Psychiatric Advance Directives and Social Workers: An Integrative Review

Psychiatric Advance Directives (PADs) are legal documents that allow individuals to express their wishes for future psychiatric care and to authorize a legally appointed proxy to make decisions on their behalf during incapacitating crises. PADs are viewed as an alternative to the coercive interventions that sometimes accompany mental health crises for persons with mental illness. Insofar as coercive interventions can abridge clients’ autonomy and self-determination -- values supported by the Profession’s Code of Ethics -- social workers have a vested interest in finding ways to reduce coercion and increase autonomy and self-determination in their practice. However, PADs are also viewed as having the potential to positively affect a variety of other clinical outcomes, including but not limited to treatment engagement, treatment satisfaction, and working alliance. This article reviews the clinical and legal history of PADs and empirical evidence for their implementation and effectiveness. Despite what should be an inherent interest in PADs, and the fact that laws authorizing PADs have proliferated in the past decade, there is little theoretical or empirical research in the social work literature