Anticipatory Planning for Psychiatric Treatment: Liberty or Limitation for our Future Life Plans?

Backlar, Patricia

doi:10.1300/j158v04n04_06

Cited by 6 publications

(7 citation statements)

References 36 publications

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“…Paternalism and vulnerability Some critics highlight the potential for overt, covert or internalised coercion when engaged in SB-ADM (21). The results of this study are consistent with the experience of paternalism being a major issue within mental health services, insofar as all service user participants reported previous experiences of feeling oppressed and subject to power differentials.…”

Section: Addressing Current Ethical Concerns About Self-bindingsupporting

confidence: 85%

‘If I’m ill, I want you to do this...even if I tell you not’: A multi-perspective qualitative study exploring experiences of making ‘self-binding’ advance decisions with service users, carers, and clinicians

Stephenson,

Owen,

Keene

et al. 2023

Preprint

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Background There is increasing international interest in mental health advance decision-making (ADM) for people with episodic severe mental illness who are at high risk of experiencing mental capacity loss and distressing involuntary treatment when unwell. ‘Self-binding’ (SB), sometimes known as a Ulysses contract, involves making advance requests for involuntary treatment. It is the most ethically controversial form of ADM but one that policy makers and researchers must engage with as evidence suggests it is supported by service users. This study aims to inform debate and policy through exploring the experience of service users, carers and health professionals involved in making ADM documents which include provision for ‘self-binding’. Methods We recruited service users diagnosed with bipolar disorder, with experience of compulsory treatment and fluctuating mental capacity during severe episodes of illness. We conducted interviews with these service users plus supporting family members/friends and clinicians before and after drafting self-binding ADM (SB-ADM) documents. Interviews were thematically analysed by an interdisciplinary team. Results 75 interviews were analysed. The sample comprised 15 service users, 14 family members/friends and 18 clinicians. Key themes were: self-binding, feeling oppressed, being mis/unheard, addressing trauma, losing mental capacity, risking hope, building alliance. Two outlying categories were identified: radical refusals and radical requests. Conclusions This is, to our knowledge, the first study of stakeholder experience of drafting SB-ADM. The findings illuminate the complex psychological context within which SB-ADM occurs and challenge assumptions found in conceptual literature that the driving motivation for self-binding is achieving personal autonomy. Instead, this study suggests stakeholders are more invested in relational autonomy - using collaborative SB-ADM to build alliance and preserve interpersonal systems challenged by episodes of illness. Crucially, the data highlighted the potential harms if service user advance decisions are not accessed or applied by clinicians. Future research should focus on developing health professional training which includes awareness of the enabling psychological factors for SB-ADM and longitudinal lived experience studies which explore SB-ADM outcomes.

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Section: Addressing Current Ethical Concerns About Self-bindingsupporting

confidence: 85%

‘If I’m ill, I want you to do this...even if I tell you not’: A multi-perspective qualitative study exploring experiences of making ‘self-binding’ advance decisions with service users, carers, and clinicians

Stephenson,

Owen,

Keene

et al. 2023

Preprint

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“…The acute controversy over involuntary outpatient commitment and other mandated treatment in the United States is a part of this larger debate, and perhaps no other issue has so polarized stakeholders in recent years (Monahan et al, 2001). Involuntary treatment may well be "effective" for improving treatment engagement and other clinical outcomes, but at the same time may override the personal liberty of people with mental illness (Swartz et al, 1999).Many believe psychiatric advance directives (PADs) may help resolve this dilemma by promoting both autonomy and beneficial treatment for people with mental illness (Appelbaum, 2004;Backlar, 2004;Saks, 2004;Srebnik, Russo, Sage, Peto, & Zick, 2003;Swanson, Tepper, Backlar, & Swartz, 2000;Varma & Goldman, 2005). In the past fifteen years, twenty-five states have passed psychiatric advance directives (PAD) laws allowing competent people to authorize proxy decision makers and document advance instructions or preferences regarding future mental health treatment in the event of an incapacitating psychiatric crisis.…”

mentioning

confidence: 99%

“…Many believe psychiatric advance directives (PADs) may help resolve this dilemma by promoting both autonomy and beneficial treatment for people with mental illness (Appelbaum, 2004; Backlar, 2004; Saks, 2004; Srebnik, Russo, Sage, Peto, & Zick, 2003; Swanson, Tepper, Backlar, & Swartz, 2000; Varma & Goldman, 2005). In the past fifteen years, twenty-five states have passed psychiatric advance directives (PAD) laws allowing competent people to authorize proxy decision makers and document advance instructions or preferences regarding future mental health treatment in the event of an incapacitating psychiatric crisis.…”

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confidence: 99%

Competence to complete psychiatric advance directives: Effects of facilitated decision making.

Elbogen

Swanson

Appelbaum

et al. 2007

Law and Human Behavior

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Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N = 469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of NIH Public Access Author ManuscriptLaw Hum Behav. Author manuscript; available in PMC 2013 November 04. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid. KeywordsPsychiatric advance directives; Treatment competence; Severe mental illness Mental health lawAt the heart of an evolving debate in mental health policy, law, and bioethics lies a tension between the principle of respect for patient autonomy in healthcare decisions and the responsibility to provide appropriate services to people with severe mental illness, many of whom experience intermittent impairment of decisional capacity and fluctuating attitudes towards accepting treatment. The acute controversy over involuntary outpatient commitment and other mandated treatment in the United States is a part of this larger debate, and perhaps no other issue has so polarized stakeholders in recent years (Monahan et al., 2001). Involuntary treatment may well be "effective" for improving treatment engagement and other clinical outcomes, but at the same time may override the personal liberty of people with mental illness (Swartz et al., 1999).Many believe psychiatric advance directives (PADs) may help resolve this dilemma by promoting both autonomy and beneficial treatment for people with mental illness (Appelbaum, 2004;Backlar, 2004;Saks, 2004;Srebnik, Russo, Sage, Peto, & Zick, 2003;Swanson, Tepper, Backlar, & Swartz, 2000;Varma & Goldman, 2005). In the past fifteen years, twenty-five states have passed psychiatric advance directives (PAD) laws allowing competent people to authorize proxy decision makers and document advance instructions or preferences regarding future mental health treatment in the ...

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“…In addition, PADs are supported by the U.S. Patient Self-Determination Act of 1990, which mandates that health facilities ask patients if they have an advance directive, including a PAD, and provide them with information regarding advance directives upon request (Backlar, 2004; Backlar & McFarland, 1998).…”

Section: Introductionmentioning

confidence: 99%

Psychiatric advance directives: A tool for consumer empowerment and recovery.

Scheyett¹,

Kim²,

Swanson³

et al. 2007

Psychiatric Rehabilitation Journal

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Individuals with psychiatric disabilities identify choice and self-direction as central elements of recovery. During times of psychiatric crisis people may experience a frightening loss of choice and self-direction, which can be damaging and traumatic. Psychiatric advance directives (PADs) are legal documents created to address this loss of autonomy and choice during crises by allowing individuals to communicate in the present wishes for care during a future crisis. This paper examines the ways in which PADs support and can be a tool for recovery and discusses future recovery-oriented directions for PAD research and intervention.

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Anticipatory Planning for Psychiatric Treatment: Liberty or Limitation for our Future Life Plans?

Cited by 6 publications

References 36 publications

‘If I’m ill, I want you to do this...even if I tell you not’: A multi-perspective qualitative study exploring experiences of making ‘self-binding’ advance decisions with service users, carers, and clinicians

‘If I’m ill, I want you to do this...even if I tell you not’: A multi-perspective qualitative study exploring experiences of making ‘self-binding’ advance decisions with service users, carers, and clinicians

Competence to complete psychiatric advance directives: Effects of facilitated decision making.

Psychiatric advance directives: A tool for consumer empowerment and recovery.

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