Implementing advance agreements into mental health treatment and care planning : a pilot evaluation of the processes and outcomes

Mental health Advance Agreements (AdAs) are a method of anticipatory planning. AdAs allow consumers to formally communicate their treatment and care preferences for an anticipated period of acute mental illness and impaired ability to partake in clinical decisions affecting their care. AdAs are individually tailored in collaboration with a mental health professional, and developed while a consumer is feeling mentally well, competent and motivated. AdAs are hailed as one strategy for promoting consumers' autonomy and empowerment in the management of their mental illness. Furthermore, AdAs are considered to be a functional method for promoting meaningful consumers involvement and informed consent in treatment and care planning (TCP), goals that are consistent with the current Australian national and territory mental health plans. The impetus for introducing AdAs into Mental Health, Australian Capital Territory (MHACT), arose out of local consumer and staff advocacy for a mechanism where consumers could advocate for themselves during periods of acute mental illness. Past literature has established strong ideological support for anticipatory planning documents, tailored to a psychiatric population, whereas empirical evidence is relatively scarce but growing. This thesis reviewed the current literature to build the scene for the current project, and provide a structure for conceptualising the process of developing an AdA, associated benefits and surrounding issues. The project is comprised of one major study, piloting AdAs within MHACT, and two smaller studies, to gather additional information on AdAs and consumer involvement in MHACT. The pilot project adopted an action research framework to develop, implement, and evaluate AdAs within MHACT. The second study utilised focus groups comprising of consumers and carers to gather further opinions and suggestions regarding the implementation of AdAs within MHACT. The third study developed and implemented the Consumer Involvement Questionnaire for Clinical Managers to uncover and explore professionals' knowledge, opinions, beliefs, and current practice concerning meaningful consumer involvement in TCP. The qualitative methods adopted by the project resulted in a rich and comprehensive collection of information. Findings from the study support the notion that developing an AdA is a highly individualistic and potentially therapeutic process, where consumers progress through several stages towards completing an AdA in differing ways and rates. The study also provides support for the potential benefits associated with AdAs. Furthermore, the study identified a range of specific issues and concerns relating to the process of developing and utilising an AdA, along with broader systemic issues concerning the implementation of AdAs into the mental health system. Overall, the current project established that relevant stakeholders generally consider AdAs to be a valuable strategy for anticipatory planning, and to achieve meaningful consumer involvement in TCP. Organisational commitment and sharing the responsibility for implementing AdAs are two broad recommendations from the study. Resource allocation, regular education and training, clear policies and guidelines, and the availability of additional staff/consumer support, are suggested as essential for AdAs to be effectively and successfully implemented. In sum, the project findings bestow further support to the current literature on anticipatory planning, and offer an initial indication of the promising prospects and future directions for AdAs tailored for MHACT