Psychiatric Advance Directives in India: What will the future hold?

Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries

“…However, the concept of psychiatric advance directive is absent in mental health legislation in most Asian countries, with the notable exception of India and the Philippines (Table ). Both of these nations have been grappling with the issue of reconciling psychiatric directives with previous treatment ideologies for several years (Ratnam, Rudra, Chatterjee, & Das, ; Sarin et al, ). They have both recently enacted legislations that enable an individual to register their wishes for treatment in a way that is recognized by local laws.…”

“…The administrative burdens of care plans (Simpson et al, ) may financially challenge nascent mental health systems. In settings where it is newly introduced, service providers' uncertainty of service users' mental capacity may jeopardize the initiation of psychiatric advance directives (Ratnam et al, ; Swanson et al, ). These barriers should be considered as legislators move to enact reforms.…”

“…Specifically in Asia, the establishment of psychiatric advance directives introduces tension when the wishes of the individual are incongruent with societal concerns. Family plays a significant role in determining the course of care, as with any medical decision (Chan, Peart, & Chin, ; Ratnam et al, ). In Singapore, this may be due to cultural norms of Confucianism, but also due to the structure of the market‐oriented healthcare system, which places financial burden on the individual, and by extension, the family (Chan et al, ).…”

Advance statements in adult mental healthcare: an update

“…Recent changes in mental health legislation in different parts of the world have sparked an interest in advance statements, and a number of articles have been published describing implementation challenges and early results from evaluations of adopting advance directives into routine care. In India, psychiatric advance directives have been incorporated into the Mental Health Care Act 2017 (Ratnam 2015) and a number of studies explored different aspects of this process (Sarin 2012; Kumar 2013; Shields 2013; Pathare 2015; Inamdar 2016; Gowda 2018; Tekkalaki 2018). In Australia, psychiatric advance directives have now been incorporated into four jurisdictions (Ouliaris 2017), and the Commonwealth of Virginia, USA, has undertaken efforts to incorporate the completion of psychiatric advance directives into routine mental health services for individuals with severe mental illness (Wilder 2013; Kemp 2015, Zelle 2015).…”

Mental health and human rights: Working in partnership with persons with a lived experience and their families and friends

“…The latter have received special attention in India as they were introduced in 2013 as part of the Mental Health Care Bill. [3]…”