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Published Online: 2 January 2015

Embedding Advance Directives in Routine Care for Persons With Serious Mental Illness: Implementation Challenges

Abstract

For people with serious mental illness, research demonstrates the potential positive effects of having an advance directive with specific instructions for mental health care. The Commonwealth of Virginia has undertaken efforts to incorporate the completion of psychiatric advance directives into routine mental health services for individuals with serious mental illness. The inherent complexities of advance directives—a single legal tool for use by a heterogeneous array of consumers, providers, and organizations—have led to more barriers than had been anticipated. This article describes challenges encountered in the first three years of implementation efforts. Data are from feedback on early training attempts and experiences of staff at pilot sites and work groups convened for the implementation project. The authors describe a range of challenges, such as how to present a complete and clear message about the nature, purposes, and potential advantages of psychiatric advance directives to various audiences, in particular their use in recovery-oriented care; how to promote cross-system collaboration among potential users of these directives; and how to overcome resource constraints and sustain interest in the process. Virginia’s experience reinforces the importance of developing multifaceted implementation strategies, such as the creation of informational and training tools to spread implementation more effectively, the identification of “champions” or staff members who are invested in implementation, and the development of multiple approaches to facilitating completion of advance directives by consumers.

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Go to Psychiatric Services
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Cover: In the Loge, by Mary Cassatt, circa 1879. Pastel and metallic paint on canvas prepared with a pastel ground. Gift of Mrs. Sargent McKean, 1950 (1950-52-1), the Philadelphia Museum of Art. Photo credit: the Philadelphia Museum of Art/Art Resources, New York.

Psychiatric Services
Pages: 10 - 14
PubMed: 25554232

History

Published in print: January 01, 2015
Published online: 2 January 2015

Authors

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Kathleen Kemp, Ph.D.
Dr. Kemp is with the Department of Child and Adolescent Psychiatry, Rhode Island Hospital, and Brown University Warren Alpert Medical School, Providence (e-mail: [email protected]). Dr. Zelle and Mr. Bonnie are with the University of Virginia School of Law, Charlottesville.
Heather Zelle, J.D., Ph.D.
Dr. Kemp is with the Department of Child and Adolescent Psychiatry, Rhode Island Hospital, and Brown University Warren Alpert Medical School, Providence (e-mail: [email protected]). Dr. Zelle and Mr. Bonnie are with the University of Virginia School of Law, Charlottesville.
Richard J. Bonnie, LL.B.
Dr. Kemp is with the Department of Child and Adolescent Psychiatry, Rhode Island Hospital, and Brown University Warren Alpert Medical School, Providence (e-mail: [email protected]). Dr. Zelle and Mr. Bonnie are with the University of Virginia School of Law, Charlottesville.

Funding Information

John D. and Catherine T. MacArthur Foundation10.13039/100000870: 05-85323-000HCD
Substance Abuse and Mental Health Services Administration10.13039/100000058: 720C-04276-10R00
Robert Wood Johnson Foundation10.13039/100000867: 67241
National Association of State Mental Health Program Directors: 720C-04358-13M00
University of Virginia Law School Foundation:

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