National survey of training of psychiatrists on advance directives to refuse treatment in bipolar disorder

Morriss, Richard; Mudigonda, Mohan; Βartlett, Peter; Chopra, Arun; Jones, Steven H.

doi:10.1192/pb.bp.116.055343

Cited by 7 publications

(14 citation statements)

References 4 publications

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“…Of the included studies, seven were quantitative, seven qualitative and two mixed methods. Quantitative studies (McCormick, Bose, & Marinis, 2017; Morriss, Mudigonda, Bartlett, Chopra, & Jones, 2017; Sawhney, Mukhopadhyay, & Karki, 2009; Schofield et al, 2012; Shah, Banner, Heginbotham, & Fulford, 2010; Willner et al, 2011, 2013) investigated training experiences (Sawhney et al, 2009; and Shah et al, 2010) or post‐training knowledge of psychiatrists and medical trainees (other than Willner et al, 2011 and Willner et al, 2013, who surveyed newly appointed clinical and nonclinical staff members). Response rates tended to be low (27%–55%).…”

Section: Resultsmentioning

confidence: 99%

“…Response rates tended to be low (27%–55%). Bias may also have been introduced due to self‐selection (McCormick et al, 2017; Morriss et al, 2017).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies directly reported on empirical research evaluating defined training programmes (Bose & McFiggans, 2019; Schofield et al, 2012; Willner et al, 2011, 2013). The remainder offered review of professional groups’ knowledge of the MCA and training experiences and outcomes (Manthorpe et al(2009); Sawhney et al (2009); Shah et al (2010); Willner et al (2011); Samsi et al, 2012; Gough and Kerlin (2012); Schofield et al (2012); Manthorpe and Samsi (2016); Marshall and Sprung (2016b); Morriss et al (2017)).…”

Section: Resultsmentioning

confidence: 99%

“…Details of the nature of training and numbers of trainees are generally sparse. In several papers, the findings reflected a range of training types, in which training might have happened recently (Lee‐Foster, 2010; Schofield et al, 2012; Willner et al, 2011, 2013) or up to 2 years previously (McCormick et al, 2017; Morriss et al, 2017; Phair & Manthorpe, 2012; Sawhney et al, 2009), in which case participants may have attended more than one training intervention. In three cases, MCA training was combined with training in related issues (communication (Lee‐Foster, 2010), record‐keeping (Willner et al, 2013), safeguarding and human rights (Pike et al, 2010)).…”

Section: Resultsmentioning

confidence: 99%

“…Some psychiatrists were reluctant (or would refuse) to discuss advance decisions to refuse treatment (Morriss et al, 2017). Nurses mistook “best interests” for a general person‐centred approach (Manthorpe & Samsi, 2016) and care workers limited clients’ choices (Manthorpe & Samsi, 2016).…”

Section: Theme 1: the Nature Of Mca Trainingmentioning

confidence: 99%

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What is the nature of Mental Capacity Act training and how do health and social care practitioners change their practice post‐training? A narrative review

Jenkins

Webster

Smythe

et al. 2020

Journal of Clinical Nursing

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Aim and objective To identify training strategies and determine how registered health and social care practitioners change their practice after Mental Capacity Act training. Design Narrative literature review. Data sources Seventeen databases were searched up to December 2019: CINAHL, Social Care Online, PubMed, Social Policy and Practice, Discover, MEDLINE, Science Direct, Ovid, 0of Science, British Nursing Index, DH‐Data and King's Fund Library Catalogue. Review Methods Empirical studies of any design investigating Mental Capacity Act training were searched and screened. Data were extracted to a bespoke spreadsheet and quality assessed. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Results Of 162 papers identified, 16 were included comprising qualitative, quantitative and mixed‐methods studies. Trainees valued interactive training with close alignment to practice. Training did not lead to demonstrable practice change. Barriers in the context and cultures of care environments were identified. Conclusion To facilitate application of Mental Capacity Act legislation, identified barriers should be addressed. Future training should be interactive, scenario‐based and relevant to trainees’ practice. Relevance to Clinical Practice The Mental Capacity Act is widely misunderstood and implemented poor. Training is proposed as a solution, but the nature of training that will positively affect practice remains unknown. This review aims to address this gap in the evidence base. Interactive training, using scenarios that reflect practice complexities, has the most positive impact. Cultural norms in care environments may impede application of this legislation. The review has international relevance as there is a global imperative to adhere to the United Nations Convention on the Rights of Persons with Disabilities. The review will inform training design and delivery to ensure that people with impaired capacity to make decisions are given the best opportunity to act autonomously.

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Section: Resultsmentioning

confidence: 99%

“…Response rates tended to be low (27%–55%). Bias may also have been introduced due to self‐selection (McCormick et al, 2017; Morriss et al, 2017).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Theme 1: the Nature Of Mca Trainingmentioning

confidence: 99%

See 3 more Smart Citations

What is the nature of Mental Capacity Act training and how do health and social care practitioners change their practice post‐training? A narrative review

Jenkins

Webster

Smythe

et al. 2020

Journal of Clinical Nursing

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Advance Statements for Black African and Caribbean people (AdStAC): protocol for an implementation study

Babatunde

Keene²,

Simpson

et al. 2023

BMC Psychiatry

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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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“Why have I not been told about this?”: a survey of experiences of and attitudes to advance decision-making amongst people with bipolar

Hindley¹,

Stephenson²,

Keene³

et al. 2019

Wellcome Open Res

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Background: The idea that people with severe mental illness should be able to plan in advance for periods of illness as a means of enhancing autonomy has been long debated and is increasingly being enshrined in codes of practice and mental health legislation. It has been argued that the ethical imperative for this is especially pronounced in bipolar (BP), a condition in which sufferers often experience episodic crises interspersed with periods of wellness. However, there is a paucity of published research investigating experiences of advance decision making (ADM) in people with BP or their attitudes towards it. Methods: An online survey of BPUK’s mailing list was conducted. 932 people with BP completed the survey (response rate 5.61%). Descriptive statistics and regression analysis were conducted to compare experience of with attitudes towards ADM and variables associated with interest in ADM. Results: A majority indicated a desire to plan care in advance of losing capacity (88%) but most had not done so (64%). High numbers of respondents expressed a wish to request as well as refuse treatment and most wanted to collaborate with psychiatrists, including on issues around self-binding. The most frequent motivation to utilise ADM was a desire to be more involved in mental health decisions. Interest in self-binding was associated with experience of compulsory treatment and trust in mental health services. Interest in refusals of all medication was associated with younger age and lack of trust in mental health services. Interest in ADM in general was associated with younger age but not educational level, ethnicity or gender. Conclusions: This study demonstrates an appetite for ADM amongst people with bipolar that is independent of educational status and ethnicity. As states reform their mental health laws, attention needs to be given to the distinctive attitudes toward ADM amongst people with bipolar.

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National survey of training of psychiatrists on advance directives to refuse treatment in bipolar disorder

Cited by 7 publications

References 4 publications

What is the nature of Mental Capacity Act training and how do health and social care practitioners change their practice post‐training? A narrative review

What is the nature of Mental Capacity Act training and how do health and social care practitioners change their practice post‐training? A narrative review

Advance Statements for Black African and Caribbean people (AdStAC): protocol for an implementation study

“Why have I not been told about this?”: a survey of experiences of and attitudes to advance decision-making amongst people with bipolar

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