Impact of psychiatric advance directive facilitation on mental health consumers: empowerment, treatment attitudes and the role of peer support specialists

Abstract

Background

A psychiatric advance directive (PAD) is designed to prevent involuntary mental health interventions by enabling people with serious mental illnesses to plan ahead for their own treatment during a future incapacitating crisis. This study implemented PAD facilitation in assertive community treatment (ACT) teams.

Aims

We examined ACT clients’ attitudes toward PAD facilitators, satisfaction with PAD facilitation, the short-term impact of PAD completion on subjective sense of empowerment and attitudes toward treatment, and whether the type of PAD facilitator made a difference.

Methods

Participants were randomly assigned to be offered PAD facilitation by a peer support specialist or non-peer ACT team clinician, and interviewed at baseline (n = 145) and post-facilitation 1–2-month follow-up (n = 116), to assess perceived consumer-directedness of PAD facilitation, empowerment and various treatment attitudes. Mean scores before and after the intervention were compared for PAD-completers, non-completers, and those who completed a PAD with a peer vs. non-peer. The effect of PAD completion was assessed using logistic and linear regression analysis.

Results

There was no evidence of bias against peer-facilitators. There was a modest positive impact of PAD facilitation on treatment attitudes and empowerment.

Conclusions

PAD facilitation by peer support specialists and others working in community mental health settings supports recovery.

Keywords:

• Assertive community treatment
• empowerment
• peer support specialist
• psychiatric advance directive
• recovery
• serious mental illness
• treatment attitudes
• treatment relationships

Acknowledgements

We are deeply grateful to staff and individuals with severe mental illness at assertive community treatment teams at four agencies: Carolina Outreach, University of North Carolina, Easter Seals, and Fellowship Health Resources, Inc. This project would not have been possible without their help. We also very much appreciate the contributions of Sherri Strickland, B.A., and Kelly Alanis-Hirsch, Ph.D.

Disclosure statement

The authors report no financial relationships with commercial interests.

Additional information

Funding

The contents of this article were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90IF0027-01-00). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, HHS, and endorsement by the Federal Government should not be assumed.