Psychiatrists’ views on different types of advance statements in mental health care in Germany

Abstract

Background: Advance directives enable patients to ensure that treatment decisions will be based on their autonomous will, even if they are incompetent at the time at which the treatment decision is taken. Although psychiatric advance directives are legally binding in Germany and their benefits are widely acknowledged, they are still infrequently used in German psychiatric practice. Aims: The aim of this study is to assess psychiatrists’ attitudes toward the use of advance statements in mental health care. Methods: A postal survey of psychiatrists in Germany was carried out to examine their views on advance statements in psychiatry. The survey addressed psychiatrists’ experiences of and attitudes toward different types of advance statements, including psychiatric advance statements written by patients without any specific assistance, and joint crisis plans ( ‘Behandlungsvereinbarungen’), where involvement of the clinical team is required. A total of 396 responded. Results: Results suggest that generally speaking, respondents held favorable views on joint crisis plans for mental health care. In all, 80.7% of participants agreed that more frequent use of joint crisis plans in clinical practice would be desirable. However, clinicians’ attitudes differ largely depending on the type of advance statement. Implications for the use of advance statements in psychiatry are discussed. Conclusion: The findings suggest that increasing the support structures available to train physicians and inform patients could lead to increased adoption of advance statements.

Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional's viewpoint

“…Nurses are ethically (morally), professionally and legally accountable for their actions (Wilson, Woollands, & Barrett, ). Given their key position as therapeutic agents and as part of the care team, nurses might work within interdisciplinary teams and support user decision‐making and ACP processes (Gieselmann et al, ).…”

“…Consequently, the Council of Europe recommended member states modify their policies regarding bioethics and legislation in the mental health field (Council of Europe, ; European Parliament, ) to include active participation in decision‐making processes and to regulate advance healthcare directives (Slade, ) in line with Article 12 of the CRPD. Member states were also recommended to align their legislation accordingly and to provide appropriate measures for supported decision‐making and AHDs (Gieselmann, Simon, Vollmann, & Schöne‐Seifert, ).…”

Knowledge and attitudes of Spanish mental health professionals towards advance healthcare directives

“…This implied the inclusion of users of mental health services in decision‐making processes and the regulation of advance healthcare directives (AHDs) in line with Article 12 of the CRPD (Slade, 2017). Member states were also advised to align their legislation accordingly and to provide appropriate measures for supported decision‐making and AHDs (Gieselmann, Simon, Vollmann, & Schöne‐Seifert, 2018).…”

“…Unlike the availability of end‐of‐life care AHD registries, no generic or specific models for AHDs in the context of mental healthcare have yet been legally established in any branches of the Spanish mental health system. Low rates of use (4%–11%) are reported for all the available AHD legal documents in the United States (Swanson et al, 2006) and some European countries, including Germany (Gieselmann et al, 2018) and England and Wales (Owen et al, 2019). Nonetheless, the completions of AHDs within the Spanish mental health services are currently almost non‐existent.…”

Akzeptanz von psychiatrischen und somatischen Patientenverfügungen: ein Vergleich unter psychiatrischen Patienten und Fachpersonen

“…Gegenüber der in früheren Publikationen beschriebenen kritischen Haltung, insbesondere von Fachpersonen [13,14,20], und der geringen Verbreitung von PPV [15,16,[20][21][22], war die Akzeptanz der PV in den vorliegenden Fallbeispielen bei allen Teilnehmergruppen hoch.…”