Variations in Consumer Self-determination within US Psychiatric Advance Directives

Abstract

Advance directives are legal documents that formalize consumer psychiatric care preferences. This article examines the statutes and goals of US psychiatric advance directives within the framework of consumer self-determination, a priority in national mental health reform. It seeks to distinguish between state models based on the degree that consumer rights are integrated into advance directive statutes and goals. The data set contains information from legislative statutes and goals from the 24 US states that enacted explicit psychiatric advance directive regulations prior to 2006. Researchers grouped the data into categories based on the similarities in consumer self-determination. The findings include an examination of the spectrum of consumer self-determination in US advance directive statutes along with a comparison of the gaps between intent and policy in state statutes.

The discursive construction of care when there is no care to be found: Organizational life (re)framed by those on the socio‐economic margins facing job loss

“…Another reason given for the closure was the financial burden and the lack of efficiency when running such a large facility. This reason was attached to both the state's fiscal challenges and the 'patient as consumer model' that is indicative of the privatizing trend in health care (Zeman and Swanke 2008). Both of these primary reasons can be traced back to the 2001 state legislative decision to 'move mental health patients from state hospitals to community-based providers' (Coletti 2008, 3).…”

“…Multiple factors have driven 'mental health care reform'. They include competition and consolidation (Coombs 2005); 'an ethos of consumerism' that has resulted in a focus on care in the community (Petersen, Kakanovic, and Hansen 2002;Zeman and Swanke 2008); and an overall health care industry shift to managed health care systems (Oliver 2002;Stroul et al 1998). As diverse as the reasons are, the results are quite similar.…”