Psychiatric Advance Directives Among Public

Psychiatric Advance Directives among Public Mental Health Consumers in Five U.S. Cities: Prevalence, Demand, and Correlates.

Jeffrey Swanson, PhD, Marvin Swartz, MD, Joelle Ferron, MSW, Eric Elbogen, PhD and Richard Van Dorn PhD

The Journal of the American Academy of Psychiatry and the Law Volume 34 Number 1, 2006, pgs 43-57.

Psychiatric Advance Directives among Public Mental Health Consumers in Five U.S. Cities: Prevalence, Demand, and Correlates begins with a relatively in depth explanations first of what psychiatric advance directives are, in a legal sense and then goes on to discuss general trends in their type and use. The article explains that there are two general types of PADs first the type that explains in detail mental health directives for treatment in the event that an individual mental health consumer experiences a period of decision making incapacity during a psychiatric crisis. The second type which can be in conjunction with or stand alone from the first is an advance directives document that names a proxy decision maker and givens then the right to make decisions associated with mental health treatment in the event of decision making incapacity. The article then goes on to discuss the laws associated with PADs in the five states associated with the study locations in California, Florida, Illinois, Massachusetts and North Carolina, explaining briefly but in detail how each of these states represent a cross section of U.S. states with statues and laws associated with the development and application of PADs, varying to some degree in a legal and practical sense.

Next the work goes on to describe in detail both the impetus for the research, i.e. To determine the prevalence, demand and specific correlates for both prevalence and demand for PADs in a mental health climate that has been advocating for their adoption and use for more than a decade. The work has a lengthy hypothesis associated with correlates of adoption and desire to adopt PADs all of which were at least moderately supported by the findings of the study. Next the work briefly describes the study methodology and then goes on to in more detail describe the questions associated with the study and the 9 supportive validity scales used to develop the data set on the study sample (n 200).

The results of the work again support to a large degree the five point exploratory hypothesis. With supportive data to describe the validity of correlates; past adverse mental health treatment experiences and pressures, disempowerment correlates, degree of insight, and high levels of social support. The main finding sof the study were in addition to correlate identification the development of a more clear idea of the real limitations of prevalence of existing PADs, in that 4-13% of study participants had already created PADs of one or both types and that this same study group had a very high statistical desire to create their own PADs (66-77%) but would like and subsequently lack appropriate assistance in doing so.

Evaluation

This article is really well organized, written and supported. The work provides substantial, timely and comprehensive information about the finer points of PADs and why they are important, as tools to ideally aide mental health consumers in both self-empowerment and to aide providers and caregivers in decision making that falls short of coercive or legal treatment demands. The work provides demonstrative insight with regard to the community need to provide adequate support to mental health consumers regarding the development of PADs and further refinement of PAD legislation and laws. The article is very clear and comprehensive in its preliminary discussion and the multivariate correlate hypothesis offers a great deal of insight into the impetus and usefulness of PADs and the information and assurances they might ideally provide all involved.

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