30th November 2018, Volume 131 Number 1486

Jessie Lenagh-Glue, Anthony O’Brien, John Dawson, Katey Thom, Johnnie Potiki, Heather Casey, Paul Glue

Consumer engagement is well documented as an important step in facilitating mental health recovery.1 One means of increasing consumers’ experience of participation in decisions regarding their mental healthcare is through…

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Summary

Advanced Directives are documents that mental healthcare consumers can create, to list treatment and support preferences when they become unwell. Advanced Directives are seldom created in New Zealand as service consumers report these are often ignored by clinicians. We developed a document and a process for creating an advanced directive, based on surveys with service consumers and clinicians. We have called this a MAP (Mental-health Advance Preferences statement). Both groups reported strong overall support for advance directives, particularly around items concerning personal support at difficult times. There was a strong difference of opinion between clinicians and consumers on whether the Mental Health Act powers should be able to override the consumer’s instructions. Using peer support workers as facilitators may be an important step in successful completion of an advance directive.

Abstract

Aim

To document the process of developing a local advance directive for mental health care, which we are calling a MAP (Mental-health Advance Preferences statement).

Method

Data on advance directive preferences were collected from consumers and service providers using online surveys and analysed using quantitative methods.

Results

Both groups reported strong overall support for advance directives. They particularly favoured inclusion of items concerning personal support at difficult times. Consumers strongly advocated inclusion of statements regarding treatment options. There was broad agreement that advance directives could increase consumers’ sense of autonomy and empowerment, but service providers were less inclined to believe they helped consumers engage with mental health services or improve self-management skills. There was a highly significant divergence between service providers and consumers on whether the powers under the Mental Health Act should be able to override the consumer’s instructions.

Conclusion

MAPs aimed at facilitating treatment decisions have good acceptability from consumers and mental health clinicians. The use of peer support workers as facilitators may be an important step in successful completion of an advance directive. Future research will aim to examine national implementation of MAPs.

Author Information

Jessie Lenagh-Glue, Senior Research Fellow, Faculty of Law, University of Otago, Dunedin;
Anthony O’Brien, Senior Lecturer, Faculty of Medical and Health Sciences, University of Auckland, Auckland; John Dawson, Professor, Faculty of Law, University of Otago, Dunedin;
Katey Thom, Centre for Non-Adversarial Justice, Auckland University of Technology, Auckland;
Johnnie Potiki, Consumer Advisor, Southern District Health Board, Dunedin;
Heather Casey, Director of Nursing, Southern District Health Board, Dunedin;
Paul Glue, Professor, Department of Psychological Medicine, University of Otago, Dunedin.

Correspondence

Paul Glue, Hazel Buckland Chair of Psychological Medicine, School of Medical Sciences, University of Otago, PO Box 913, Dunedin.

Correspondence Email

paul.glue@otago.ac.nz

Competing Interests

This research was supported by a grant from the James Hume Fund.

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