Psychiatric Advance Directives: A Review of the Evidence

Psychiatric advance directives (PADs) offer individuals with psychiatric conditions the opportunity to document their preferences for treatment and interactions during a mental health crisis before that crisis occurs. In completing a PAD, individuals are encouraged to identify and document their preferences for medication management, setting of care, points of contact, a decisionmaking surrogate, and ways of interacting with emergency response and health care teams. Although PADs have grown in popularity and their legality has been increasingly recognized in international contexts and among individual U.S. states, evidence regarding their use is not well synthesized or documented. In this environmental scan, the authors take a broad approach that combines evidence from systematic reviews, primary empirical literature, and grey literature to better understand the state of the evidence regarding implementing PADs in community, inpatient, and outpatient contexts. The authors sought to identify the potential and realized benefits of PADs, the barriers to the adoption and implementation of PADs, and promising practices for PAD implementation. This study summarizes those findings and can help inform future efforts to develop and implement PADs. Overall, PADs are a promising tool to improve care for individuals with serious mental illness; however, implementation requires clear legal guidance and clinician buy-in to ensure the effectiveness of PADs.