Advance Directives in Mental Health Service: A Qualitative Study on Stakeholders' Perspectives

Advance directives in mental health services aim to reduce coercion, enhance adherence, and prevent violence by giving patients a voice during relapses. However, their use is limited due to diverse stakeholder perspectives and insufficient familiarity.

To explore stakeholders' perspectives on advance directives in Icelandic mental health services, focusing on potential benefits and implementation challenges.

Data were gathered via focus groups with purposively sampled mental health service users and providers. Using a multiple category design allowed for constant comparative and interpretive analysis of data collected from these two groups.

The study involved 19 individuals divided into four focus groups, with service users comprising one group (n = 4) and service providers comprising three groups (n = 15). Participants had limited familiarity with advance directives and had not used them. While both service users and providers viewed advance directives favourably, significant differences emerged: users valued the opportunity for self-expression and autonomy, whereas providers, though supportive of user empowerment, struggled with relinquishing control in the therapeutic relationship, thereby preserving power imbalances.

Implementing advance directives in mental healthcare requires in-depth dialogue to align stakeholder expectations. A strategy should focus on education, stakeholder engagement, and co-created interventions to reconcile diverse perspectives.