Psychiatric advance directives among public mental health consumers in five U.S. cities: prevalence, demand, and correlates.
Psychiatric advance directives (PADs) are legal instruments that allow competent persons to document their preferences regarding future mental health treatment and to designate a surrogate decisionmaker in the event they lose capacity to make reliable treatment decisions during an acute episode of psychiatric illness. This study reports the findings of a survey of 1,011 psychiatric outpatients in five U.S. cities about their interest in, and completion of, PADs. Across the sites, only 4 to 13 percent of participants had completed a PAD; however, between 66 and 77 percent reported wanting to complete one if given assistance. Significantly higher demand for PADs was found among participants who were female; were nonwhite; had a history of self-harm, arrest, and decreased personal autonomy; and those who felt pressured to take medication. Actual completion of PADs was more likely among participants with higher insight, those reporting leverage by a representative payee, and those who felt external pressure to keep outpatient appointments for mental health treatment.
Swanson
Jeffrey
J
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3071, Brightleaf Square Suite 23-A, Durham, NC 27710, USA. jeffrey.swanson@duke.edu
Swartz
Marvin
M
Ferron
Joelle
J
Elbogen
Eric
E
Van Dorn
Richard
R
D000328:Adult; D016223:Advance Directives; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D011570:Psychiatry; D017150:Public Sector; D014481:United States; D014505:Urban Population