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Babatunde A, Ruck Keene A, Simpson A, Gilbert S, Stephenson L, Chua KC, Owen G, Simpson AJ, Smith S, Henderson C. Advance Statements for Black African and Caribbean people (AdStAC): protocol for an implementation study. BMC Psychiatry 2023; 23:344. [PMID: 37198589 DOI: 10.1186/s12888-023-04825-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND The UK government committed to legislating for Advance Choice Documents/Advance Statements (ACD/AS) following their recommendation by the Independent Review of the MHA (2018). ACDs/AS are yet to be implemented in routine practice despite evidence and high demand; they are associated with improved therapeutic relationships and a reduction (25%, RR 0.75, CI 0.61-0.93) in compulsory psychiatric admission. Barriers to their implementation are well documented, ranging from low knowledge levels to logistical challenges in accessing the content during episodes of acute care. In the UK this is an issue for Black people, who experience detention rates disproportionately (over three times) higher than those of White British people and have poorer care experiences and outcomes. ACDs/AS allow for Black people to have their concerns heard by mental health professionals in a care system where they often feel their views are ignored. AdStAC aims to improve Black service users' experiences in mental health services in South London by co-producing and testing an ACD/AS implementation resource with Black service users, mental health professionals and carers/supporters of Black service users. METHODS/DESIGN The study will take place in South London, England over three phases: 1) formative work through stakeholder workshops; 2) co-production of resources through a consensus development exercise and working groups; and 3) testing of the resources using quality improvement (QI) methods. A lived experience advisory group, staff advisory group and project steering committee will support the study throughout. The implementation resources will comprise: advance choice document/advance statement (ACD/AS) documentation, stakeholder trainings, a manual for mental health professionals to facilitate the processes of creating and revising advance statements, and informatics development. DISCUSSION The implementation resources will help increase the likelihood of the new mental health legislation in England being implemented effectively; through aligning evidence-based medicine, policy and law to effectively provide positive clinical, social and financial outcomes for Black people, the National Health Service (NHS) and wider society. This study will likely benefit a wider group of people with severe mental illness, as when marginalised groups who are least engaged, can be supported with these strategies, then the strategies are likely to work for others.
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Affiliation(s)
- Abigail Babatunde
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Alex Ruck Keene
- Institute of Psychiatry, Psychology and Neuroscience, 39 Essex Chambers, London, UK
| | - Alan Simpson
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Steven Gilbert
- Steve Gilbert Consulting, Blackthorn House, St Pauls Square, Birmingham, BC 1RL, UK
| | - Lucy Stephenson
- Department of Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF , UK
| | - Kia-Chong Chua
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Gareth Owen
- Department of Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF , UK
| | - Adelabu Jonathan Simpson
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | | | - Claire Henderson
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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Wilson K, Purushothaman S, Kolur U. Psychiatric advance directives and consent to electroconvulsive therapy (ECT) in Australia: A legislative review and suggestions for the future. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 85:101836. [PMID: 36115127 DOI: 10.1016/j.ijlp.2022.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 06/15/2023]
Abstract
Psychiatric Advance Directives (PADs) have been adopted in many jurisdictions around the world and in most Australian states and territories. They are seen as a less restrictive and patient-centered approach to the provision of mental health care. Electroconvulsive therapy (ECT) is a restricted treatment in most jurisdictions in Australia and across the world. This paper explores the history, regulation and use of ECT and PADs and the intersections between them. It provides an overview of the legislative framework in each Australian state and territory and explores some of the issues which have arisen such as complexity of the regulatory framework, making PADs binding for refusing and consenting to ECT, involving treating teams in how PADs are made, using restrictive interventions to implement PADs, and the role of the Tribunal. While PADs are often framed as an important legal tool for allowing patients to refuse psychiatric treatment (especially ECT), the paper emphasizes that they can also be an innovative way for people to consent to psychiatric treatment in advance and an empowering option to access mental health care. It then makes some suggestions for future reform.
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Affiliation(s)
- Kay Wilson
- Melbourne Law School, University of Melbourne, 185 Pelham Street, Carlton, Victoria, Australia.
| | - Subramanian Purushothaman
- University of Queensland, Metro North Mental Health and Royal Brisbane and Womens Hospital, Butterfield Street, Herston, QLD 4006, Australia
| | - Uday Kolur
- University of Queensland, Metro North Mental Health and The Prince Charles Hospital, Rode Road, Chermside, QLD 4032, Australia
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James R, Maude P, Searby A. Clinician knowledge and attitudes of mental health advance statements in Victoria, Australia. Int J Ment Health Nurs 2022; 31:1164-1175. [PMID: 35592928 PMCID: PMC9546340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 06/07/2024]
Abstract
Embedded into Victoria's mental health legislation as part of the 2014 Mental Health Act suite of reforms, advance statements are designed to convey an individuals' preferences for treatment during times when the ability to communicate or make decisions may be impaired. This study investigated Victorian mental health clinicians' knowledge and attitudes of advance statements as well as their experience with training and implementation. We used an online Qualtrics survey of Victorian mental health clinicians (n = 190) to achieve this aim. Instrument validity was determined using the Content Validity Index (CVI) with field experts rating each item for relevance. A value of 80% or higher was sought and computed for each individual item on the scale, as well as for the overall scale. The Cronbach's Alpha coefficient was conducted to determine internal consistency reliability with a value of α = 0.721 for the survey, suggesting that the scale had acceptable internal consistency and reliability. Despite widespread support and positive attitudes towards advance statements existing among mental health clinician participants, the level of knowledge and perception of barriers continues to significantly affect the wide-spread uptake of advance statements. The quality and extent of training in legal and clinical aspects of advance statement varied widely among the study participants, with the quality and benefits of the training affecting participant reported confidence level as well as their practical experience with advance statements. Three recommendations can be made: that advance statements are embed into routine mental health practice to identify individuals who have existing advance statements and support those who do not to prepare one; that regular co-produced and facilitated training be provided to increase understanding, promotion, and overall use and uptake of advance statements; and finally, for local mental health service to develop a culture for positive engagement and promotion of autonomy through inclusive practices around decision-making.
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Affiliation(s)
- Russell James
- School of Nursing, College of Health and MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | - Phil Maude
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health ResearchLatrobe UniversityMelbourneVictoriaAustralia
| | - Adam Searby
- School of Nursing & MidwiferyDeakin University, Institute for Health TransformationGeelongVictoriaAustralia
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Hansen A, Hazelton M, Rosina R, Inder K. What do we know about the experience of seclusion in a forensic setting? An integrative literature review. Int J Ment Health Nurs 2022; 31:1109-1124. [PMID: 35592928 PMCID: PMC9546340 DOI: 10.1111/inm.13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
Seclusion is used in forensic and general mental health settings to protect a person or others from harm. However, seclusion can result in trauma-related harm and re-traumatization with little known about the experience of seclusion for consumers in forensic mental health settings from their perspectives. This article explores consumer experiences of seclusion in forensic mental health settings and explores the differences between female and male experiences of seclusion. Five electronic databases were systematically searched using keywords and variations of experience, attitude, seclusion, coercion, forensic mental health, and forensic psychiatry. Inclusion criteria were original peer-reviewed studies conducted in adult forensic mental health settings reporting data on the experiences of or attitudes towards seclusion. Seven studies met the criteria for inclusion and a quality assessment was undertaken. Results found consumers in forensic mental health settings perceive seclusion to be harmful, a punishment for their behaviour, and largely a negative experience that impacts their emotional health. Some consumers report positive experiences of seclusion. Differences in the experience of seclusion for females and males are unclear. Further research is required to understand the experience of seclusion for women in forensic mental health settings. Identification and consideration of differences in the experience of seclusion for males and females may assist in identifying sex-specific interventions and may inform policy and practices to eliminate or reduce the trauma associated with seclusion use.
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Affiliation(s)
- Alison Hansen
- School of Nursing & Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,School of Nursing & Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michael Hazelton
- School of Nursing & Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Robyn Rosina
- Independent Researcher, Sydney, New South Wales, Australia
| | - Kerry Inder
- School of Nursing & Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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Gumley A, Glasgow A, McInnes G, Jackson C. Mental Health Professionals' Positions in Relation to Advance Statements: A Foucauldian Discourse Analysis. QUALITATIVE HEALTH RESEARCH 2021; 31:2378-2389. [PMID: 34382884 DOI: 10.1177/10497323211036893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Advance Statements enable mental health patients to have their preferences considered in treatment decisions in the event of losing capacity, but their uptake is poor. This is for complex and often conflicting reasons and factors related to service user, clinician, and institutional priorities, which influence clinical practice. A Foucauldian discourse analysis approach was used to explore how 13 mental health clinicians positioned their role in relation to Advance Statements. Five positions emerged from the data: taking account of peoples' wishes, enabling people to have their say (to a point), we know what's best, firefighting with risk, and leverage and liability. Discursive practices demonstrated and reinforced power relations between patients, clinicians, and wider systems. These findings highlight the challenge of legitimizing the knowledge of patients and need for a cultural shift at a systems level, which recognizes the ways Advance Statements meet the needs of all stakeholders.
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Affiliation(s)
| | | | - Gordon McInnes
- Mental Health Network Greater Glasgow and Clyde, Suite 11, Templeton House, Templeton Business Centre, 62 Temple Street, Glasgow, G401DA
| | - Calum Jackson
- Inpatient Psychology Services, Dykebar Hospital, Grahamston Road, Paisley, PA2 7DE
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James R, Maude P, McGrath I. Advance Statements within the Victorian Mental Health Setting: A Contextual and Legislative Global Comparison. Issues Ment Health Nurs 2020; 41:355-365. [PMID: 31714802 DOI: 10.1080/01612840.2019.1652871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides context to the establishment of advance statements within the Australian mental health setting, in the state of Victoria. A movement to legislate for a more humane and liberal approach to mental health consumer care resulted in changes to the Victorian Mental Health Act (2014a). This Act mirrored legislative changes across the western world and resulted in a socially progressive movement embracing recovery focussed care and consumer clinician partnerships. Thus, we purport that an identified need for a more liberal way to work with individuals who have a diagnosis of mental ill health was a major aim of this law reform. The advance statement model is seen as a tool in addressing a growing recognition of how mental health providers engage consumers of mental health services, and value their preferences to care received. This article arises from a larger study which has aimed to explore the role and scope of advance statements. This research has sought to demonstrate how advanced statements can be used within mental health services by providing recommendations for the mental health nursing workforce in relation to the implementation and deliverables for training.
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Affiliation(s)
- Russell James
- Department of Nursing, University of Tasmania, Hobart, TAS, Australia.,School of Health Sciences, RMIT University, Bundoora, VIC, Australia
| | - Phil Maude
- Department of Nursing, University of Tasmania, Hobart, TAS, Australia.,School of Health Sciences, RMIT University, Bundoora, VIC, Australia
| | - Ian McGrath
- School of Health Sciences, RMIT University, Bundoora, VIC, Australia
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Lenagh-Glue J, Thom K, O'Brien A, Potiki J, Casey H, Dawson J, Glue P. The content of Mental Health Advance Preference statements (MAPs): An assessment of completed advance directives in one New Zealand health board. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 68:101537. [PMID: 32033701 DOI: 10.1016/j.ijlp.2019.101537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mental health advance directives support service users' autonomy and provide a voice in their care choices when they may not have capacity to give informed consent. New Zealand's Southern District Health Board has recently introduced advanced directives in mental health services. METHOD Completed advance directives (n = 53) and additional demographic data were accessed from clinical records. ANALYSIS Each advance directive was read and analysed by three members of the research team. The advance directive instrument has eight possible fields which could be completed, covering such topics as who should be contacted in a crisis; people service users do, or do not, want involved in their treatment; what service users would, or would not like to have happen should they become unwell; management of personal affairs; other specific preferences; and provision of further relevant information. The number of preferences stated in each field was also calculated. RESULTS The advance directives provided expressions of preferences which were personally meaningful for service users and provided practical guidance for clinicians. Service users expressed mainly positive preferences, though some expressed negative treatment preferences, and many service users expressed preferences relating to personal affairs. Friends, family members and clinicians were nominated as preferred contacts in a crisis. CONCLUSIONS Service users will engage with advance directives if supported to do so. This study's results should help promote the wider availability of advance directives in New Zealand and the current reform of our mental health legislation.
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Affiliation(s)
| | - Katey Thom
- Centre for Non-Adversarial Justice, Auckland University of Technology, Auckland, New Zealand
| | - Anthony O'Brien
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Heather Casey
- Southern District Health Board, Dunedin, New Zealand
| | - John Dawson
- Faculty of Law, University of Otago, Dunedin, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
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Kokanović R, Brophy L, McSherry B, Flore J, Moeller-Saxone K, Herrman H. Supported decision-making from the perspectives of mental health service users, family members supporting them and mental health practitioners. Aust N Z J Psychiatry 2018; 52:826-833. [PMID: 29952217 DOI: 10.1177/0004867418784177] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Supporting the decision-making of mental health service users fulfils professional, ethical and moral obligations of mental health practitioners. It may also aid personal recovery. Previous research on the effectiveness of supported decision-making interventions is limited. AIMS The study aims to explore from several perspectives the barriers and facilitators to supported decision-making in an Australian context. Supported decision-making was considered in terms of interpersonal experiences and legal supported decision-making mechanisms. METHODS In all, 90 narrative interviews about experiences of supported decision-making were conducted and analysed. Participants were mental health service users who reported diagnoses of schizophrenia, psychosis, bipolar disorder and severe depression; family members supporting them and mental health practitioners, including psychiatrists. The data were analysed thematically across all participants. RESULTS Negative interpersonal experiences in the mental health care system undermined involvement in decision-making for people with psychiatric diagnoses and family carers. Mental health practitioners noted their own disempowerment in service systems as barriers to good supported decision-making practices. All groups noted the influence of prevailing attitudes towards mental health service users and the associated stigma and discrimination that exist in services and the broader community. They believed that legal supported decision-making mechanisms facilitate the participation of mental health service user and their family supporters in supported decision-making. CONCLUSIONS Enabling supported decision-making in clinical practice and policy can be facilitated by (1) support for good communication skills and related attitudes and practices among mental health practitioners and removing barriers to their good practice in health and social services and (2) introducing legal supported decision-making mechanisms.
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Affiliation(s)
- Renata Kokanović
- 1 Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia.,2 Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lisa Brophy
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Bernadette McSherry
- 4 Melbourne Social Equity Institute and Melbourne Law School, The University of Melbourne, Parkville, VIC, Australia
| | - Jacinthe Flore
- 1 Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia
| | - Kristen Moeller-Saxone
- 5 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,6 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Herrman
- 5 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,6 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Ouliaris C, Kealy-Bateman W. Psychiatric advance directives in Australian mental-health legislation. Australas Psychiatry 2017; 25:574-577. [PMID: 28875720 DOI: 10.1177/1039856217726719] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Following the recent widespread reform of mental-health legislation in Australia, psychiatric advance directives (PADs) have now been incorporated in four jurisdictions. We contextualise the potential role for PADs within the Australian legal framework and note their varying introduction across jurisdictions, with a focus on progressive legislation in the Australian Capital Territory (ACT). CONCLUSION The formal recognition of PADs effectively shifts the trajectory of mental-health law towards a stronger recognition of consumer autonomy, albeit to varying degrees across jurisdictions. The most inspiring of these changes may be seen in the ACT Act, where an innovative framing of PAD provisions creates a safe space for clinicians and patients to engage, build therapeutic alliances and develop appropriate frameworks for further change.
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Affiliation(s)
- Calina Ouliaris
- Medical Student, University of Sydney, Sydney, NSW, Australia
| | - Warren Kealy-Bateman
- Clinical Senior Lecturer, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, and; Senior Staff Specialist Psychiatrist, Department of Psychiatry, Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Camperdown, NSW, and; Graduate Student, College of Global Public Health, New York University, New York, NY, USA
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