Advance agreements for mental health care: An examination of process and outcomes

Objective: Despite high demand for anticipatory planning tools in mental health there is little Australian research about their implementation. This study examines the processes and outcomes of the introduction of structured mental health advanced agreements in the Australian Capital Territory. Method: Thirty-three patients with serious mental illness collaborated with a key clinician to develop an advanced agreement. Patients and clinicians were provided with appropriate education, workbooks and materials. The process and outcomes associated with developing and completing an agreement were evaluated with patient and clinician interviews and self-report measures. Results: The process was strongly accepted by the patients with only 16% discontinuing for reasons related to the advanced agreement. Participants strongly endorsed benefits both to themselves and to the management of patients' illnesses. Service level impediments, particularly clinician acceptance, limited treatment options, and the lack of legal force of the agreement were identified. Conclusions: When supported, mental health patients can work collaboratively with clinicians to produce anticipatory treatment requests which are beneficial, feasible and consistent with good care. Implementation of anticipatory planning in mental health will require service-level changes to promote clinician acceptance and to embed practices which facilitate these tools as part of routine care.