Advance directives empower users and need professionals for implementation

Amering, Michaela; Schaffer, Markus
January 2007
BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1
Academic Journal
Background Psychiatric Advance Directives (PAD) offer persons the opportunity to specify treatment preferences - and register opposition to certain interventions - in the event of a future loss of capacity. PADs are introduced and promoted as vehicles for enhancing the autonomy of mental health service recipients and decreasing coercive measures in psychiatric emergencies. A scientific consensus on what the intervention is and under which circumstances it unfolds which effects is yet to be reached. Methods An overview of the published literature on PADs will be used to illustrate and discuss their relevance, meaning, and effects on patients and on the mental health system. Results There is little question about the high level of interest on the part of consumers, their families and providers. Nor do comprehension or ability to complete a meaningful PAD appear to be commonly encountered barriers, even for those suffering from severe mental disorders. However, progress toward implementing PADs as a routine provision in mental health has not kept pace with such enthusiasm. The complexity of the process of drafting advance directives and the lack of consensus on what kind of support should be offered necessitate ongoing conceptual and research efforts. Legal knowledge as well as ethical considerations vary among the professionals that represent the mental health system vis a vis a patient with an advance directive. Conclusion Obstacles to be overcome in order to use the potential of PADs concern consumers as well as the mental health system and individual professionals. The necessary capacity building processes are likely to empower both consumers and mental health workers.


Related Articles

  • Crisis intervention and acute psychiatry in Amsterdam: 20 years of change? A historical comparison of consultations in 1983 and 2004 - 2005. Dekker, Jack; van der Post, Louk; Visch, Irene; Schoevers, Robert // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background To establish a picture of the changes in emergency psychiatry that have contributed to the sharp increase in the number of acute compulsory admissions in the Netherlands since 1992. Treatment in Amsterdam psychiatric clinics is in danger of being dominated by coercive treatment. These...

  • Joint Crisis Plans reduce coercive treatment. Henderson, Claire; Flood, Chris; Morven, Leese; Thornicroft, Graham; Sutherby, Kim; Szmukler, George // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background To investigate whether a form of advance agreement for people with severe mental illness can reduce the use of inpatient services and compulsory admission. Methods Design: Single blind randomized controlled trial. Setting: Eight community mental health teams in southern England....

  • Compulsory psychiatric treatment of inmates in prisons in Russia. Malkin, Dmitry // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    According to article 99 of the Criminal Code of the Russian Federation those persons who are imprisoned for different crimes but at the same time suffer from psychiatric disorders may receive compulsory treatment by the decision of the court. It is necessary to emphasize that these psychiatric...

  • Istorijat tretmana osoba sa psihičkim teÅ¡koćama u Srbiji i krÅ¡enje njihovih ljudskih prava. PETROVIĆ, NIKOLA M.; ŠAĆIRI, BEJAN // Temida;jun2013, Vol. 16 Issue 2, p33 

    Treatment of persons with psychological difficulties varied in different historical periods, but in its essence remained similar until today. It included an inhumane relationship towards these persons, involuntary treatment through torture, and isolation from society as a kind of punishment for...

  • Review backs government move to extend compulsory treatment. Brody, Simeon // Community Care;9/21/2006, Issue 1641, p10 

    The article focuses on the proposal of introducing compulsory community treatment to people with severe mental illness according to the "Review of Homicides by People With Serious Mental Health Problems," conducted by professor Anthony Maden of Imperial College in England. The government plans...

  • From Rogers to Rivers: The Rights of the Mentally Ill to Refuse Medication. Clayton, Ellen Wright // American Journal of Law & Medicine;1987, Vol. 13 Issue 1, p7 

    Many individuals with mental illness wish to avoid psychotropic drugs, a type of treatment that may relieve their symptoms only at the risk of unpleasant, even permanent, side effects. In marked contrast to the widely-held view that most patients may refuse any treatment and that even patients...

  • Advance directives in psychiatric care: a narrative approach. Widdershoven, Guy; Berghmans, Ron // Journal of Medical Ethics;Apr2001, Vol. 27 Issue 2, p92 

    Ulysses contracts raise a number of ethical questions. In this article the central issues of concern and debate are discussed from a narrative perspective. Ulysses contracts are viewed as elements of an ongoing narrative in which patient and doctor try to make sense of and get a hold on the...

  • Techniques Used by Assertive Community Treatment (ACT) Teams to Encourage Adherence: Patient and Staff Perceptions. Appelbaum, Paul S.; Le Melle, Stephanie // Community Mental Health Journal;Dec2008, Vol. 44 Issue 6, p459 

    Assertive community treatment (ACT) has become a cornerstone of care for people with serious mental illnesses. But it has also been suggested that ACT is an inherently coercive approach, with a variety of techniques, including leverage, frequently employed to encourage treatment adherence. Staff...

  • Racial Disparities In Involuntary Outpatient Commitment: Are They Real? Swanson, Jeffrey; Swartz, Marvin; van Dorn, Richard A.; Monahan, John; McGuire, Thomas G.; Steadman, Henry J.; Robbins, Pamela Clark // Health Affairs;May/Jun2009, Vol. 28 Issue 3, p816 

    In this paper we explore racial disparities in outpatient civil commitment, using data from Kendra's Law in New York State. Overall, African Americans are more likely than whites to be involuntarily committed for outpatient psychiatric care in New York. However, candidates for outpatient...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics