Factors influencing advance directives among psychiatric inpatients in India

Abstract

This study's findings are relevant for India and Western countries alike while generating legislation including patients' perspectives. A majority of patients favoured PADs. Absent insight, severe psychopathology and incomplete recovery may negatively influence the way PADs are completed. Therefore, clinicians must assess patient's capacity to formulate PADs carefully, as capacity may significantly influence patients' views. The timing of when to formulate one's PAD within the illness process may be essential.

Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries

“…Considering resource constraints, clinicians working with people with a psychiatric condition may wish to prioritize psychiatric care planning. This is because fluctuating mental capacity seen during relapses of psychiatric conditions may mean these people still retain the capacity to direct other physical or mental health aspects of their care (Chamberlain, Walsh, & Falkowski, ; Gowda et al, ). In the current state of affairs, the medical system depends on an immediate need for care to justify a meeting between a medical professional and service user.…”

“…This act is not specific to mental health but allows individuals with mental capacity to register an advance directive documenting their wishes for medical care (Chu et al, ). Unsurprisingly, systematic reviews of the effectiveness of advance medical directives in Asia are lacking, possibly because the service user demand for such services has been low due to limited awareness (Chu et al, ; Gowda et al, ; Lai, Mohd Mudri, Chinna, & Othman, ; Tay, Chia, & Sng, ).…”

“…While the paucity of evidence supporting the implementation of psychiatric advance directives in Asia and their logistical challenges appear to detract from the merits of further investigation, several arguments can be made to justify its wider consideration in Asia (Gowda et al, ). First, the potential impact of psychiatric advance directives in an Asian population remains largely unknown.…”

Advance directives and nominated representatives: A critique

“…Another study,[ 13 ] conducted in a premier institute, reported that among inpatients about to be discharged, most tended to make greater use of the prescriptive sections of PADs. This study evaluated nearly 200 inpatients who had received acute care and were ready to be discharged in the next couple of days.…”

Mental Healthcare Act 2017 – Aspiration to action

“…Only the MHRB has the powers to amend or overrule the AD. [ 16 ] This would need to be done in a very short time to enable the treatment (24–48 h). There is a dearth of human resources (medical and judicial), economic resources, and collective community efforts in treating PMI.…”