Effect on outcomes of advance statements of patient preferences

Abstract

An ‘advance statement’ allows a patient to state treatment preferences in anticipation of a time in the future when, as a result of a mental disorder or disability, he or she may no longer be able to make treatment decisions. A number of types of advance statements in psychiatry can be described: ‘advance directives’ (and ‘facilitated advance directives’), ‘crisis cards’ and ‘joint crisis plans’. They differ according to a number of characteristics – the degree to which they have legal force, whether the clinical team is involved in their formulation, and whether a third party acts as a facilitator. There is accumulating evidence that some forms of advance statement empower patients and reduce the need for coercive treatments. The results of a randomized controlled trial of ‘joint crisis plans’ carried out by our research team in SE England will be discussed. A significant reduction in compulsory admissions to hospital was an important finding.