Advanced mental health elective papers ‘would reduce the number of sections’

Fewer people with mental illness would suffer the trauma of the section if advanced choice documents – which set out a treatment plan while they are well – were included in reforms to the Mental Health Act, a leading psychiatrist has said.

Advanced Choice Documents are the only proven way to reduce the number of people detained under the Mental Health Act in England and Wales, which is one of the core aims of the reforms, said Dr Lade Smith, the president of the Royal College or Psychiatrists.

Research suggests that the use of these documents could reduce the number of mandatory detentions in psychiatric wards, often known as sectioning, by 25%, minimizing traumatic experiences for people with bipolar disorders, schizophrenia and other psychotic illnesses.

“It is high time that there is a reform of the Mental Health Act as the number of detentions is increasing, especially for marginalized groups, those who are poor or minority, especially the black Caribbean… Advanced Options documents were a recommendation of the review, I don’t know why they didn’t go through with it,” Smith said.

Advanced choice documents are especially effective in reducing the significantly higher incarceration rates for Black people with mental illness because they can help patients feel more autonomous and reduce unconscious biases.

The documents can also speed and improve recovery, and reduce time spent in the hospital, which can negatively impact patients’ jobs, homes or relationships, Smith said.

Advanced choice documents are similar to those used in palliative care. Patients work with a healthcare professional when they are able to identify the signs of a manic or psychotic episode, effective treatments and their personal preferences.

This may include background information and prompting questions to help healthcare providers identify delusional thinking patterns; medications and doses that were previously effective; and requesting to be hospitalized for their own safety, or, more unusually, that of others.

Although the documents have now been incorporated into NHS guidelines, uptake remains low due to limited awareness, logistical challenges and the misconception that patients may request ineffective treatments such as Reiki healing, Smith said.

“Ideally there should be a mandatory requirement for services to offer advanced choice documents to anyone who has ever been detained under the Mental Health Act – that is what we would like to see,” she said.

King’s College London wants to raise awareness with a new sitewhich will be used as a tool for the NHS to drive a culture shift towards shared decision-making.

Dr. Tania Gergel, a researcher at UCL who leads the Advance Choice project, said this would mark a move away from the ‘paternalistic’ model of psychiatry, which reflects that ‘people have a very good understanding of their illness’ .

In interviews for the project, she found examples where doctors refused to follow the advanced choice document. One patient had written that an antipsychotic drug worked for them at a lower dose, while the usual prescribed dose made them physically unwell, but this was ignored and recovery could only be achieved through a traumatic process of trial and error after the section.

Others said they hated being injected, which is common in forced detentions, including in the buttocks when held in the middle of a ward. “People can feel like who they are as a person is being completely erased,” says Gergel.

Gergel, who has bipolar disorder, believes pre-choice documents saved her life as she experiences severe mixed manic and psychotic episodes in which she quickly becomes uncontrollably suicidal. She struggles to stay safe because she is good at hiding her symptoms.

Her document includes trigger questions to help doctors dispel her delusions, and includes a “self-binding” agreement, meaning that when these symptoms are present, she must receive immediate treatment and monitoring for her own safety. It adds that conventional medicines have not worked for her and she needs electroconvulsive therapy (ECT) – this helped doctors get hospital permission to give her this during pregnancy, a treatment that is usually avoided despite there being there is no evidence that the baby is harmed.

She said the document helps her understand intellectually why it is important to stay in the hospital, even if she feels the desire to go into hiding.

Since writing it, she said her episodes have been “much calmer.” ‘It really worked and kept me safe, even though I had serious suicidal thoughts. When I think back, no matter how difficult the episode was, the trauma is nothing compared to when it was still formal detention and literally being held.”

A spokesperson for the Department of Health and Social Care said the Mental Health Bill did not include provisions for a statutory document for advanced choices because “it is important that a person can make choices in advance in a way that best suits their needs, which may not always be the case. in a written document”. Instead, the bill gives pre-made choices the same legal weight, without the need for a legal document.