Department of Psychiatry and Behavioral Sciences, Services Effectiveness Research Program, Duke University School of Medicine, Durham, NC, USA.
Department of Psychiatry, Center for Excellence in Community Mental Health, UNC School of Medicine, Chapel Hill, NC, USA.
J Ment Health. 2021 Oct;30(5):585-593. doi: 10.1080/09638237.2020.1714008. Epub 2020 Feb 4.
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.
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.
Participants were randomly assigned to be offered PAD facilitation by a peer support specialist or non-peer ACT team clinician, and interviewed at baseline ( = 145) and post-facilitation 1-2-month follow-up ( = 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.
There was no evidence of bias against peer-facilitators. There was a modest positive impact of PAD facilitation on treatment attitudes and empowerment.
PAD facilitation by peer support specialists and others working in community mental health settings supports recovery.
精神科预先指示（PAD）旨在通过使患有严重精神疾病的人能够在未来的丧失能力危机中提前计划自己的治疗，从而防止非自愿的精神卫生干预。本研究在坚定的社区治疗（ACT）团队中实施了 PAD 促进措施。
我们研究了 ACT 客户对 PAD 促进者的态度、对 PAD 促进的满意度、PAD 完成对主观赋权感和治疗态度的短期影响，以及 PAD 促进者的类型是否有影响。
参与者被随机分配接受同伴支持专家或非同伴 ACT 团队临床医生提供的 PAD 促进，并在基线（ = 145）和促进后 1-2 个月随访（ = 116）进行访谈，以评估 PAD 促进的消费者导向感、赋权感和各种治疗态度。对 PAD 完成者、未完成者和与同伴或非同伴完成 PAD 的人进行干预前后的平均分数进行比较。使用逻辑回归和线性回归分析评估 PAD 完成的效果。
没有证据表明对同伴促进者有偏见。PAD 促进对治疗态度和赋权感有适度的积极影响。
同伴支持专家和其他在社区心理健康环境中工作的人提供 PAD 促进措施支持康复。
