Assessment of Barriers to Effective Use of Psychiatric Advance Directives: Providers' Knowledge and Attitudes

• Published in: Psychological services 2022-05, Vol.19 (2), p.271-282
• Main Authors: Avila, Andrea, Leeper, Ericia
• Format: Article
• Language: English
• Subjects: Advance Directives; Attitudes; Barriers; Brief interventions; Community hospitals; Confidence; Educational programs; Familiarity; Female; Futility; Health behavior; Health Personnel Attitudes; Human; Implementation; Knowledge (General); Male; Medical decision making; Mental disorders; Mental health; Mental health services; Polls & surveys; Psychiatric Evaluation; Psychiatric Hospitals; Psychosis; Rehabilitation; Relapse; School Based Intervention; Self determination; Self-Confidence
• ISSN: 1541-1559; 1939-148X
• DOI: 10.1037/ser0000525

Psychiatric advance directives, or directives for mental health treatment (DMHTs), are consistent with the principles of psychiatric rehabilitation, self-determination, and a recovery orientation. DMHTs have promise as a consumer-empowering part of a relapse prevention plan. In the context of state psychiatric hospitals, where successful community reintegration is crucial, they have particular relevance. However, DMHTs tend to be underutilized, despite the existence of consumer-friendly laws and consumer interest. Mental health providers (n = 225) were surveyed to assess knowledge of and attitudes toward more comprehensive implementation of DMHTs to test the hypothesis that at least an initial barrier to implementation is provider familiarity with DMHTs. Results of the survey indicate a lack of familiarity with DMHTs, which was addressed by a brief educational intervention embedded in the survey. Prior to education, providers demonstrated a sense of futility and low confidence in their ability to help families plan ahead for future episodes of psychosis. After brief education, they reported more confidence in their ability to effectively intervene and more confidence a DMHT would be a useful intervention. Furthermore, they reported attitudes more supportive of DMHT use as well as an increased likelihood to use DMHTs in their own practice. These findings suggest that an initial barrier to implementation of DMHTs may often be provider familiarity and understanding. Future directions, including broader interventions to increase familiarity, and limitations are discussed. Impact StatementPsychiatric advance directives were intended to empower consumers to plan ahead for the type of care they would want if incapacitated by mental illness. However, they tend to be underused despite consumer interest. Our findings suggest an initial barrier is provider familiarity and understanding, which once addressed may independently increase implementation or, at least, provide the opportunity to gather reliable information about other barriers.