Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany
PurposeSelf-binding directives (SBDs) are a special type of psychiatric advance directive in which mental health service users can consent in advance to involuntary hospital admission and involuntary treatment during future mental health crises. This study presents opportunities and risks of SBDs re...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2022.974132/full |
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| author | Sarah Potthoff Marleen Finke Matthé Scholten Astrid Gieselmann Astrid Gieselmann Jochen Vollmann Jakov Gather Jakov Gather |
| author_facet | Sarah Potthoff Marleen Finke Matthé Scholten Astrid Gieselmann Astrid Gieselmann Jochen Vollmann Jakov Gather Jakov Gather |
| author_sort | Sarah Potthoff |
| collection | DOAJ |
| description | PurposeSelf-binding directives (SBDs) are a special type of psychiatric advance directive in which mental health service users can consent in advance to involuntary hospital admission and involuntary treatment during future mental health crises. This study presents opportunities and risks of SBDs reported by users with bipolar disorder, family members of people with bipolar disorder, professionals working with people with bipolar disorder and researchers with expertise in mental health ethics and law.MethodsSeventeen semi-structured interviews with users, family members and professionals, and one focus group with five researchers were conducted. The data was analyzed using qualitative content analysis.ResultsSix opportunities and five risks of SBDs were identified. The opportunities were promotion of autonomy and self-efficacy of users, relief of responsibility for family members, early intervention, reduction of (perceived) coercion, positive impact on the therapeutic relationship and enhancement of professionals' confidence in decision-making. The risks were problems in the assessment of mental capacity, inaccurate information or misinterpretation, increase of coercion through misuse, negative impact on the therapeutic relationship due to noncompliance with SBDs, and restricted therapeutic flexibility and less reflection on medical decision-making. Stakeholders tended to think that the opportunities of SBDs outweigh their risks, provided that appropriate control and monitoring mechanisms are in place, support is provided during the drafting process and the respective mental healthcare setting is sufficiently prepared to implement SBDs in practice.ConclusionsThe fact that stakeholders consider SBDs as an opportunity to improve personalized crisis care for people with bipolar disorder indicates that a debate about the legal and clinical implementation of SBDs in Germany and beyond is necessary. |
| first_indexed | 2024-04-11T19:22:51Z |
| format | Article |
| id | doaj.art-1a494a9571704481bc9c4c0efeb77d05 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-04-11T19:22:51Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-1a494a9571704481bc9c4c0efeb77d052022-12-22T04:07:14ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402022-10-011310.3389/fpsyt.2022.974132974132Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in GermanySarah Potthoff0Marleen Finke1Matthé Scholten2Astrid Gieselmann3Astrid Gieselmann4Jochen Vollmann5Jakov Gather6Jakov Gather7Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, GermanyInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, GermanyInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, GermanyInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, GermanyDepartment of Psychiatry, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Berlin, GermanyInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, GermanyInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, GermanyDepartment of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, GermanyPurposeSelf-binding directives (SBDs) are a special type of psychiatric advance directive in which mental health service users can consent in advance to involuntary hospital admission and involuntary treatment during future mental health crises. This study presents opportunities and risks of SBDs reported by users with bipolar disorder, family members of people with bipolar disorder, professionals working with people with bipolar disorder and researchers with expertise in mental health ethics and law.MethodsSeventeen semi-structured interviews with users, family members and professionals, and one focus group with five researchers were conducted. The data was analyzed using qualitative content analysis.ResultsSix opportunities and five risks of SBDs were identified. The opportunities were promotion of autonomy and self-efficacy of users, relief of responsibility for family members, early intervention, reduction of (perceived) coercion, positive impact on the therapeutic relationship and enhancement of professionals' confidence in decision-making. The risks were problems in the assessment of mental capacity, inaccurate information or misinterpretation, increase of coercion through misuse, negative impact on the therapeutic relationship due to noncompliance with SBDs, and restricted therapeutic flexibility and less reflection on medical decision-making. Stakeholders tended to think that the opportunities of SBDs outweigh their risks, provided that appropriate control and monitoring mechanisms are in place, support is provided during the drafting process and the respective mental healthcare setting is sufficiently prepared to implement SBDs in practice.ConclusionsThe fact that stakeholders consider SBDs as an opportunity to improve personalized crisis care for people with bipolar disorder indicates that a debate about the legal and clinical implementation of SBDs in Germany and beyond is necessary.https://www.frontiersin.org/articles/10.3389/fpsyt.2022.974132/fullpsychiatric advance directiveadvance statementUlysses arrangementjoint crisis planmental healthcarecoercion |
| spellingShingle | Sarah Potthoff Marleen Finke Matthé Scholten Astrid Gieselmann Astrid Gieselmann Jochen Vollmann Jakov Gather Jakov Gather Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany Frontiers in Psychiatry psychiatric advance directive advance statement Ulysses arrangement joint crisis plan mental healthcare coercion |
| title | Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany |
| title_full | Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany |
| title_fullStr | Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany |
| title_full_unstemmed | Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany |
| title_short | Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany |
| title_sort | opportunities and risks of self binding directives a qualitative study involving stakeholders and researchers in germany |
| topic | psychiatric advance directive advance statement Ulysses arrangement joint crisis plan mental healthcare coercion |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2022.974132/full |
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