Embedding advance directives in routine care for persons with serious mental illness: implementation challenges

Area of Science:

• Mental Health Services Research
• Health Law and Policy
• Psychiatry

Background:

• Research indicates psychiatric advance directives (PADs) can positively impact individuals with serious mental illness.
• Virginia has initiated efforts to integrate PAD completion into mental health services for this population.
• Advance directives present complexities due to diverse users and organizational structures, leading to implementation barriers.

Purpose of the Study:

• To describe challenges encountered during the initial three years of implementing psychiatric advance directives in Virginia.
• To identify key obstacles in communicating the value and purpose of PADs, fostering collaboration, and sustaining the initiative.

Main Methods:

• Qualitative data collection through feedback on training.
• Analysis of staff experiences at pilot sites.
• Insights from work groups involved in the implementation project.

Main Results:

• Difficulties in clearly communicating the nature, purpose, and benefits of PADs to various stakeholders.
• Challenges in promoting cross-system collaboration among users and providers.
• Obstacles related to resource constraints and maintaining long-term interest.

Conclusions:

• Virginia's experience highlights the need for multifaceted implementation strategies for PADs.
• Developing effective training tools and identifying implementation "champions" are crucial.
• Multiple approaches are necessary to facilitate PAD completion by consumers.