Mental health clinician training and experiences with utilization of advance statements in Victoria, Australia

Abstract

Advance statements, advance directives, or psychiatric wills are a key component of a shift to mental healthcare that promotes autonomy and choice and aims to reduce restrictive and coercive care practices in mental health treatment settings. The use of advance statements has gained momentum to provide a means for individuals to detail clear preferences for mental health treatment. This paper uses a qualitative descriptive design to explore the experiences of clinicians (n = 15) implementing advance statements in the state of Victoria, Australia, a region that introduced advance statements as part of an overhaul of mental health legislation in 2014. The study, reported using the COREQ framework, found two key themes after analysis: experiences of advance statement training, with the availability and quality of training and training as a driver of change emerging as sub-themes, and experiences of advance statements in practice, with participants providing narratives of the barriers and facilitators to successful advance statement implementation. We recommend that clinician and service user experiences of advance statement implementation are further explored to identify existing and emerging barriers to implementation of these tools, which are crucial to achieve autonomy and choice for individuals receiving mental healthcare.

Promoting and hindering factors in the use of advance statements by Australian mental health clinicians

“…Advance statements, also known as advance directives and psychiatric wills, are documents that provide individuals the opportunity to be active participants in their care by documenting preferences for care they would like to receive during a period of mental ill health, particularly where involuntary or compulsory treatment is required (Gumley et al, 2021; James et al, 2021). When used collaboratively, advance statements have been shown to have great benefit for individuals accessing mental health services and are acknowledged as a tool to build therapeutic alliance between service users and clinicians (Swanson, Swartz, Elbogen, et al, 2006; Swanson, Swartz, Ferron, et al, 2006).…”

“…This paper reports the results of the phase one survey, which aimed to explore the perceived hindering factors for advance statement implementation among clinicians in the state of Victoria, Australia. Findings from phase two, qualitative interviews are published (James et al, 2021, 2022). The paper is timely given the introduction of advance statements as part of the suite of reforms introduced in the 2014 Victorian Mental Health Act with new legislation in draft for a proposed Mental Health and Wellbeing Act.…”

“…Findings from phase two, qualitative interviews are published (James et al, 2021(James et al, , 2022…”

Clinician knowledge and attitudes of mental health advance statements in Victoria, Australia

“…The inclusion of advance statements within mental health legislation is acknowledged as a practice change that recognizes how mental health providers engage individuals who encounter mental health services, and value their preferences to care received (James et al 2019). However, the familiarity and knowledge mental health clinicians have of advance statements greatly affects their implementation within the mental health setting (James et al 2022).…”

“…However, the familiarity and knowledge mental health clinicians have of advance statements greatly affects their implementation within the mental health setting (James et al . 2022).…”