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Administration and Policy in Mental Health and Mental Health Services Research

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01-05-2013 | Original Article

A Survey of Stakeholder Knowledge, Experience, and Opinions of Advance Directives for Mental Health in Virginia

Authors: Christine M. Wilder, Jeffrey W. Swanson, Richard J. Bonnie, Tanya Wanchek, Laura McLaughlin, Jeanita Richardson

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 3/2013

Abstract

An innovative Virginia health care law enables competent adults with serious mental illness to plan for treatment during incapacitating crises using an integrated advance directive with no legal distinction between psychiatric or other causes of decisional incapacity. This article reports results of a survey of 460 individuals in five stakeholder groups during the initial period of the law’s implementation. All respondents held favorable views of advance directives for mental health care. Identified barriers to completing and using advance directives varied by group. We conclude that relevant stakeholders support implementation of advance directives for mental health, but level of baseline knowledge and perception of barriers vary. A multi-pronged approach will be needed to achieve successful implementation of advance directives for mental health.

Administrators were notified of the survey through the Virginia Hospital and Healthcare Association (VHHA) or the Commonwealth of Virginia Department of Behavioral Health and Developmental Services (DBHDS). Clinicians were reached through the National Association of Social Workers of Virginia (NASWVA) or the Virginia Association of Community Service Boards (VACSB). Members of the consumers/family/advocates group were reached through the National Alliance on Mental Illness, Virginia chapter (NAMI-VA) or the Virginia Organization of Consumers Asserting Leadership (VOCAL).

The URL link to the clinician survey was included in the regular biweekly email sent to approximately 2,000 members of NASWVA and was also provided to clinicians at each of the 40 CSBs in Virginia. However, the number of clinicians at each CSB who received the email link is unknown; the number of clinicians at each CSB ranged from approximately 5–20 (personal communication, Mary Ann Bergeron). Finally, NAMI-VA also included the URL link in its weekly mail to approximately 2,300 members, while VOCAL posted the URL on its website. It is unknown how many individuals visited the website and saw the URL.

Bonnie, R. J., Reinhard, J., Hamilton, P., et al. (2009). Mental health system transformation after the Virginia Tech tragedy. Health Affairs, 28, 793–804.PubMedCrossRef

Commonwealth of Virginia Commission on Mental Health Law Reform. (2008). Progress report on mental health law reform. June 1, 2011, available from http://www.courts.state.va.us/programs/cmh/2008_1222_progress_report.pdf.

Commonwealth of Virginia Commission on Mental Health Law Reform. (2009). Progress report on mental health law reform. June 1, 2011, available from http://www.courts.state.va.us/programs/cmh/2009_progress_report.pdf.

Commonwealth of Virginia Commission on Mental Health Law Reform. (2008). Report of the task force on empowerment and self determination. June 1, 2011, available from http://www.courts.state.va.us/programs/cmh/2009_progress_report.pdf.

Elbogen, E. B., Swartz, M. S., Van Dorn, R. A., et al. (2006). Clinical decision making and views about psychiatric advance directives. Psychiatric Services, 57, 350–355.PubMedCrossRef

Henderson, C., Swanson, J. W., Szmukler, G., et al. (2008). A typology of advance statements in mental health care. Psychiatric Services, 59, 63–71.PubMedCrossRef

Scheyett, A., Kim, M., Swanson, J., et al. (2007). Psychiatric advance directives: A tool for consumer empowerment and recovery. Psychiatric Rehabilitation Journal, 31, 70–75.PubMedCrossRef

Swanson, J. W., Swartz, M. S., Elbogen, E. B., et al. (2006a). Facilitated psychiatric advance directives: A randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness. American Journal of Psychiatry, 163, 1943–1951.PubMedCrossRef

Swanson, J. W., Swartz, M. S., Elbogen, E. B., et al. (2008). Psychiatric advance directives and reduction of coercive crisis interventions. Journal of Mental Health, 17, 255–267.PubMedCrossRef

Swanson, J. W., Swartz, M. S., Ferron, J., et al. (2006b). Psychiatric advance directives among public mental health consumers in five U.S. cities: Prevalence, demand, and correlates. Journal of the American Academy of Psychiatry & the Law, 34, 43–57.

Swanson, J. W., Swartz, M. S., Hannon, M. J., et al. (2003). Psychiatric advance directives: A survey of persons with schizophrenia, family members, and treatment providers. International Journal of Forensic Mental Health, 2, 73–86.CrossRef

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Van Dorn, R. A., Swartz, M. S., Elbogen, E. B., et al. (2006). Clinicians’ attitudes regarding barriers to the implementation of psychiatric advance directives. Administration and Policy in Mental Health and Mental Health Services Research, 33, 449–460.PubMedCrossRef

Virginia Code Annotated (2010). Sect. 54.1-2981.

Wilder, C. M., Elbogen, E. B., Moser, L. L., et al. (2010). Medication preferences and adherence among individuals with severe mental illness and psychiatric advance directives. Psychiatric Services, 61, 380–385.PubMedCrossRef

Title: A Survey of Stakeholder Knowledge, Experience, and Opinions of Advance Directives for Mental Health in Virginia
Authors: Christine M. Wilder
Jeffrey W. Swanson
Richard J. Bonnie
Tanya Wanchek
Laura McLaughlin
Jeanita Richardson
Publication date: 01-05-2013
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 3/2013
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-011-0401-9

At a glance: The STEP trials

Springer Medicine

A Survey of Stakeholder Knowledge, Experience, and Opinions of Advance Directives for Mental Health in Virginia

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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