Models of advance directives in mental health care: stakeholder views.
OBJECTIVE
The aim of this study was to examine perceptions of the place of advance directives in mental health care.


METHODS
Postal survey of stakeholders was carried out to assess their views on different models of advance directives in mental health care. A total of 473 responded.


RESULTS
In all, 28% of psychiatrists thought advance directives were needed compared to 89% of voluntary organisations and above two-thirds of the other stakeholder groups. There were clear tensions between patient "autonomy" and "right to treatment" which underpin many of the concerns raised. Autonomy provided by advance directive can be contrasted with a co-operative partnership approach to advance planning. The legal status of advance directives is important for some people in relation to treatment refusal. There was general concern about the practical issues surrounding their implementation.


CONCLUSIONS
There is a wide range of views in all stakeholder groups about the possible form advance directives should take. Although there is a widespread desire to increase patient involvement in treatment decisions, which advance directives could possibly help to realise, they may also have unwanted consequences for mental health services and individuals.
Public Health and Health Policy, Division of Community Based Sciences University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, Scotland. j.m.atkinson@clinmed.gla.ac.uk
Jacqueline M
JM
Atkinson
Helen C
HC
Garner
W Harper
WH
Gilmour
D000328:Adult; D016223:Advance Directives / Q000331:legislation & jurisprudence*; D001291:Attitude of Health Personnel; D004739:England; D006306:Health Surveys; D006801:Humans; D008605:Mental Health Services / Q000331:legislation & jurisprudence*; D008962:Models, Theoretical; D028701:Patient Rights / Q000331:legislation & jurisprudence; D026684:Personal Autonomy; D011570:Psychiatry / Q000331:legislation & jurisprudence; D012606:Scotland; D016312:Treatment Refusal / Q000331:legislation & jurisprudence