Advance care planning ahead of life-altering clinical deterioration in secure settings: Do not wait until a crisis

All professionals involved in someone's care should be equipped to support individuals, and the people close to them, to understand how their health is likely to change, consider the burdens and likely outcomes of treatment options and make realistic, informed recommendations to guide future care. This can be particularly challenging in forensic mental health, when it covers cardiopulmonary resuscitation alongside recommendations about acute hospital admission and medical escalation within and outside of hospital settings. Some clinicians question whether or not the harms of raising the spectre of invasive ventilation and potential mortality risks unnecessary anxiety and psychological harm amongst detained patients. Instead, we argue that timely advance care and treatment escalation planning with each patient, informed by psychiatric clinicians, is long overdue.