Advance statements in adult mental health

Jelena Jankovic; Felicity Richards; Stefan Priebe

doi:10.1192/apt.bp.109.006932

Advance statements in adult mental health

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.109.006932 ◽

2010 ◽

Vol 16 (6) ◽

pp. 448-455 ◽

Cited By ~ 10

Author(s):

Jelena Jankovic ◽

Felicity Richards ◽

Stefan Priebe

Keyword(s):

Mental Health ◽

Psychiatric Treatment ◽

Mental Capacity ◽

Treatment Preferences ◽

Limited Evidence ◽

Adult Mental Health ◽

Satisfaction With Treatment ◽

Barriers To Implementation ◽

Advance Statements ◽

Advance Decisions

SummaryThis article reviews the literature on advance statements, including current mental health law and guidance in England and Wales, ethical and practical advantages, disadvantages and barriers to implementation. The idea of planning psychiatric treatment for a time when mental capacity may be impaired is not new. Yet there has been a renewed interest following the introduction of the Mental Capacity Act's 2005 provision of legally binding advance decisions to refuse treatment. In addition to information on treatment refusals, advance statements provide information on treatment preferences and personal care instructions which, although not legally binding, should inform treatment decisions. Advance statements are not yet widely used, but existing limited evidence suggests that they could reduce coercion and improve service users' satisfaction with treatment.

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Mental capacity and mental health Acts part 1: advance decisions

British Journal of Nursing ◽

10.12968/bjon.2014.23.14.812 ◽

2014 ◽

Vol 23 (14) ◽

pp. 812-813 ◽

Cited By ~ 2

Author(s):

Richard Griffith

Keyword(s):

Mental Health ◽

Mental Capacity ◽

Advance Decisions

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Advance statements: the view from Scotland† Commentary on … Advance Statements in Adult Mental Health

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.109.007856 ◽

2010 ◽

Vol 16 (6) ◽

pp. 456-458 ◽

Cited By ~ 2

Author(s):

Jacqueline M. Atkinson

Keyword(s):

Mental Health ◽

Health Care ◽

Decision Making ◽

Mental Health Care ◽

Medical Decisions ◽

Adult Mental Health ◽

Personal Statement ◽

Advance Statements ◽

Care And Treatment ◽

Legal Meaning

SummaryAdvance statements in Scotland have a specific legal meaning and come into effect when someone is subject to the Mental Health (Care and Treatment) (Scotland) Act 2003. This Act requires a person being compulsorily treated to have significantly impaired decision-making ability in respect of medical decisions. The advance statement is intended to cover treatment wishes – both refusal and acceptance of treatment. In addition, a personal statement can be made which covers wider issues. There is evidence that in many statements these are being combined, raising questions about what is meant by treatment. Issues of revoking advance statements are also considered.

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Capacity and Consent in England and Wales: The Mental Capacity Act under Scrutiny

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180110000125 ◽

2010 ◽

Vol 19 (3) ◽

pp. 344-352 ◽

Cited By ~ 3

Author(s):

PETER HERISSONE-KELLY

Keyword(s):

Mental Health ◽

Learning Disabilities ◽

Mental Health Problems ◽

Legal Framework ◽

Mental Capacity ◽

Decision Makers ◽

England And Wales ◽

Mental Capacity Act 2005 ◽

Advance Decisions ◽

Mental Capacity Act

The Mental Capacity Act 2005 came into force in England and Wales in 2007. Its primary purpose is to provide “a statutory framework to empower and protect people who may lack capacity to make some decisions for themselves.” Examples of such people are those with dementia, learning disabilities, mental health problems, and so on. The Act also gives those who currently have capacity a legal framework within which they can make arrangements for a time when they may come to lack it. Toward this end, it allows for them to make advance decisions (in effect, refusals of consent to certain forms of treatment) or to appoint proxy decision makers with lasting powers of attorney.

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Retrospective views of psychiatric in-patients regaining mental capacity

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.065151 ◽

2009 ◽

Vol 195 (5) ◽

pp. 403-407 ◽

Cited By ~ 26

Author(s):

Gareth S. Owen ◽

Anthony S. David ◽

Peter Hayward ◽

Genevra Richardson ◽

George Szmukler ◽

...

Keyword(s):

Mental Health ◽

Decision Making ◽

Psychiatric Treatment ◽

Treatment Decisions ◽

Mental Capacity ◽

Self Determination ◽

Surrogate Decision Making ◽

People With Mental Illness ◽

Surrogate Decision ◽

Few Data

BackgroundAn individual's right to self-determination in treatment decisions is a central principle of modern medical ethics and law, and is upheld except under conditions of mental incapacity. When doctors, particularly psychiatrists, override the treatment wishes of individuals, they risk conflicting with this principle. Few data are available on the views of people regaining capacity who had their treatment wishes overridden.AimsTo investigate individuals' views on treatment decisions after they had regained capacity.MethodOne hundred and fifteen people who lacked capacity to make treatment decisions were recruited from a sample of consecutively admitted patients to a large psychiatric hospital. After 1 month of treatment we asked the individuals for their views on the surrogate treatment decisions they received.ResultsEighty-three per cent (95% CI 66–93) of people who regained capacity gave retrospective approval. Approval was no different between those admitted informally or involuntarily using Mental Health Act powers (χ2 = 1.52, P = 0.47). Individuals were more likely to give retrospective approval if they regained capacity (χ2 = 14.2, P = 0.001).ConclusionsMost people who regain capacity following psychiatric treatment indicate retrospective approval. This is the case even if initial treatment wishes are overridden. These findings moderate concerns both about surrogate decision-making by psychiatrists and advance decision-making by people with mental illness.

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Advance statements: survey of patients' views and understanding

Psychiatric Bulletin ◽

10.1192/pb.bp.106.013599 ◽

2007 ◽

Vol 31 (9) ◽

pp. 339-341 ◽

Cited By ~ 6

Author(s):

Jane Foy ◽

Alison Macrae ◽

Alex Thom ◽

Ajay Macharouthu

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Health Professionals ◽

Treatment Preferences ◽

Clinical Implications ◽

Loss Of Control ◽

Mental Health Legislation ◽

Advance Statements ◽

Types Of Information ◽

Health Legislation

Aims and MethodA survey of patients was undertaken to determine their knowledge and understanding of advance statements (a new addition to Scottish mental health legislation introduced with the Mental Health (Care and Treatment) (Scotland) Act 2003). Few patients have taken up this facility and this study attempts to identify potential explanations.ResultsA minority of the initial 58 participants had heard of advance statements prior to the survey (5 of 58, 8.6%). After issuing information about advance statements, awareness and understanding increased significantly among those who completed the study, with 59% (16 of 27) now understanding the concept. The types of information that patients wished to be documented in an advance statement fell into two broad groups: treatment preferences and statements regarding loss of control and autonomy. Out of 27 participants 19 (70%) stated they would now consider drawing up an advance statement.Clinical ImplicationsA lack of knowledge among patients about the existence of advance statements is highlighted. After a brief intervention, awareness, understanding and interest increased significantly, suggesting that poor uptake could be because of lack of awareness. Most participants would consult mental health professionals when drawing up an advance statement, therefore we have a responsibility to be fully informed about the process.

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