Abstract

Psychiatric advance directivesdocument patients ’ treatmentpreferences and, if desired, a surrogate decision maker in advance of periods of symptom exacerbation and compromised decision making (1–4). Advance directives provide a means to recognize treatment prefer-ences when meaningful patient partic-ipation in treatment decisions would otherwise be unlikely (5–8). Such recognition may decrease perceived coercion and increase treatment col-laboration, motivation for treatment, and treatment adherence (3,4,9–11). Advance directives may also improve crisis intervention by identifying re-sources to deescalate crises and to serve as viable alternatives to hospital-ization, which may, in turn, reduce hospitalizations (3,12–14). We know little about the content and clinical utility of psychiatric ad-vance directives, although this infor-mation is important for anticipating individual treatment needs and for broader service planning. For exam-ple, while one person’s directive in-structions about alternatives to hospi-talization and methods of deescalat-ing crises may shape care at the indi-vidual level, patterns of such instruc-tions may prompt development of cri-sis services and policies. In the 18 states with statutes about psychiatric advance directives, content parame-ters for the document are spelled out, typically permitting instructions about psychotropic medications, elec-troconvulsive therapy (ECT), hospital admission, and appointment of surro

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