Opportunities and challenges of self-binding directives: A comparison of empirical research with stakeholders in three European countries

Matthé Scholten; Simone Efkemann; Mirham Faissner; Marleen Finke; Gather Jakov; Gergel Tania; Gieselmann Astrid; Lia van der Ham; Jackel Georg; Laura van Melle; Gareth Owen; Sarah Pothoff; Lucy Stephenson; Szmukler George; Vellinga Astrid; Vollman Jochen; Yolande Vosges; Anna Werning; Guy Widdershoven

doi:10.1192/j.eurpsy.2023.2421

Opportunities and challenges of self-binding directives: A comparison of empirical research with stakeholders in three European countries

Matthé Scholten^*, Simone Efkemann, Mirham Faissner, Marleen Finke, Gather Jakov, Gergel Tania, Gieselmann Astrid, Lia van der Ham, Jackel Georg, Laura van Melle, Gareth Owen, Sarah Pothoff, Lucy Stephenson, Szmukler George, Vellinga Astrid, Vollman Jochen, Yolande Vosges, Anna Werning, Guy Widdershoven

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background

Self-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concerns. Until recently, little was known about the views of stakeholders on the opportunities and challenges of SBDs.

Aims

This article aims to foster an international exchange on SBDs by comparing recent empirical findings on stakeholders’ views on the opportunities and challenges of SBDs from Germany, the Netherlands, and the United Kingdom.

Method

Comparisons between the empirical findings were drawn using a structured expert consensus process.

Results

Findings converged on many points. Perceived opportunities of SBDs include promotion of autonomy, avoidance of personally defined harms, early intervention, reduction of admission duration, improvement of the therapeutic relationship, involvement of persons of trust, avoidance of involuntary hospital admission, addressing trauma, destigmatization of involuntary treatment, increase of professionals’ confidence, and relief for proxy decision-makers. Perceived challenges include lack of awareness and knowledge, lack of support, undue influence, inaccessibility during crisis, lack of cross-agency coordination, problems of interpretation, difficulties in capacity assessment, restricted therapeutic flexibility, scarce resources, disappointment due to noncompliance, and outdated content. Stakeholders tended to focus on practical challenges and did not often raise fundamental ethical concerns.

Conclusions

Stakeholders tend to see the implementation of SBDs as ethically desirable, provided that the associated challenges are addressed.

Original language	English
Article number	e48
Number of pages	6
Journal	European Psychiatry
Volume	66
Issue number	1
Early online date	9 Jun 2023
DOIs	https://doi.org/10.1192/j.eurpsy.2023.2421
Publication status	Published - 9 Jun 2023

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Scholten et al-2023-Opportunities and challenges of self-binding directivesFinal published version, 158 KBLicence: CC BY

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Scholten, M., Efkemann, S., Faissner, M., Finke, M., Jakov, G., Tania, G., Astrid, G., van der Ham, L., Georg, J., van Melle, L., Owen, G., Pothoff, S., Stephenson, L., George, S., Astrid, V., Jochen, V., Vosges, Y., Werning, A., & Widdershoven, G. (2023). Opportunities and challenges of self-binding directives: A comparison of empirical research with stakeholders in three European countries. European Psychiatry, 66(1), Article e48. https://doi.org/10.1192/j.eurpsy.2023.2421

@article{3caa3df9f9f74de6a4415d9d481d22cf,

title = "Opportunities and challenges of self-binding directives: A comparison of empirical research with stakeholders in three European countries",

abstract = "BackgroundSelf-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concerns. Until recently, little was known about the views of stakeholders on the opportunities and challenges of SBDs.AimsThis article aims to foster an international exchange on SBDs by comparing recent empirical findings on stakeholders{\textquoteright} views on the opportunities and challenges of SBDs from Germany, the Netherlands, and the United Kingdom.MethodComparisons between the empirical findings were drawn using a structured expert consensus process.ResultsFindings converged on many points. Perceived opportunities of SBDs include promotion of autonomy, avoidance of personally defined harms, early intervention, reduction of admission duration, improvement of the therapeutic relationship, involvement of persons of trust, avoidance of involuntary hospital admission, addressing trauma, destigmatization of involuntary treatment, increase of professionals{\textquoteright} confidence, and relief for proxy decision-makers. Perceived challenges include lack of awareness and knowledge, lack of support, undue influence, inaccessibility during crisis, lack of cross-agency coordination, problems of interpretation, difficulties in capacity assessment, restricted therapeutic flexibility, scarce resources, disappointment due to noncompliance, and outdated content. Stakeholders tended to focus on practical challenges and did not often raise fundamental ethical concerns.ConclusionsStakeholders tend to see the implementation of SBDs as ethically desirable, provided that the associated challenges are addressed.",

author = "Matth{\'e} Scholten and Simone Efkemann and Mirham Faissner and Marleen Finke and Gather Jakov and Gergel Tania and Gieselmann Astrid and {van der Ham}, Lia and Jackel Georg and {van Melle}, Laura and Gareth Owen and Sarah Pothoff and Lucy Stephenson and Szmukler George and Vellinga Astrid and Vollman Jochen and Yolande Vosges and Anna Werning and Guy Widdershoven",

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier Masson SAS. All rights reserved. Publisher Copyright: {\textcopyright} The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association.",

year = "2023",

month = jun,

day = "9",

doi = "10.1192/j.eurpsy.2023.2421",

language = "English",

volume = "66",

journal = "European Psychiatry",

issn = "0924-9338",

publisher = "Elsevier B.V.",

number = "1",

}

Scholten, M, Efkemann, S, Faissner, M, Finke, M, Jakov, G, Tania, G, Astrid, G, van der Ham, L, Georg, J, van Melle, L, Owen, G, Pothoff, S, Stephenson, L, George, S, Astrid, V, Jochen, V, Vosges, Y, Werning, A & Widdershoven, G 2023, 'Opportunities and challenges of self-binding directives: A comparison of empirical research with stakeholders in three European countries', European Psychiatry, vol. 66, no. 1, e48. https://doi.org/10.1192/j.eurpsy.2023.2421

TY - JOUR

T1 - Opportunities and challenges of self-binding directives: A comparison of empirical research with stakeholders in three European countries

AU - Scholten, Matthé

AU - Efkemann, Simone

AU - Faissner, Mirham

AU - Finke, Marleen

AU - Jakov, Gather

AU - Tania, Gergel

AU - Astrid, Gieselmann

AU - van der Ham, Lia

AU - Georg, Jackel

AU - van Melle, Laura

AU - Owen, Gareth

AU - Pothoff, Sarah

AU - Stephenson, Lucy

AU - George, Szmukler

AU - Astrid, Vellinga

AU - Jochen, Vollman

AU - Vosges, Yolande

AU - Werning, Anna

AU - Widdershoven, Guy

N1 - Publisher Copyright: © 2023 Elsevier Masson SAS. All rights reserved. Publisher Copyright: © The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association.

PY - 2023/6/9

Y1 - 2023/6/9

N2 - BackgroundSelf-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concerns. Until recently, little was known about the views of stakeholders on the opportunities and challenges of SBDs.AimsThis article aims to foster an international exchange on SBDs by comparing recent empirical findings on stakeholders’ views on the opportunities and challenges of SBDs from Germany, the Netherlands, and the United Kingdom.MethodComparisons between the empirical findings were drawn using a structured expert consensus process.ResultsFindings converged on many points. Perceived opportunities of SBDs include promotion of autonomy, avoidance of personally defined harms, early intervention, reduction of admission duration, improvement of the therapeutic relationship, involvement of persons of trust, avoidance of involuntary hospital admission, addressing trauma, destigmatization of involuntary treatment, increase of professionals’ confidence, and relief for proxy decision-makers. Perceived challenges include lack of awareness and knowledge, lack of support, undue influence, inaccessibility during crisis, lack of cross-agency coordination, problems of interpretation, difficulties in capacity assessment, restricted therapeutic flexibility, scarce resources, disappointment due to noncompliance, and outdated content. Stakeholders tended to focus on practical challenges and did not often raise fundamental ethical concerns.ConclusionsStakeholders tend to see the implementation of SBDs as ethically desirable, provided that the associated challenges are addressed.

AB - BackgroundSelf-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concerns. Until recently, little was known about the views of stakeholders on the opportunities and challenges of SBDs.AimsThis article aims to foster an international exchange on SBDs by comparing recent empirical findings on stakeholders’ views on the opportunities and challenges of SBDs from Germany, the Netherlands, and the United Kingdom.MethodComparisons between the empirical findings were drawn using a structured expert consensus process.ResultsFindings converged on many points. Perceived opportunities of SBDs include promotion of autonomy, avoidance of personally defined harms, early intervention, reduction of admission duration, improvement of the therapeutic relationship, involvement of persons of trust, avoidance of involuntary hospital admission, addressing trauma, destigmatization of involuntary treatment, increase of professionals’ confidence, and relief for proxy decision-makers. Perceived challenges include lack of awareness and knowledge, lack of support, undue influence, inaccessibility during crisis, lack of cross-agency coordination, problems of interpretation, difficulties in capacity assessment, restricted therapeutic flexibility, scarce resources, disappointment due to noncompliance, and outdated content. Stakeholders tended to focus on practical challenges and did not often raise fundamental ethical concerns.ConclusionsStakeholders tend to see the implementation of SBDs as ethically desirable, provided that the associated challenges are addressed.

UR - http://www.scopus.com/inward/record.url?scp=85162245356&partnerID=8YFLogxK

U2 - 10.1192/j.eurpsy.2023.2421

DO - 10.1192/j.eurpsy.2023.2421

M3 - Article

SN - 0924-9338

VL - 66

JO - European Psychiatry

JF - European Psychiatry

IS - 1

M1 - e48

ER -

Opportunities and challenges of self-binding directives: A comparison of empirical research with stakeholders in three European countries

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