Marital Commitment and Marital Quality in Spouses of Patients with Psychiatric Disorders (2025)

Indian journal of social psychiatry

Advance directives in mental health care: hearing the voice of the mentally ill

Medico Legal Journal of Ireland, 2010

Advance directives or "living wills" are statements by competent adults setting out

Clinical decision making and views about psychiatric advance directives

2006

Psychiatric Advance Directives: An Understanding

Zenodo (CERN European Organization for Nuclear Research), 2019

Undoubtedly, 2017 is a watershed year for mental health professionals and sufferers; this year witnessed the historic moment of the advance of Mental Health Care Act (MHCA). The importance of this Act cannot be underestimated as it has come as a ray of hope as few rights have been given to the persons with mental illness, first time, like the right to make advance directives. Hence, it can be said that its coming is a tremendous achievement and a beacon of hope for the millions of people. It is a pivotal Act in the battle against the mental illness that also directs the public's attention toward the ongoing pandemic. Efforts to implement it will cause many challenges as well as renewed optimism. Understanding of concepts related to ADs is essential for mental health professionals as they have an important role to play with severe, persistent, mental illnesses. The purpose of this article is to collect the blinding flashes of insight, as well as the mundane aspects of ADs to begin to understand its benefits and prediction of barriers in its implementation and their possible solution.

Commentary: Toward Resolving Some Dilemmas Concerning Psychiatric Advance Directives

Journal of the American Academy of Psychiatry and the Law Online, 2006

Psychiatrists' Views and Attitudes About Psychiatric Advance Directives

International Journal of Forensic Mental Health, 2005

Psychiatric Advance Directives

Journal of Psychiatric Practice, 2003

Issues in the development of advance directives in mental health care

Journal of Mental Health, 2003

Background: Interest in advance directives in mental health care is growing internationally. There is no clear universal agreement as to what such an advance directive is or how it should function. Aim: To describe the range of issues embodied in the development of advance directives in mental health care. Method: The literature on advance directives is examined to highlight the pros and cons of different versions of advance directive. Results: Themes emerged around issues of terminology, competency and consent, the legal status of advance directives independent or collaborative directives and their content. Opinions vary between a unilateral legally enforceable instrument to a care plan agreed between patient and clinician. Conclusion: There is immediate appeal in a liberal democracy that values individual freedom and autonomy in giving weight to advance directives in mental health care. They do not, however, solve all the problems of enforced treatment and early access to treatment. They also raise new issues and highlight persistent problems.

Advance Directives: identifying possible barriers in implementation and potential remedies

Open Journal of Psychiatry & Allied Sciences

Advance Directives (AD) are the legal right of every adult individual, who has the mental capacity to decide at the time of making AD, irrespective of one's previous mental illness. AD seem to be an answer for many concerns and make it possible for an individual to take or retain control over one's care by specifying treatment choices, well in advance and by naming someone as a Nominate Representative (NR) to make medical decisions once one is no longer able to do so. It can be expected that many barriers in the implementation of AD will be encountered that cannot be overlooked and active steps need to be taken to explore the possible barriers standing in the way of its effective implementation in our country. In short, it can be concluded that it is a challenging time for the mental health community as we live in a world of scarce workforce and millions of people need mental health services which demands urgent action. Despite the backing of the new law, we are well aware that we have a massive challenge on our hands. Hence, it is essential to accept the crucial role of country leadership in efforts to improve the mental health along with the critical part of civil society, media, and others to account for health outcomes. The purpose of this article is to collect the blinding flashes of insight to begin the prediction of barriers to AD's implementation and possible solutions.

The Time Frame of Preferences, Dispositions, and the Validity of Advance Directives for the Mentally Ill

Philosophy, Psychiatry and Psychology, 1998

Advance directives have not been used extensively in mental illness. Mental health legislation in most Anglo-American countries gives considerable power to clinicians to override the advance directives of the mentally ill, if they choose. We offer a conceptual analysis of preferences and show how this helps better understand the place of advance directives in mental illness. We argue for a dispositional rather than occurrent analysis of preferences and desires. On this analysis, preferences and desires are dispositions to act. A person may have a desire now for a state of affairs though he is not now actively seeking to promote that state of affairs. In clinical practice, advance directives have been hailed as a means by which people can express their autonomy when they are incompetent. Currently, an advance directive must have been freely formed when a person was competent and informed of the consequences of his choice. Particular problems face their use in mental illness because they have been seen as an expression of a past preference. It is difficult to establish whether a mentally ill person was competent at the time of completing an advance directive and whether the preference was the product of mental illness. On the dispositional analysis of preferences, advance directives are relevant to treatment insofar as they represent a person's present dispositional preference. Although a mentally ill person in the grip of psychosis may have disordered and irrational preferences now, he may also have dispositional preferences which should be respected. The imperative to respect a person's present preferences in a liberal society is great. According to the dispositional analysis, it is not necessary for clinicians to show that a mentally ill person was competent, informed, and acting freely at the time he expressed his preference in an advance directive, but only that the person has a present dispositional preference similar to that expressed in the advance directive, and that he was free, competent, and fully informed at some point during the time he has had the preference. We distinguish this dispositional analysis of advance directives from an analysis in terms of substituted judgment. We distinguish three groups of patients who might form advance directives: (1) those who are and have been well and who anticipate future illness; (2) those who are intermittently ill; (3) those who are chronically ill. We argue that, according to the dispositional analysis, advance directives are appropriate for groups 2 and 3 and, crucially, that it makes no difference whether their illness is physical or mental. Failing to respect these relevant present preferences constitutes discrimination against the mentally ill. While advance directives have been proposed as a way to facilitate the mentally ill consenting in advance to psychiatric treatment when they become incompetent, we believe advance directives have a much broader role: to allow the mentally ill to make decisions about all aspects of their medical care, including in some cases refusal of treatment for mental illness, even if this exposes that person to a greater than necessary risk, including the risk of self-harm or suicide.