Faculty of Law, University of Otago, Dunedin, New Zealand.
Centre for Non-Adversarial Justice, Auckland University of Technology, Auckland, New Zealand.
Int J Law Psychiatry. 2020 Jan-Feb;68:101537. doi: 10.1016/j.ijlp.2019.101537. Epub 2020 Jan 14.
Mental health advance directives support service users' autonomy and provide a voice in their care choices when they may not have capacity to give informed consent. New Zealand's Southern District Health Board has recently introduced advanced directives in mental health services.
Completed advance directives (n = 53) and additional demographic data were accessed from clinical records.
Each advance directive was read and analysed by three members of the research team. The advance directive instrument has eight possible fields which could be completed, covering such topics as who should be contacted in a crisis; people service users do, or do not, want involved in their treatment; what service users would, or would not like to have happen should they become unwell; management of personal affairs; other specific preferences; and provision of further relevant information. The number of preferences stated in each field was also calculated.
The advance directives provided expressions of preferences which were personally meaningful for service users and provided practical guidance for clinicians. Service users expressed mainly positive preferences, though some expressed negative treatment preferences, and many service users expressed preferences relating to personal affairs. Friends, family members and clinicians were nominated as preferred contacts in a crisis.
Service users will engage with advance directives if supported to do so. This study's results should help promote the wider availability of advance directives in New Zealand and the current reform of our mental health legislation.
心理健康预先指示支持服务使用者的自主权，并在他们可能没有能力做出明智同意时，为他们的护理选择提供声音。新西兰南部地区卫生局最近在精神卫生服务中引入了预先指示。
从临床记录中获取已完成的预先指示（n=53）和其他人口统计学数据。
研究团队的三名成员阅读并分析了每个预先指示。预先指示文书有八个可能填写的字段，涵盖了以下主题：在危机中应该联系谁；服务使用者希望或不希望参与其治疗的人员；如果他们身体不适，服务使用者希望或不希望发生什么；个人事务的管理；其他具体偏好；并提供其他相关信息。还计算了每个字段中表示的偏好数量。
预先指示表达了对服务使用者具有个人意义的偏好，并为临床医生提供了实用的指导。服务使用者主要表达了积极的偏好，尽管有些表达了消极的治疗偏好，而且许多服务使用者表达了与个人事务有关的偏好。朋友、家人和临床医生被指定为危机时的首选联系人。
如果得到支持，服务使用者将参与预先指示。本研究的结果应该有助于在新西兰更广泛地提供预先指示，并推动我们的精神卫生立法改革。
