Advance directives in mental health care: evidence, challenges and promise

Zelle, Heather; Kemp, Kathleen; Bonnie, Richard J.

doi:10.1002/wps.20268

Cited by 34 publications

(21 citation statements)

References 44 publications

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“…We excluded reviews if they 1) focused only on calculating completion rates of advance medical directives and did not mention any EOL care discussions or interventions; 2) included only pediatric patients (aged <18 years old); or 3) focused on advance treatment directives for psychiatric conditions, which are not related to EOL and involve different dynamics and aims (i.e., to improve recovery-oriented outcomes and be used for psychiatric crises) 27 other than the ACP process addressed in this study.…”

Section: Eligibility Criteriamentioning

confidence: 99%

Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons

Jiménez

Tan

Virk

et al. 2018

Journal of Pain and Symptom Management

371

361

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Preliminary evidence highlights several elements that influence the ACP process and provides a variety of features that could support successful, effective, and sustainable ACP implementation. However, this evidence is compartmentalized and limited. Further studies evaluating ACP as a unified program and assessing the impact of ACP for different populations, settings, and contexts are needed to develop programs that are able to unleash ACP's full potential.

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Section: Eligibility Criteriamentioning

confidence: 99%

Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons

Jiménez

Tan

Virk

et al. 2018

Journal of Pain and Symptom Management

371

361

View full text Add to dashboard Cite

show abstract

“…Their potential impact will depend on their specific nature in each jurisdiction, particularly their legal enforceability. Despite this potential, studies show that they have not had high take up rates in other jurisdictions (Zelle et al 2015;Radenbach et al 2014), and in the absence of enforceable legal standing, are reliant on the support of substitute decision makers (Ruchlewska et al 2016;Radenbach and Simon 2016). This support has not always been widespread (Gooding 2015;Sellars et al 2016;Haw et al 2011).…”

Section: Aiding Recovery and Improving Carementioning

confidence: 99%

“…In light of other literature highlighting low uptake rates (Zelle et al 2015;Radenbach et al 2014) and a lack of support from clinicians (Gooding 2015;Sellars et al 2016;Haw et al 2011), a key implication for policy and practice is that despite the clear intention that advance statements should feature prominently in the new legislative mental health framework, much work remains to be done to increase clinician acceptance. Other studies have highlighted a lack of awareness amongst consumers as the cause of low take up rates, but also highlighted that clinicians are responsible for informing consumers of their existence (Foy et al 2007).…”

Section: Increasing Clinician Acceptancementioning

confidence: 99%

Consumers’ Experiences of Mental Health Advance Statements

Maylea

Jørgensen²,

Matta³

et al. 2018

Laws

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Mental health psychiatric advance directives, advance statements, and similar documents are designed to convey a person's treatment preferences to their treating clinicians at times when, due to their mental health, their ability to communicate or make decisions might be impaired. This paper explores the current debates in the literature and presents the findings of a small qualitative study that explored the experiences of people who had completed advance statements in Victoria, Australia. Data was collected through interviews with participants and analysis of their advance statement. Participants completed their advance statements for two main reasons; to authorise future treatment or to limit the power of their treating team. Participants also included non-treatment preferences that were linked to their recovery and pragmatic considerations, such as contact details and dietary requirements. Participants who had used their advance statement reported a lack of acceptance or inclusion from clinicians. Further consideration of the legal enforceability of advance statements is necessary, and if they are to continue to lack legal force, much work remains to be done to support acceptance by clinicians.

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“…in cases of severe dementia) [ 42 ]. Advance directives are one possible remedy, but these are not currently widely implemented in psychiatry and often focus on other aspects of mental health care [ 43 ]. Consequently, health care professionals may shy away from “difficult discussions” and subsequent “difficult decisions” because they cannot rely on a clear mandate from the patient.…”

Section: Risks Of a Palliative Approach To Psychiatrymentioning

confidence: 99%

Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks

et al. 2016

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BackgroundAs a significant proportion of patients receiving palliative care suffer from states of anxiety, depression, delirium, or other mental symptoms, psychiatry and palliative care already collaborate closely in the palliative care of medical conditions. Despite this well-established involvement of psychiatrists in palliative care, psychiatry does not currently explicitly provide palliative care for patients with mental illness outside the context of terminal medical illness.DiscussionBased on the WHO definition of palliative care, a, a working definition of palliative psychiatry is proposed. Palliative psychiatry focuses on mental health rather than medical/physical issues. We propose that the beneficiaries of palliative psychiatry are patients with severe persistent mental illness, who are at risk of therapeutic neglect and/or overly aggressive care within current paradigms. These include long-term residential care patients with severe chronic schizophrenia and insufficient quality of life, those with therapy-refractory depressions and repeated suicide attempts, and those with severe long-standing therapy-refractory anorexia nervosa. An explicitly palliative approach within psychiatry has the potential to improve quality of care, person-centredness, outcomes, and autonomy for patients with severe persistent mental illness.ConclusionsThe first step towards a palliative psychiatry is to acknowledge those palliative approaches that already exist implicitly in psychiatry. Basic skills for a palliative psychiatry include communication of diagnosis and prognosis, symptom assessment and management, support for advance (mental health) care planning, assessment of caregiver needs, and referral to specialized services. Some of these may already be considered core skills of psychiatrists, but for a truly palliative approach they should be exercised guided by an awareness of the limited functional prognosis and lifespan of patients with severe persistent mental illness.

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Advance directives in mental health care: evidence, challenges and promise

Cited by 34 publications

References 44 publications

Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons

Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons

Consumers’ Experiences of Mental Health Advance Statements

Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks

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