Tuesday, March 27, 2012

Respect for the Rights of Individuals with Mental Health Problems

Just left a very interesting class discussing psychiatric advanced directives...
We discussed an article by Swanson (2008) evaluating whether individuals with Psychiatric Advanced Directives (PAD's) had reduced risk of coercive crisis interventions.  (here is the reference to the article: Swanson, J., Swartz, M., Elbogen, E., Van Dorn, R., Wagner, H.R., Moser, L., Wilder, C., & Gilbert, A. (2008) Psychiatric advance directives and reduction of coercive crisis interventions.  Journal of Mental Health, 17, 255-267.)  The short answer was yes... completing the psychiatric advanced directive may reduce coercive interventions... you may want to read the article.

This article also finds at baseline high rates of lifetime prevalence of being placed in handcuffs (41.8%) or transported by police to treatment (67.8%).  Rates of involuntary commitment were 61% and use of physical restraints was 37.7% in their population...  Nothing to be very happy about there.  (reminds me of my last post...!)

More importantly, what is your experience with PAD's?  Do your patients come to you with them?  Do you ask if they have one?  Many states require them and some have very specific requirements.  I would love to hear more about the 'reality' of them.

In my view they set a frame for partnership of individuals with their care providers.  What an important discussion to have.  It seems setting the stage for this kind of work together is very important and provides a sense of respect and dignity to individuals we work with.

Tell me what you think!
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2 comments:

  1. NatashaApril 10, 2012 at 9:08 AM

    Mental health providers are obligated to understand and facilitate the use of psychiatric advanced directives. Especially in patients with severe mental illness and high likelihood of episodes of decisional incapacity, PADs may serve to preserve dignity and enhance autonomy. Let’s keep the discussion going! For more information, please check out the National Resource Center on Psychiatric Advance Directives http://www.nrc-pad.org

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  2. JoanneApril 11, 2012 at 9:03 PM

    Thanks for the link Natasha!

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