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Advance Directives for Psych Care Reduce Compulsory Admissions

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Providing peer or community health workers to help psychiatric patients with complete psychiatric advance directives (PAD) to govern care in advance of a mental health crisis is associated with a significant reduction in compulsory hospital admissions, new research shows.

Results of a randomized trial showed the peer worker PAD group had a 42% reduction in compulsory admission over the following 12 months. This study group also had lower symptom scores, greater rates of recovery, and increased empowerment compared vs patients assigned to usual care.

In addition to proving that PADs are effective in reducing compulsory admission, the results show that facilitation by peer workers is relevant, study investigator Aurélie Tinland, MD, PhD, Faculté de Médecine Timone, Aix-Marseille University,

Marseille, France, told delegates attending the virtual European Psychiatric Association (EPA) 2022 Congress. The study was simultaneously published online June 6 in JAMA Psychiatry.

However, Tinland noted that more research that includes “harder to reach” populations is needed. In addition, greater use of PADs is also key to reducing compulsory admissions.

“Most Coercive” Country
The researchers note that respect for patient autonomy is a strong pillar of healthcare, such that “involuntary treatment should be unusual.” However, they point out that “compulsory psychiatric admissions are far too common in countries of all income levels.”

In France, said Tinland, 24% of psychiatric hospitalizations are compulsory. The country is ranked the sixth “most coercive” country in the world and there are concerns about human rights in French psychiatric facilities.

She added that advance care statements are the most efficient tool for reducing coercion, with one study suggesting they could cut rates by 25% compared with usual care.

However, she noted there is an “asymmetry” between medical professionals and patients and a risk of “undue influence” when clinicians facilitate the completion of care statements.

To examine the impact on clinical outcomes of peer-worker facilitated PADs, the researchers studied adults with a diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who were admitted to a psychiatric hospital within the previous 12 months. Peer workers are individuals who have lived experience with mental illness and help inform and guide current patients about care options in the event of a mental health crisis.

Study participants were randomly assigned 1:1 to an intervention group or a usual care control group. The intervention group received a PAD document and were assigned a peer worker while the usual care group received comprehensive information about the PAD concept at study entry and were free to complete it, but they were not connected with a peer worker.

The PAD document included information about future treatment and support preferences, early signs of relapse, and coping strategies. Participants could meet the peer worker in a place of their choice, be supported in drafting the document, and in sharing it with healthcare professionals.

In all, 394 individuals completed the study. The majority (61%) of participants were male and 66% had completed post-secondary education. Schizophrenia was diagnosed in 45%, bipolar I disorder in 36%, and schizoaffective disorder in 19%.

Participants in the intervention group were significantly younger than those in the control group, with a mean of 37.4 years vs 41 years (P=.003) and were less likely to have one or more somatic comorbidities, at 61.2% vs 69.2%.

A PAD was completed by 54.6% of individuals in the intervention group vs 7.1% of controls (P <.001 the pad was written with peer worker support by of those in intervention and controls. who complete a met care facilitators used it during crisis over following months. results showed that rate compulsory admissions significantly lower group at vs control participants an odds ratio had symptoms on modified colorado symptom score than usual patients effect size higher scores empowerment scale p=".003)." recovery assessment were also controls there no significant differences however overall admission rates quality therapeutic alliance life. putting driver seat commenting findings for medscape medical news robert dabney jr ma mdiv apprentice program manager depression bipolar chicago illinois said study us are many benefits to completing psychiatric advance directive but perhaps most powerful one is person receiving mental healthcare their own recovery. he noted people living health conditions don know option exists decide treatment plan crisis. where specialists can come in. having has been through similar experiences guide you process as comforting empowering. i have witnessed experienced firsthand power said. my personal hope goal empower more either become or seek out services because we improves even saves lives added. virginia a. brown phd department psychiatry behavioral sciences university texas austin dell school huge between systems france united states. she explained two greatest barriers pads until filling not billable anything about advanced plans. her work shows individuals believe would be helpful if some kind document could share system says: look designated speak this patient they identified me document. so actually describing need didn existed. another problem hospitals operate cannot talk unrelated hospital police get information first responders emergency wishes preferences. lot hurdles got make robust protects autonomy live serious illness capacity time-limited requires respond emergency. supported institutional grant from french national research. clinical research direction assistance publique h de marseille sponsored trial. tinland declares grants ministry directorate general conduct study. european association congress. abstract: facilitation directives peer-workers: daip. presented june jama psych. published online full text join facebook twitter>
Source : Medscape

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