Towards a consensus on training for advance care planning in mental health: Results from a Delphi study

Advance Care Planning (ACP) in mental health enables individuals with psychosocial disabilities to express preferences for future care, thus safeguarding autonomy during crises. Although legally recognised in several countries, ACP remains under-implemented, partly due to insufficient training among key stakeholders. This study aimed to establish consensus on the essential contents and the most appropriate trainer profiles required to develop tailored, brief ACP training programs in mental health for service users, their supportive networks, and mental health professionals for implementation in Catalonia (Spain). A three-round Delphi study was conducted with 85 ACP experts from 26 countries, representing diverse stakeholder groups including mental health service users, members of their support network, professionals, and mixed profiles. Participants assessed the relevance of 71 preselected training topics and evaluated the suitability of different trainer profiles. Consensus was defined as ≥75% agreement across participants. Consensus was achieved for 59 training topics for being included in the mental health service users training program, 62 training topics for the training program for support networks, and 63 training topics for the training program for professionals. The inclusion of mental health service users as trainers was highly endorsed, particularly in peer training. This study provides a consensus-driven training framework for ACP in mental health that emphasises tailored content for each group, as well as the active involvement of service users as trainers. It provides a scalable model for harmonising training initiatives internationally and aligns with the United Nations Convention on the Rights of Persons with Disabilities and the WHO QualityRights initiative.