A template for a psychiatric advance directive: Co-development and qualitative evaluation with key stakeholders

Psychiatric advance directives (PADs) allow mental health service users to express their treatment preferences for future mental health crises. An accessible template for PADs can improve their implementation in practice.

Developing and evaluating a PAD template tailored to the German context together with key stakeholders.

We co-developed a prototype PAD template based on a systematic review of the content of PADs and a review of existing templates in consultation with our research group's lived experience council. The prototype was evaluated in 5 focus groups with service users, relatives, mental healthcare professionals, peer support workers and legal guardians as well as 4 consultation sessions with clinical and legal experts and the research group's lived experience council. We revised the template after each feedback round.

Participants valued the inclusion of the options to articulate personal values, preferred types of support in their recovery process, and preferred measures of supported decision-making in the template. They recommended including a summary page with the most important information in a crisis, a section for service users to describe themselves when stable or well, and the option to state preferences for post-inpatient care. There was controversy among study participants on whether the template should include individual indicators of decision-making capacity, preferences regarding treatment setting, and de-escalation strategies.

This study presents the development of the first German PAD template together with key stakeholders. The study design can be used as a model for developing templates tailored to other legal contexts.