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Dr. Swanson, Dr. Swartz, Ms. Ferron, Dr. Elbogen, and Dr. Van Dorn are with the Services Effectiveness Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC. This work was supported by the John D. and Catherine T. MacArthur Foundation Research Network on Mandated Community Treatment. Address correspondence to: Jeffrey Swanson, PhD, Associate Professor in Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3071, Brightleaf Square Suite 23-A, Durham, NC 27710. E-mail: jeffrey.swanson{at}duke.edu
Psychiatric advance directives (PADs) are legal instruments that allow competent persons to document their preferences regarding future mental health treatment and to designate a surrogate decisionmaker in the event they lose capacity to make reliable treatment decisions during an acute episode of psychiatric illness. This study reports the findings of a survey of 1,011 psychiatric outpatients in five U.S. cities about their interest in, and completion of, PADs. Across the sites, only 4 to 13 percent of participants had completed a PAD; however, between 66 and 77 percent reported wanting to complete one if given assistance. Significantly higher demand for PADs was found among participants who were female; were nonwhite; had a history of self-harm, arrest, and decreased personal autonomy; and those who felt pressured to take medication. Actual completion of PADs was more likely among participants with higher insight, those reporting leverage by a representative payee, and those who felt external pressure to keep outpatient appointments for mental health treatment.
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