Advance statements in mental healthcare: time to close the evidence to practice gap

TY - JOUR

T1 - Advance statements in mental healthcare

T2 - time to close the evidence to practice gap

AU - Lasalvia, Antonio

AU - Patuzzo, Sara

AU - Braun, Esther

AU - Henderson, Claire

N1 - Publisher Copyright: © The Author(s), 2023. Published by Cambridge University Press.

PY - 2023/12/6

Y1 - 2023/12/6

N2 - This article discusses advance statements in mental health care, which allow individuals with mental disorders to express their preferences for treatment during mental health crises. Despite the evidence supporting their effectiveness, their implementation in clinical practice remains limited. This article explores variations among advance statements, such as psychiatric advance directives (PADs), joint crisis plans (JCPs) and self-binding directives (SBDs), highlighting their content, development process and legal status. We outline the benefits of advance statements, including empowerment, early intervention, improved therapeutic relationships and reduced compulsory admissions. We then draw attention to the challenges that may contribute to their lack of implementation, including legal complexities, communication issues, cultural factors, potential inequities, healthcare provider knowledge, changing preferences, resource constraints, crisis responses, data privacy, family involvement, and long-term evaluation. In conclusion, advance statements offer significant benefits but require addressing these critical aspects to ensure ethical and effective use. Bridging the evidence-to-practice gap is essential, with a focus on implementation science. Integrating these tools into routine clinical practice can significantly benefit individuals with severe mental disorders and mental health systems.

AB - This article discusses advance statements in mental health care, which allow individuals with mental disorders to express their preferences for treatment during mental health crises. Despite the evidence supporting their effectiveness, their implementation in clinical practice remains limited. This article explores variations among advance statements, such as psychiatric advance directives (PADs), joint crisis plans (JCPs) and self-binding directives (SBDs), highlighting their content, development process and legal status. We outline the benefits of advance statements, including empowerment, early intervention, improved therapeutic relationships and reduced compulsory admissions. We then draw attention to the challenges that may contribute to their lack of implementation, including legal complexities, communication issues, cultural factors, potential inequities, healthcare provider knowledge, changing preferences, resource constraints, crisis responses, data privacy, family involvement, and long-term evaluation. In conclusion, advance statements offer significant benefits but require addressing these critical aspects to ensure ethical and effective use. Bridging the evidence-to-practice gap is essential, with a focus on implementation science. Integrating these tools into routine clinical practice can significantly benefit individuals with severe mental disorders and mental health systems.

KW - community mental health

KW - discrimination

KW - ethics

KW - rights of persons with disabilities

KW - social and political issues

UR - http://www.scopus.com/inward/record.url?scp=85178850996&partnerID=8YFLogxK

U2 - 10.1017/S2045796023000835

DO - 10.1017/S2045796023000835

M3 - Review article

C2 - 38053411

AN - SCOPUS:85178850996

SN - 2045-7960

VL - 32

JO - Epidemiology and Psychiatric Sciences

JF - Epidemiology and Psychiatric Sciences

M1 - e68

ER -