Psychiatric Advance Directives, a Possible Way to Overcome Coercion and Promote Empowerment

Abstract

Psychiatric advance directives (ADs) allow an individual to state their preferences for future treatment at times when they may be unable to make considered decisions. There are differences in their form and legal value and the process associated with their use and completion. Several studies have now been completed to assess the impact of ADs on service use and coercion. Their results give a mixed picture but directives nevertheless have the potential to support the empowerment process, minimize experienced coercion, and improve coping strategies. These may in turn reduce the frequency of in-patient service use. Further studies on the different processes of facilitation involved and on different populations are necessary to improve our knowledge and use of these potentially powerful interventions.

Preventing Compulsory Admission to Psychiatric Inpatient Care: Perceived Coercion, Empowerment, and Self-Reported Mental Health Functioning after 12 Months of Preventive Monitoring

“…Rogers et al ( 19 , 23 ), who conducted large-scale surveys to investigate the level of empowerment among users of mental health services, identified five factors supposed to be constituent components of patient empowerment: self-esteem/self-efficacy, power, community activism, optimism/control over the future, and righteous anger. Empowerment is considered a key component of recovery ( 24 , 25 ) and has been found to be related to quality of life ( 19 ).…”

Beiträge zur Vermeidung von Zwang in der Akutpsychiatrie

“…Insgesamt muss davon ausgegangen werden, dass gemeinsame Krisenpläne bzw. Behandlungsvereinbarungen nur dann wirksam sind, wenn sie von Seiten der Behandler auch in ausreichender Qualität implementiert und unterstützt werden [49] sinnvoll erscheint die Einbettung in einen fokussierten therapeutischen Prozess [52].…”

“…Krisenpläne und Behandlungsvereinbarungen sollen die Behandlungspräferenzen von Betroffenen gerade auch im Falle ernster Krisen zum Ausdruck bringen und auf diesem Weg Empowerment und Selbstbestimmung fördern [52]. Dies ist nur möglich, wenn die vereinbarten Bestimmungen auch eingehalten werden [49].…”

Regaining ownership and restoring belongingness: impact of family group conferences in coercive psychiatry

“…Belongingness Being connected or related to family and friends (Baumeister & Leary 1995, Gere & MacDonald 2010 Coercion Referring to all forms of pressures exerted on clients to accept treatment, such as persuasion, leverage, inducement, threat and compulsion (Khazaal et al 2014). Measured as perceived coercive treatment, ranging from voluntary professional support (10) to an involuntary admission (0).…”