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48. Advance Statements

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Planning ahead

Introduction

Whether they’re called, Advance Directives, Advance Statements , Advance Decisions or, frankly anything along these lines, it is highly beneficial to have information about their care preferences from patients when they are in a good mental state to provide it.

The legal situation is that the Mental Capacity Act 2005 gives people (in England and Wales) a statutory right to state what forms of treatment they would or would not like should they become unable to decide for themselves in the future. Technically an Advance Decision is legally binding in a particular set of circumstances, whereas an Advance Statement is more informal. But the main thing is that it is both ethically right and of considerable practical help to have a clear account from patients about what aspects of hospital care they find valuable and which they find aversive.

Of course Advance Statements can also create considerable dilemmas for staff, who in some situations may firmly believe that a particular approach or treatment would be in the patient’s best interests despite it conflicting with what is in their statement. But such conflicts occur frequently anyway, and at least if there’s an Advance Statement there’s an expression of the individual’s preferences written when they are in a better mental state than they might be in hospital. And one that, ideally, has been produced in partnership with health professionals and others who know them well.

And for the times when there isn’t a complex conflict of views between patient and professionals, Advance Statements are a rich source of detailed information about what the individual finds helps them cope with mental health crises.

Ward examples

Nottinghamshire Healthcare NHS Trust have produced some excellent resources for patients to express their preferences, including easy read versions.

Patient examples

  • I did an advance statement a few years ago. I felt it really made a difference to my stay in hospital as there was lots of information about what “works for me” which helped staff bring me out of my depression.
  • I have specific action plans for when I start to struggle – each one is unique and is tried and tested by me.

This is an easy to read overview of advance statements that dispels common myths. It guides step by step from identifying signs of relapse to explaining possibilities for what you may or may not want from treatment in times of crisis through to completing an advance directive. The activities help with thinking through possibilities. Even readers who chose not to create a formal advance statement immediately, are finding the process helps to be prepared for times of crisis and with the avoidance of relapses. It is also useful for staff in the NHS, friends and relatives even if you have never had a crisis yourself.
http://www.amazon.co.uk/Advance-Statement-Workbook-Directives-Preferences/dp/0955959128

 

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