Psychiatric Advance Directives: Advocacy Considerations & Efforts
Poster Presentation Abstract:
The person-centered utilization and implementation of psychiatric advance directives (PADs) is a recommended standard practice in behavioral health crisis service planning. Psychiatric advance directives facilitate the expression of mental health treatment preferences during a period when individuals may be deemed incompetent to do so. Similar to medical advance directives, PADs protect individuals’ autonomy by emphasizing their fundamental right to make decisions about their mental health treatment. Utilization of PADs encourages using historical personal experiences and knowledge in planning effective crisis intervention techniques and treatments. Imparting PAD information to crisis intervention teams helps avert many potential treatment adverse reactions such as severe akathisia, critically low blood pressure, cardiac issues, and treatment-emergent suicidality and mania, and expedite identification and utilization of effective interventions. The use of PADs also promotes the recovery process through supporting empowerment, minimizing experienced coercion, improving the identification and utilization of coping strategies, and decreasing the use of involuntary hospitalizations. While individual support for PADs is high, there is a significant disparity between the number of people who want and the number who successfully complete PADs. This disparity disproportionately impacts marginalized individuals whose input and desires are disproportionately unsolicited and ignored in treatment/intervention processes. Currently only a fifth of submitted PADs are being accessed by treatment teams. Advocacy efforts are needed to facilitate the appropriate utilization and ensure implementation of PADs. A three-fold approach of provider education, public education, and facilitated support/implementation is recommended via the creation of community PAD clinics as well as hospital and state policy changes.
Authors: Lauren Lang, MS; Keith A. Wood, PhD; DeJuan White, MD
