Abstract
Background: An advance directive is a statement of a person's preferences for treatment, should he or she lose capacity to make treatment decisions in the future.
Aims: To examine the content of advance directives used in psychiatric care and both patients' and professionals' views concerning their content, implementation and usefulness.
Method: Randomized, controlled trial in two psychiatric services in inner London. The trial compared usual psychiatric care with usual care plus the completion of an advance directive. Primary outcome was rate of compulsory readmission over 12 months. The content of the directives was analysed along with patient and staff views regarding their use.
Results: There were no group differences in number of subsequent compulsory psychiatric readmissions. However, patients with severe and enduring mental health problems were capable of drawing up realistic, logical, rational and consistent advance directives and did not use them as an opportunity to refuse all subsequent treatment. Most consultant psychiatrists who returned questionnaires did not find the directives useful in the management of the patients.
Conclusion: Users' advance instruction directives had little observable impact on the outcome of care at 12 months. The qualitative data discussed here reveal that patients did not always realize the importance of the directives, and were not subsequently encouraged to do so by mental health clinicians, who claimed they were either unaware of them or who were doubtful about their usefulness.