psychiatric crisis people may experience a frightening loss of choice and self-direction, which can be damaging and traumatic. Psychiatric advance directives (PADs) are legal documents created to address this loss of autonomy and choice during crises by allowing individuals to communicate in the present wishes for care during a future crisis. This paper examines the ways in which PADs support and can be a tool for recovery and discusses future recovery-oriented directions for PAD research and intervention.
Reducing Barriers to Completing Psychiatric Advance Directives
Administration and Policy in Mental Health and Mental Health Services Research, 2008
Objective-Psychiatric advance directives (PADs) allow individuals to plan for future mental health treatment. However, little is known about barriers to PAD completion. This paper examines an intervention's effect in reducing barriers to PAD completion.