Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
, Steve Gilbert Consulting, Suite 2A, Blackthorn House, St Pauls Square, Birmingham, B3 1RL, UK.
BMC Psychiatry. 2024 Nov 6;24(1):777. doi: 10.1186/s12888-024-06213-0.
Advance Choice Documents (ACDs) have been recommended for use in England and Wales based on evidence from trials that show that they can reduce involuntary hospitalisation, which disproportionately affects Black African and Caribbean people. Our aim was therefore to develop and test ACD implementation resources and processes for Black people who have previously been involuntarily hospitalised and the people that support them.
Resource co-production workshops were held to inform the development of the ACD template and two types of training for all stakeholders, comprising a Recovery College course and simulation training. An ACD facilitator then used the ACD template developed through the workshops to create personalised ACDs with service users and mental health staff over a series of meetings. Interviews were then conducted with service user and staff participants and analysed to document their experience of the process and opinions on ACDs. Other implementation strategies were also employed alongside to support and optimise the creation of ACDs.
Nine ACDs were completed and were largely reported as appropriate, acceptable, and feasible to service users and staff. Both reported it being an empowering process that encouraged hope for better future treatment and therefore better wellbeing. Uncertainty was also expressed about the confidence people had that ACDs would be adhered to/honoured, primarily due to staff workload. The information provision training and the skills training were generally considered to be informative by trainees.
The project has developed an ACD creation resource that was reported as agreeable to all stakeholders; however, the generalisability of the findings is limited due to the small sample size. The project also highlights the importance of staff and ACD facilitator capacity and good therapeutic relationships in ACD completion. Further research is needed to determine the adjustments needed for large scale use, including for those under age 18 and those under the care of forensic mental health services; and how to include carers/supporters more in the process.
基于试验证据，英格兰和威尔士推荐使用预先指示文件（Advance Choice Documents，ACDs），该证据表明，ACDs 可减少非自愿住院治疗，这种情况不成比例地影响到非裔和加勒比裔人群。因此，我们的目标是为以前被非自愿住院治疗的人和支持他们的人开发和测试针对黑人的 ACD 实施资源和流程。
举行了资源共同制定研讨会，为 ACD 模板的制定提供信息，并为所有利益攸关方提供两种类型的培训，包括康复学院课程和模拟培训。然后，ACD 协调员使用通过研讨会开发的 ACD 模板，在一系列会议上与服务使用者和心理健康工作人员一起创建个性化的 ACD。然后对服务使用者和工作人员参与者进行访谈，并对其进行分析，以记录他们对该过程的经验和对 ACD 的看法。还采取了其他实施策略来支持和优化 ACD 的创建。
完成了 9 份 ACD，服务使用者和工作人员报告称这些 ACD 基本适当、可接受且可行。双方都报告称，这是一个赋权的过程，鼓励对未来更好的治疗和因此更好的幸福感抱有希望。人们对 ACD 是否会被遵守/尊重表示不确定，主要是因为工作人员的工作量。受训者普遍认为信息提供培训和技能培训内容丰富。
该项目开发了一种 ACD 创建资源，所有利益攸关方都报告称其可以接受；然而，由于样本量小，研究结果的普遍性有限。该项目还强调了工作人员和 ACD 协调员的能力以及良好的治疗关系在 ACD 完成中的重要性。需要进一步研究来确定大规模使用 ACD 所需的调整，包括 18 岁以下人群和法医心理健康服务照顾者的调整；以及如何使照顾者/支持者更多地参与该过程。
