Mental Capacity and Advance Directive of Persons with Mental Illness: A Descriptive Cross-sectional Study from India

For persons with mental illnesses (PWMI), mental capacity (MC) refers to their ability to perceive, choose, and articulate their treatment options. An advance directive (AD) is a declaration stating a person's wishes for care if their mental condition renders them handicapped. It also permits them to designate a nominated representative (NR) to assist them in making treatment-related decisions. The study aimed to ascertain the MC for treatment decisions, including admission of Indian PWMI, and analyze their AD.

This was a descriptive, exploratory, cross-sectional study involving 74 PWMI. The Clinical Global Impression-Severity (CGI-S) scale, "Capacity Assessment for Treatment Decisions Including Admission," the Bengaluru Advanced Directive Interview (BADI), and the Insight and Treatment Attitudes Questionnaire (ITAQ) were used to assess the severity of illness, MC, AD, and insight, respectively.

The majority of PWMI (N = 66, 89.18%) had MC and were able to make choices regarding their admission, care, and treatment for mental health issues. Twelve patients who did not receive AD for treatment believed that in the future, they would never have any mental illness. The MC was significantly related to gender and insight (p values .020 and .001, respectively). Regarding AD, patients predominantly chose outpatient care (55.38%) and management by psychiatrists (78.38%) over other treatment providers. Mainly, parents (55.4%) were selected as NRs.

The majority of the Indian PWMI had MC and provided AD. The MC was significantly related to insight. According to current regulations, when providing care for PWMI, MC, and AD should be routinely assessed and documented.