Advance statements in the new Victorian Mental Health Act

Mental health clinician training and experiences with utilization of advance statements in Victoria, Australia

Advance statements, advance directives, or psychiatric wills are a key component of a shift to mental healthcare that promotes autonomy and choice and aims to reduce restrictive and coercive care practices in mental health treatment settings. The use of advance statements has gained momentum to provide a means for individuals to detail clear preferences for mental health treatment. This paper uses a qualitative descriptive design to explore the experiences of clinicians (n = 15) implementing advance statements in the state of Victoria, Australia, a region that introduced advance statements as part of an overhaul of mental health legislation in 2014. The study, reported using the COREQ framework, found two key themes after analysis: experiences of advance statement training, with the availability and quality of training and training as a driver of change emerging as sub-themes, and experiences of advance statements in practice, with participants providing narratives of the barriers and facilitators to successful advance statement implementation. We recommend that clinician and service user experiences of advance statement implementation are further explored to identify existing and emerging barriers to implementation of these tools, which are crucial to achieve autonomy and choice for individuals receiving mental healthcare.

The importance of motivational postures to mental health regulators: Lessons for Victoria's mental health system in reducing the use of force

OBJECTIVE

To consider whether research into "motivational postures" can assist the Victorian Government and the forthcoming Mental Health and Wellbeing Commission to regulate and implement forthcoming mental health laws.

CONCLUSION

Although no research explicitly uses a motivational postures framework, there is evidence of a diverse set of postures amongst the mental health workforce. Some practitioners and disciplines reflect positive motivational postures towards mental health laws and consumer rights, while others show resistance, and others disengagement altogether. More research explicitly built on motivational postures is required to inform appropriate regulatory responses.

Psychiatric advance directives in Australian mental-health legislation

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.