Preparing for Mental Health Act reform: Pilot study of co-produced implementation strategies for Advance Choice Documents

Wellcome Open Research

article

Lucy A. Stephenson¹  Tania Gergel¹  Alex Ruck Keene²  Larry Rifkin⁴  Gareth Owen¹ 

[1] Institute of Psychiatry, Psychology & Neuroscience, King's College London;39 Essex Chambers;Dickson Poon School of Law, Kings College London;South London and Maudsley NHS Foundation Trust

关键词: Advance directive;    advance choice document;    co-production;    implementation;    quality improvement;    mental health act;    mental capacity;    bipolar;   

DOI  :  10.12688/wellcomeopenres.17947.1

学科分类：内科医学

来源: Wellcome

【 摘 要 】

Background Advance Decision Making (ADM) is strongly supported by stakeholders but implementation remains challenging. In England and Wales, implementation strategies are urgently required to prepare for the introduction of mental health ‘Advance Choice Documents’ (ACDs) as part of Mental Health Act reforms. We report on a pilot project which aimed to co-produce and evaluate implementation strategies for ACDs with those who experience fluctuating mental capacity in the context of bipolar. Methods A co-produced prototype ACD template was piloted in ‘Plan, Do, Study Act’ (PDSA) cycles. Implementation strategies were co-produced with participants and mapped onto the Expert Recommendations for Implementing Change (ERIC) framework. Strategies were evaluated during thematically analysed qualitative interviews. Results We piloted the template with 17 service users during 5 successive PDSA cycles and conducted 75 in depth interviews with stakeholders. Key strategies identified as accessible, appropriate and feasible were: interactive assistance from an independent ‘supporter’, a structured template and active offers of involvement to service users and informal carers. Conclusions Mental health professionals and organisations must prepare for increased expectations around mental health ADM. We recommend further pilot projects and the establishment of ‘ACD workshops’. Resource is essential to fund independent ‘supporters’, training, network building and embedding ADM in clinical pathways.

【 授权许可】

CC BY