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Gaillard AS, Braun E, Vollmann J, Gather J, Scholten M. The Content of Psychiatric Advance Directives: A Systematic Review. Psychiatr Serv 2023; 74:44-55. [PMID: 36039553 DOI: 10.1176/appi.ps.202200002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Psychiatric advance directives (PADs) enable users of mental health services to express their treatment preferences for future mental health crises. PAD completion rates remain low despite high rates of interest among service users and empirically confirmed benefits of their use. A systematic review of service users' preferences regarding the content of PADs could be a valuable resource for clinicians and policy makers and might help reduce barriers to PAD implementation. METHODS A systematic review concordant with PRISMA guidelines was conducted. CINAHL, Cochrane, EMBASE, PsycINFO, MEDLINE, PubMed, SCOPUS, and Web of Science databases were searched up to July 2, 2021. Included articles contained original empirical data on service users' preferences regarding the content of PADs or a document analysis of existing PADs. Studies were analyzed thematically, and a narrative synthesis was conducted. The Mixed Methods Appraisal Tool was used to assess the methodological quality and risk of bias of the included studies. RESULTS The search yielded 4,047 articles, 42 of which were eligible for inclusion. Six themes emerged (most of which included subthemes): signs of crisis, general treatment approach, preferences regarding the treatment setting, treatment preferences, coercion, and social instructions. CONCLUSIONS The concern that PADs may be unclear or incompatible with practice standards was not confirmed. Service users generally included clear, comprehensible, and clinically relevant information in their PADs, often providing underlying reasons for their preferences. These reasons were related to previous adverse effects of medication and personal experiences with hospital admissions.
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Affiliation(s)
- Anne-Sophie Gaillard
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy, and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Esther Braun
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy, and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy, and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy, and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy, and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
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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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Domingues VN, Castro L, Monteiro MD, Cordero da Silva JA, Rego F, Rego G. Advance Directives: Knowledge of the Topic Among Psychiatrists. Front Public Health 2022; 10:822577. [PMID: 35284390 PMCID: PMC8904751 DOI: 10.3389/fpubh.2022.822577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Advance directives are becoming increasingly important as health technologies evolve. We sought to assess psychiatrists' knowledge of advance directives, as this knowledge is fundamental to the implementation and drafting of these personal documents. Methods A previously published questionnaire that evaluated the knowledge of medical professors was used. The sample, composed of psychiatrists from Rio de Janeiro, Brazil, originated from a publicly available list. During the search process, the COVID-19 pandemic affected Brazil and the rest of the world, which influenced our methodology and results. Results A total of 40 psychiatrists participated in the study. The results obtained, although not significant, suggested that psychiatrists with an increased time of practice had more knowledge of advance directives. Nevertheless, less than half of the participants had knowledge about this topic. Conclusion The number of psychiatrists surveyed indicates the need for further studies on the subject. The influence of the COVID-19 pandemic on this study led to findings such as a change in sensitivity when addressing the topic and greater difficulty in contacting professionals.
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Affiliation(s)
| | - Luísa Castro
- Faculty of Medicine, University of Porto, Porto, Portugal
| | | | | | - Francisca Rego
- Faculty of Medicine, University of Porto, Porto, Portugal
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James R, Maude P, Searby A. Mental health clinician training and experiences with utilization of advance statements in Victoria, Australia. Int J Ment Health Nurs 2022; 31:25-34. [PMID: 34626072 DOI: 10.1111/inm.12939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/31/2021] [Accepted: 09/19/2021] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- Russell James
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Phil Maude
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, Latrobe University, Melbourne, Victoria, Australia
| | - Adam Searby
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
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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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Poremski D, Alexander M, Fang T, Tan GMY, Ong S, Su A, Fung D, Chua HC. Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries. Asia Pac Psychiatry 2020; 12:e12374. [PMID: 31872576 PMCID: PMC7027531 DOI: 10.1111/appy.12374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022]
Abstract
People with mental illness may be unable to provide critical input about the care they wish to receive during a psychiatric crisis because of altered mental states. It is therefore imperative that clinicians seek to understand service users' wishes for care while they are well and able to provide meaningful input into the discussion. Achieving such an end may be done by discussing and completing a psychiatric advance directive. However, very few Asian countries have legislation that supports such advance directives. The present article seeks to give physicians more information about advance psychiatric directives and the potential role they could play to improve the healthcare provided in Asia to people at risk of losing capacity due to a mental illness. The degree to which mental health legislation supports psychiatric advance directives is documented for each country of South East Asia and Eastern Asia.
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Affiliation(s)
- Daniel Poremski
- Health Intelligence Unit, Institute of Mental Health, Singapore
| | | | - Tina Fang
- Health Intelligence Unit, Institute of Mental Health, Singapore
| | - Giles Ming-Yee Tan
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | - Samantha Ong
- Nursing Department, Institute of Mental Health, Singapore
| | - Alex Su
- Medical Board, Institute of Mental Health, Singapore
| | - Daniel Fung
- Medical Board, Institute of Mental Health, Singapore
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Thom K, Lenagh-Glue J, O'Brien AJ, Potiki J, Casey H, Dawson J, Glue P. Service user, whānau and peer support workers' perceptions of advance directives for mental health. Int J Ment Health Nurs 2019; 28:1296-1305. [PMID: 31361087 DOI: 10.1111/inm.12637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 11/30/2022]
Abstract
Advance directives allow users of mental health services to make statements for their future care. In New Zealand, use of advance directives is supported by the Health and Disability Commissioner and was identified in the 2012 Blueprint as a key mechanism for service users to advocate for responses they find most helpful. This study used a qualitative descriptive methodology involving focus groups to explore the perceptions of service users, whānau and peer support workers concerning advance directives. Thematic analysis revealed certain belief patterns about what should or could be included in an advance directive, and about how and with whom one should be created. It revealed generally positive perceptions about how they can uphold service users' right to have preferences considered, to plan flexibly around dynamic needs, and about their value and utility. We conclude that advance directives can support services users' expressions of their preferences for care, but they need to be supported by clinicians if they are to realize this potential. Our findings can also inform service provision in New Zealand, and the planned reform of mental health legislation.
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Affiliation(s)
- Katey Thom
- Centre for Non-Adversarial Justice, Law School, Auckland University of Technology, Auckland, New Zealand
| | | | - Anthony John O'Brien
- University of Auckland, Auckland, New Zealand.,Liaison Psychiatry Service, Auckland City Hospital, 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
- University of Otago, Dunedin, New Zealand
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Jankovic J, Richards F, Berrisford G, Priebe S. Advance statements in adult mental healthcare: an update. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYIn this article we re-examine the conclusions of our article on advance statements in adult mental healthcare that was published in 2010 in the light of new literature published in the intervening decade. We explore the results of studies on the implementation and effectiveness of advance statements in adult mental health services, and then summarise recommendations for legislative changes from the Independent Review of the Mental Health Act 1983 that are relevant for England and Wales.
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Marynowski-Traczyk D, Broadbent M, Kinner SA, FitzGerald G, Heffernan E, Johnston A, Young JT, Keijzers G, Scuffham P, Bosley E, Martin-Khan M, Zhang P, Crilly J. Mental health presentations to the emergency department: A perspective on the involvement of social support networks. Australas Emerg Care 2019; 22:162-167. [PMID: 31300299 DOI: 10.1016/j.auec.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 12/30/2022]
Abstract
The involvement of families, carers and significant others (i.e. social support networks) has a positive corollary for a person experiencing mental health problems. Accordingly, in Australia involvement of social support networks within mental health services is endorsed in national health policy and service guidelines. Despite the endorsement, this is yet to be fully realised in all areas that provide mental health services, including emergency departments. Social support networks are integral in the provision of mental health consumers' care. Supporting the involvement of social support networks in the emergency department can provide healthcare services with opportunities for enhanced and cost-effective care, contributing to improved outcomes for consumers. An overview of some of the barriers and facilitators of social support network involvement is provided. The intention of this paper is to encourage reflection and dialogue on this important area of mental health service provision and support the evolution of a new paradigm of research into social support network involvement in the emergency department.
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Affiliation(s)
- Donna Marynowski-Traczyk
- Griffith University, Menzies Health Institute Queensland, QLD, Australia; University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, QLD, Australia.
| | - Marc Broadbent
- University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, QLD, Australia
| | - Stuart A Kinner
- Murdoch Children's Research Institute, Centre for Adolescent Health, VIC, Australia; University of Melbourne, Melbourne School of Population and Global Health, VIC, Australia; University of Queensland, Mater Research Institute-UQ, QLD, Australia; Griffith University, Griffith Criminology Institute, QLD, Australia; Monash University, School of Public Health and Preventive Medicine, VIC, Australia
| | - Gerard FitzGerald
- Queensland University of Technology, School of Public Health and Social Work, QLD, Australia
| | - Ed Heffernan
- Queensland Forensic Mental Health Service, Queensland Health, QLD, Australia
| | - Amy Johnston
- University of Queensland, School of Nursing, Midwifery and Social Work, QLD, Australia; Department of Emergency Medicine, Princess Alexandra Hospital, QLD, Australia
| | - Jesse T Young
- Murdoch Children's Research Institute, Centre for Adolescent Health, VIC, Australia; University of Melbourne, Melbourne School of Population and Global Health, VIC, Australia; University of Western Australia, School of Population and Global Health, WA, Australia; Curtin University, National Drug Research Institute, WA, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Health, QLD, Australia; Bond University, School of Medicine, QLD, Australia; Griffith University, School of Medicine, QLD, Australia
| | - Paul Scuffham
- Griffith University, Menzies Health Institute Queensland, QLD, Australia; Griffith University, School of Medicine, QLD, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Information Support, Research and Evaluation, QLD, Australia
| | - Melinda Martin-Khan
- University of Queensland, Centre for Health Services Research, QLD, Australia
| | - Ping Zhang
- Griffith University, Menzies Health Institute Queensland, QLD, Australia
| | - Julia Crilly
- Griffith University, Menzies Health Institute Queensland, QLD, Australia; Department of Emergency Medicine, Gold Coast Health, QLD, Australia
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