Effect of Psychiatric Advance Directives Facilitated by Peer Workers on Compulsory Admission Among People With Mental Illness

Abstract

This randomized clinical trial examines 12 months of follow-up data on rehospitalization and mental health outcomes for patients with schizophrenia, bipolar I disorder, or schizoaffective disorder who completed psychiatric advance directives with help from peer workers.

Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study)

“…PW-PAD was associated with a significant decrease in total psychiatric inpatient days/nights and with a significant improvement in compulsory admissions, with no significant reduction in the rate of overall psychiatric admissions (Tinland et al ., 2022 ). Our hypothesis is that, rather than preventing psychiatric hospital admissions, PADs may reduce compulsory admissions by making participants more willing to consider voluntary admission when a crisis occurs.…”

“…The benefits in terms of autonomy of PADs were at first only theoretical but have gradually gained ground as studies have shown that PADs improve user involvement, empowerment and recovery; the therapeutic alliance and integration of care, but these positive results are still low in evidence (Nicaise et al ., 2013 ). Recently, a randomized controlled trial that we conducted showed that PADs facilitated by peer workers were associated with fewer symptoms (effect size [95% confidence interval, CI]: −0.20 [−0.40 to 0.00]), higher empowerment (0.30 [0.10 to 0.50]) and higher recovery (0.44 [0.24 to 0.65]) compared to the control group (Tinland et al ., 2022 ).…”

“…The model of PADs that we have experimented in this trial had the originality of being facilitated by peer workers, that is, people with personal experiences of mental distress who are trained to assist users in filling their PAD statement and sharing it with relatives and psychiatrists. We observed that this model of PADs was associated with a significant reduction of over 32% in the proportion of compulsory hospitalized people (main criterion of our trial) (Tinland et al ., 2022 ). As in the Molyneaux’ meta-analysis, we found a less clear effect on voluntary hospitalizations and on the total number of hospital admissions.…”

Crisis plans in mental health: A scoping review

“…For example, in the United States (Scholten et al, 2021), despite the legal nature of the plan, healthcare professionals can override the decisions made by the service user in their Psychiatric Advance Directive if they deem the measures to be impossible to apply or if it is an emergency situation, which raises serious ethical questions about the service user's right to play an active role in their care (Braun et al, 2022; Scholten et al, 2021; Wilson et al, 2022). This type of situation can also lead to ethical distress for healthcare professionals who find themselves in an ethical dilemma between the principle of benevolence and autonomy (Hem et al, 2018; Tinland et al, 2022).…”

Preparing for Mental Health Act reform: Pilot study of co-produced implementation strategies for Advance Choice Documents

“…The European trial explored different options for facilitators and concluded that a trained peer supporter could achieve better results than clinicians in support for drafting ADM documents ( Ruchlewska et al , 2014 ). A recent randomised controlled trial in France also concluded that ADM documents completed by service users with SMI supported by peer workers resulted in significantly fewer compulsory admissions ( Tinland et al , 2022 ). Interestingly, the New Zealand experience suggested that more service users were able to complete their document with a clinician, the key factor being trust rather than nature of the facilitator’s previous experience ( Lenagh-Glue et al , 2021 ).…”