Advance healthcare directives and advance choice documents in psychiatry: New resources, new legislation, new opportunities

Abstract

In recent years, bodies such as the United Nations and the World Health Organization have highlighted the need for mental healthcare and legislation to better conform to contemporary human rights principles. They place particular emphasis on the right of people with mental health conditions to make their own decisions in all areas of life, including mental health treatment. One of the challenges in this context is that a person can lose the capacity to make these decisions during episodes of severe mental illness. Advance Healthcare Directives (AHDs), also known as Advance Choice Documents (ACDs), can help to overcome this challenge and allow people to exercise more agency over their care choices. AHDs are statements about the type of treatment a person would or would not like to receive in future if they are in a situation where they require treatment but are unable to make or communicate their decision. Despite an expanding body of evidence that AHDs enhance autonomy and are supported by patients and staff alike, uptake of AHDs is extremely low across many jurisdictions. Legislative reform and educational initiatives to enhance knowledge and awareness are vital for advancing and enlivening this field in clinical practice. This paper explores one such legislative development (Ireland's Assisted Decision Making (Capacity) Act, 2015) and one such educational initiative (the www.advancechoice.org website and videos). We highlight the need for further developments in the realms of both legislative reform and outreach and accessibility, in addition to greater advocacy by clinicians for the use of AHDs in mental health care.