Effectively implementing psychiatric advance directives to promote self-determination of treatment among people with mental illness (original) (raw)
Related papers
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.
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.
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.
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.
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.
Psychiatric Advance Directives, a Possible Way to Overcome Coercion and Promote Empowerment
Frontiers in Public Health, 2014
Psychiatric advance directives (ADs) allow an individual to state their preferences for future treatment at times when they may be unable to make considered decisions. There are differences in their form and legal value and the process associated with their use and completion. Several studies have now been completed to assess the impact of ADs on service use and coercion. Their results give a mixed picture but directives nevertheless have the potential to support the empowerment process, minimize experienced coercion, and improve coping strategies. These may in turn reduce the frequency of in-patient service use. Further studies on the different processes of facilitation involved and on different populations are necessary to improve our knowledge and use of these potentially powerful interventions.
Narratives of individuals concerning psychiatric advance directives: Qualitative study
Little is known about the values individuals living with specifi c mental disorders that complete psychiatric advance directives (PADs) hold. The aim of this study is to explore how individuals narrate their experiences with mental illness and PADs in relation to autonomy, mental capacity, medications, involuntary treatment, the doctor-patient relationship, substitute decision-makers, and recovery. Semi-structured interviews were conducted with individuals living in the community with schizophrenia, depression, or bipolar disorder (N=12). Transformation methods were used to yield new and emergent themes. The quality and quantity of trust one has in family members and friends are two important factors to explain why some individuals choose a particular substitute decision-maker when mentally incapable. Individuals perceive PADs as useful for themselves to improve communication with doctors, avoid side eff ects, and prevent involuntary treatment. PADs could be off ered as documents that promote trust in the doctor-patient relationship.
Administration and Policy in Mental Health and Mental Health Services Research, 2010
The aim of this study was to measure expert consensus on the implementation of Psychiatric Advance Directives (PADs) within the Veterans Health Administration. We conducted a two-round Delphi study with 55 panelists including consumers, caregivers, mental health providers and researchers. For a number of items where no positive or negative consensus was reached we found differences between the views of consumers and non-consumers, reflecting consumer's preferences for nonmedical settings for completion and assistance with completion independent of the treatment team. Thus, the principle of consumer choice that applies to MHAD content should also be applied to the process of completion offered.
The journal of the American Academy of Psychiatry and the Law, 2006
Psychiatric advance directives (PADs) are legal instruments that allow competent persons to document their preferences regarding future mental health treatment and to designate a surrogate decisionmaker in the event they lose capacity to make reliable treatment decisions during an acute episode of psychiatric illness. This study reports the findings of a survey of 1,011 psychiatric outpatients in five U.S. cities about their interest in, and completion of, PADs. Across the sites, only 4 to 13 percent of participants had completed a PAD; however, between 66 and 77 percent reported wanting to complete one if given assistance. Significantly higher demand for PADs was found among participants who were female; were nonwhite; had a history of self-harm, arrest, and decreased personal autonomy; and those who felt pressured to take medication. Actual completion of PADs was more likely among participants with higher insight, those reporting leverage by a representative payee, and those who f...