title: EFFECTIVELY IMPLEMENTING PSYCHIATRIC ADVANCE DIRECTIVES TO PROMOTE SELF-DETERMINATION OF TREATMENT AMONG PEOPLE WITH MENTAL ILLNESS.
abstract: Statutes on psychiatric advance directives (PADs) allow competent individuals to document instructions for future mental health treatment in the event of an incapacitating crisis. PADs are aimed at promoting a stronger sense of patient self-determination, considered a central tenet of psychosocial rehabilitation and recovery; however, it is unknown what factors (if any) lead psychiatric patients with PADs to experience this benefit long term. The current study involves examination of 1 year effects on perceived treatment self-determination among 125 people with mental disorders who completed PADs via a 1-on-1 facilitated PAD intervention. Descriptive analyses showed participants documented medically relevant information that would assist doctors in a crisis and participants reported a high level of satisfaction with the facilitated PAD intervention. Multivariate analyses demonstrated that increased sense of autonomy at 1 year was predicted by race, understanding PADs, and verbal memory. Results provide useful guidance for administrators and clinicians, suggesting that PADs show promise in helping empower people with mental illness, especially African-American clients. Further, findings indicate that optimal implementation of PADs will be achieved when facilitated intervention assists people with mental illness to better understand what PADs are and to remember they have a PAD at the time they are experiencing a psychiatric crisis.
authors.affiliation: Forensic Psychiatry Program and Clinic, University of North Carolina at Chapel Hill School of Medicine.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Elbogen
authors.forename: Richard
authors.initials: R
authors.lastname: Van Dorn
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Swanson
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Swartz
authors.forename: Joelle
authors.initials: J
authors.lastname: Ferron
authors.forename: H Ryan
authors.initials: HR
authors.lastname: Wagner
authors.forename: Christine
authors.initials: C
authors.lastname: Wilder
keywords: mental health law; patient self-determination; psychiatric advance directives; psychiatric disabilities; psychosocial rehabilitation