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Francis CJ, Johnson A, Wilson RL. Supported decision-making interventions in mental healthcare: A systematic review of current evidence and implementation barriers. Health Expect 2024; 27:e14001. [PMID: 38433012 PMCID: PMC10909645 DOI: 10.1111/hex.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND There is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In-principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice. OBJECTIVES We conducted a systematic review of quantitative, qualitative and mixed-method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation. METHODS Seven databases were searched and 5137 articles were screened. Articles were included if they reported on an intervention for adult service users, were published between 2008 and October 2023 and were in English. Evidence in the 140 included articles was synthesised according to the JBI guidance on Mixed Methods Systematic Reviews. RESULTS Research in this field remains exploratory in nature, with a wide range of interventions investigated to date but little experimental replication. Overarching barriers to shared and supported decision-making in mental health treatment planning were (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health-related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians). CONCLUSIONS On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programs, the designing of new tools and for clinicians seeking to practice shared and supported decision-making in the healthcare they offer. PATIENT OR PUBLIC CONTRIBUTION This systematic review has been guided at all stages by a researcher with experience of mental health service use, who does not wish to be identified at this point in time. The findings may inform organisations, researchers and practitioners on implementing supported decision-making, for the greater involvement of people with mental ill health in their healthcare.
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Affiliation(s)
| | - Amanda Johnson
- Head of School, Dean of Nursing and MidwiferyUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Rhonda L. Wilson
- University of NewcastleNewcastleNew South WalesAustralia
- Massey UniversityPalmerston NorthNew Zealand
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Braun E, Gaillard AS, Vollmann J, Gather J, Scholten M. Mental Health Service Users' Perspectives on Psychiatric Advance Directives: A Systematic Review. Psychiatr Serv 2022; 74:381-392. [PMID: 36128696 DOI: 10.1176/appi.ps.202200003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychiatric advance directives (PADs) are documents that allow users of mental health services to express their preferences for treatment in future mental health crises. To increase the use of PADs in psychiatric practice, it is helpful to consider how service users view PADs and the factors that facilitate or hinder PAD creation and implementation. A systematic review of the empirical literature on this topic may help inform evidence-based policy making. METHODS A systematic review concordant with PRISMA guidelines was conducted. Relevant electronic databases were searched up to July 2, 2021. Articles containing original empirical data on service users' perspectives on PADs were included. Data were analyzed thematically, tabulated, and narratively synthesized. RESULTS Fifty-three articles were identified and included. The following categories were identified: general preferences regarding factors such as legal force and revocability; benefits of PADs at the personal, treatment-related, and social levels; challenges and barriers concerning PAD creation and application; and possible and experienced facilitators of PAD creation. CONCLUSIONS Users of mental health services are highly interested in PADs and regard them as tools to improve their involvement in care. They generally prefer legally binding PADs that can be revoked only when users are competent to consent. Barriers reported by service users were mainly related to the creation and application of PADs, and support in PAD creation was the most important facilitator identified. The involvement of mental health professionals in creating PADs appears essential to realize the benefits of PADs and to reduce barriers to their use.
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Affiliation(s)
- Esther Braun
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Anne-Sophie Gaillard
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
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James R, Maude P, McGrath I. Advance Statements within the Victorian Mental Health Setting: A Contextual and Legislative Global Comparison. Issues Ment Health Nurs 2020; 41:355-365. [PMID: 31714802 DOI: 10.1080/01612840.2019.1652871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides context to the establishment of advance statements within the Australian mental health setting, in the state of Victoria. A movement to legislate for a more humane and liberal approach to mental health consumer care resulted in changes to the Victorian Mental Health Act (2014a). This Act mirrored legislative changes across the western world and resulted in a socially progressive movement embracing recovery focussed care and consumer clinician partnerships. Thus, we purport that an identified need for a more liberal way to work with individuals who have a diagnosis of mental ill health was a major aim of this law reform. The advance statement model is seen as a tool in addressing a growing recognition of how mental health providers engage consumers of mental health services, and value their preferences to care received. This article arises from a larger study which has aimed to explore the role and scope of advance statements. This research has sought to demonstrate how advanced statements can be used within mental health services by providing recommendations for the mental health nursing workforce in relation to the implementation and deliverables for training.
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Affiliation(s)
- Russell James
- Department of Nursing, University of Tasmania, Hobart, TAS, Australia.,School of Health Sciences, RMIT University, Bundoora, VIC, Australia
| | - Phil Maude
- Department of Nursing, University of Tasmania, Hobart, TAS, Australia.,School of Health Sciences, RMIT University, Bundoora, VIC, Australia
| | - Ian McGrath
- School of Health Sciences, RMIT University, Bundoora, VIC, Australia
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Hindley G, Stephenson LA, Ruck Keene A, Rifkin L, Gergel T, Owen G. "Why have I not been told about this?": a survey of experiences of and attitudes to advance decision-making amongst people with bipolar. Wellcome Open Res 2019; 4:16. [PMID: 31080892 PMCID: PMC6492047 DOI: 10.12688/wellcomeopenres.14989.2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2019] [Indexed: 12/13/2022] Open
Abstract
Background: The idea that people with severe mental illness should be able to plan in advance for periods of illness as a means of enhancing autonomy has been long debated and is increasingly being enshrined in codes of practice and mental health legislation. It has been argued that the ethical imperative for this is especially pronounced in bipolar (BP), a condition in which sufferers often experience episodic crises interspersed with periods of wellness. However, there is a paucity of published research investigating experiences of advance decision making (ADM) in people with BP or their attitudes towards it. Methods: An online survey of BPUK's mailing list was conducted. 932 people with BP completed the survey (response rate 5.61%). Descriptive statistics and regression analysis were conducted to compare experience of with attitudes towards ADM and variables associated with interest in ADM. Results: A majority indicated a desire to plan care in advance of losing capacity (88%) but most had not done so (64%). High numbers of respondents expressed a wish to request as well as refuse treatment and most wanted to collaborate with psychiatrists, including on issues around self-binding. The most frequent motivation to utilise ADM was a desire to be more involved in mental health decisions. Interest in self-binding was associated with experience of compulsory treatment and trust in mental health services. Interest in refusals of all medication was associated with younger age and lack of trust in mental health services. Interest in ADM in general was associated with younger age but not educational level, ethnicity or gender. Conclusions: This study demonstrates an appetite for ADM amongst people with bipolar that is independent of educational status and ethnicity. As states reform their mental health laws, attention needs to be given to the distinctive attitudes toward ADM amongst people with bipolar.
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Affiliation(s)
- Guy Hindley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, SE5 8AB, UK
| | - Lucy A Stephenson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, SE5 8AB, UK
| | - Alex Ruck Keene
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, SE5 8AB, UK
- 39 Essex Chambers, London, WC2A 1DD, UK
| | - Larry Rifkin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, SE5 8AB, UK
- South London and Maudsely NHS Foundation Trust, London, SE5 8AZ, UK
| | - Tania Gergel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, SE5 8AB, UK
| | - Gareth Owen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, SE5 8AB, UK
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Hindley G, Stephenson LA, Ruck Keene A, Rifkin L, Gergel T, Owen G. "Why have I not been told about this?": a survey of experiences of and attitudes to advance decision-making amongst people with bipolar. Wellcome Open Res 2019; 4:16. [PMID: 31080892 PMCID: PMC6492047 DOI: 10.12688/wellcomeopenres.14989.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 07/18/2024] Open
Abstract
Background: The idea that people with severe mental illness should be able to plan in advance for periods of illness as a means of enhancing autonomy has been long debated and is increasingly being enshrined in codes of practice and mental health legislation. It has been argued that the ethical imperative for this is especially pronounced in bipolar (BP), a condition in which sufferers often experience episodic crises interspersed with periods of wellness. However, there is a paucity of published research investigating experiences of advance decision making (ADM) in people with BP or their attitudes towards it. Methods: An online survey of BPUK's mailing list was conducted. 932 people with BP completed the survey (response rate 5.61%). Descriptive statistics and regression analysis were conducted to compare experience of with attitudes towards ADM and variables associated with interest in ADM. Results: A majority indicated a desire to plan care in advance of losing capacity (88%) but most had not done so (64%). High numbers of respondents expressed a wish to request as well as refuse treatment and most wanted to collaborate with psychiatrists, including on issues around self-binding. The most frequent motivation to utilise ADM was a desire to be more involved in mental health decisions. Interest in self-binding was associated with experience of compulsory treatment and trust in mental health services. Interest in refusals of all medication was associated with younger age and lack of trust in mental health services. Interest in ADM in general was associated with younger age but not educational level, ethnicity or gender. Conclusions: This study demonstrates an appetite for ADM amongst people with bipolar that is independent of educational status and ethnicity. As states reform their mental health laws, attention needs to be given to the distinctive attitudes toward ADM amongst people with bipolar.
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Affiliation(s)
- Guy Hindley
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, London, SE5 8AB, UK
| | - Lucy A. Stephenson
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, London, SE5 8AB, UK
| | - Alex Ruck Keene
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, London, SE5 8AB, UK
- 39 Essex Chambers, London, WC2A 1DD, UK
| | - Larry Rifkin
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, London, SE5 8AB, UK
- South London and Maudsely NHS Foundation Trust, London, SE5 8AZ, UK
| | - Tania Gergel
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, London, SE5 8AB, UK
| | - Gareth Owen
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, London, SE5 8AB, UK
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Gowda GS, Noorthoorn EO, Lepping P, Kumar CN, Nanjegowda RB, Math SB. Factors influencing advance directives among psychiatric inpatients in India. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 56:17-26. [PMID: 29701595 DOI: 10.1016/j.ijlp.2017.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/30/2017] [Accepted: 10/10/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Advance directives are documents stating treatment preferences in case of future lack of decision making capacity. In India, as in many other countries, legislators advocate Psychiatric Advance Directives (PADs), while evidence on its use is limited. This study examined factors influencing PADs by gathering inpatients perspectives on PADs at discharge and investigating patient characteristics associated with the expression of treatment wishes in PADs. METHODS We conducted a hospital based descriptive study in Bangalore. 200 patients were included. The Mini International Neuropsychiatric Interview, CGI-S and CGI-I (Clinical Global Impression scales), the Insight Scale-2, and an Illness insight assessment were completed within 3days of admission. We used the Bangalore Advance Directive Interview (BADI) to assess attitudes towards PADs. 182 subjects were reassessed within 3days of discharge, along with an interview on their perspectives on PADs. RESULTS 67% welcomed the need for PADs in India. 95.6% made their own PADs. 80% followed their doctors' advice in their PAD. Subjects lacking insight or remaining symptomatic at discharge opted significantly more often against ECT, antipsychotics, and inpatient care. Linear regression showed that low socio-economic status, unwillingness to stay in hospital, and having received ECT before were inversely associated with the expression of treatment wishes in PADs. CONCLUSIONS This study's findings are relevant for India and Western countries alike while generating legislation including patients' perspectives. A majority of patients favoured PADs. Absent insight, severe psychopathology and incomplete recovery may negatively influence the way PADs are completed. Therefore, clinicians must assess patient's capacity to formulate PADs carefully, as capacity may significantly influence patients' views. The timing of when to formulate one's PAD within the illness process may be essential.
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Affiliation(s)
- Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India.
| | - Eric O Noorthoorn
- Dutch Information Centre on Containment Measures located Bilthoven Utrecht, The Netherlands; GGNet Community Mental Health Centre, PO Box 2003, 7230 GC Warnsveld, The Netherlands
| | - Peter Lepping
- BCUHB, Department of liaison psychiatry, Wrexham, UK, and Bangor University, Wales, UK; Department of Psychiatry, Mysore Medical College and Research Institute (MMCRI), Mysore, India; Centre for Mental Health and Society, Technology Park, Croesnewydd Road,Wrexham LL13 7TP, Wales, United Kingdom
| | | | - Raveesh Bevinahalli Nanjegowda
- Department of Psychiatry, Mysore Medical College and Research Institute (MMCRI), Mysore, India; Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences, (DIMHANS), Belgaum Road, Dharwad 580008, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
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Morriss R, Mudigonda M, Bartlett P, Chopra A, Jones S. National survey and analysis of barriers to the utilisation of the 2005 mental capacity act by people with bipolar disorder in England and Wales. J Ment Health 2017. [PMID: 28644738 DOI: 10.1080/09638237.2017.1340613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both health and welfare in England and Wales for people if they lose mental capacity, for example, through mania or severe depression.Aims: To determine the proportion of people with bipolar disorder (BD) who utilise advance planning, their experience of using it and barriers to its implementation.Methods: National survey of people with clinical diagnosis of BD of their knowledge, use and experience of the MCA. Thematically analysed qualitative interviews with maximum variance sample of people with BD.Results: A total of 544 respondents with BD participated in the survey; 18 in the qualitative study. 403 (74.1%) believed making plans about their personal welfare if they lost capacity to be very important. A total of 199 (36.6%) participants knew about the MCA. A total 54 (10%), 62 (11%) and 21 (4%) participants made advanced decisions to refuse treatment, advance statements and lasting power of attorney, respectively. Barriers included not understanding its different forms, unrealistic expectations and advance plans ignored by services.Conclusion: In BD, the demand for advance plans about welfare with loss of capacity was high, but utilisation of the MCA was low with barriers at service user, clinician and organisation levels.
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Affiliation(s)
- Richard Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, UK
| | - Mohan Mudigonda
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, UK
| | - Peter Bartlett
- Professor of Mental Health Law, School of Law and Institute of Mental Health, University of Nottingham, UK
| | - Arun Chopra
- Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK, and
| | - Steven Jones
- Professor of Clinical Psychology, Spectrum Centre, Lancaster University, UK
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Abstract
OBJECTIVE There is growing recognition of the utility of advance statements in the area of mental health. The definition of advance statements and procedure for making and varying advance statements under the Victorian legislation is described. The implications for psychiatrists, mental health tribunals and the process should the psychiatrist vary their decision from that made in the advance statement are discussed. CONCLUSION Advance statements being enshrined in legislation is another step in the direction of recovery-oriented service provision for persons with mental illness. The challenge for services will be to develop systems and processes that promote increased uptake of these instruments to empower persons with mental illness to participate in their treatment.
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Affiliation(s)
- Sudeep Saraf
- Consultant psychiatrist, Austin Health, Heidelberg, Rosanna, VIC, Australia
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Shields LS, Pathare S, van der Ham AJ, Bunders J. A Review of Barriers to Using Psychiatric Advance Directives in Clinical Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 41:753-66. [DOI: 10.1007/s10488-013-0523-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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