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Advanced decisions: planning ahead

14th July 2015 | Categories: Mental Health

There’s a chapter in the new Mental Health Act Code of Practice on ‘wishes expressed in advance’, which I think makes for useful discussion in relation to care planning for people with mental health problems. This is only a minor amendment to the previous Code but is worth us revisiting.

Refusing treatment

First, some clarification about terminology. The chapter advises the benefit everybody telling someone now, when we are reasonably mentally well, what we would like to happen in relation to our care if we should become mentally unwell – hoping they’re in a position to make sure our wishes are carried out.

There are some legal issues here, and in particular two terms, advance decisions and advance statements. It is important to note the difference. Advance decisions are described in mental capacity law, whereby we can make an advance decision to refuse treatment and if at some future point it is said we need that treatment, then the advance decision to refuse has to be respected as though it was being made now by someone who has capacity. To do otherwise would be assault. However, importantly, advance decisions cannot be made to refuse compulsory mental health treatment. I wrote about this issue in a previous blog which you can find at: http://www.ukqcs.co.uk/mental-capacity-act/best-interests/

What you wish for

Advance statements do not carry the same weight in law as advance decisions. These are wishes which we hope will be carried out. The Mental Health Act Code of Practice says these expressions of what people want to happen should be given the same consideration as a wish expressed at the time. So those wishes might be about where someone wants to be treated, or who they want to be informed, if they become unwell. The Code is aimed primarily at people involved in operating the Mental Health Act, but I think this chapter on advance statements can be useful material for anyone working with someone with mental health problems, by highlighting how these can be used:

  • The chapter talks about discussing advance statements as being a therapeutic tool. Workers discussing with service users about their choices can help the service user feel central to the care planning process
  • It can ensure that choices and wishes are recorded, and passed on as appropriate if someone is in a mental health crisis.
  • It can be a focus for regular review of someone’s care plan. People can change their mind and should be encouraged to think though different options.
  • It can be a way of building genuine collaborative care, making sure the people that the service user wants involved, are involved.

Of course as I said before, these are not legally binding, and professionals are still bound to make decisions to meet the person’s needs, and this might conflict with their wishes. Being aware of that has to be part of the process of using advance statements as part of care planning. As I write this blog I see that the Law Commission’s proposals on the Mental Capacity Act just published includes a discussion as to how advance statements could be much more widely used in health and social care planning. I hope to be writing about their other proposals very soon.

David Beckingham – QCS Expert Mental Health Contributor

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