MODULE 3: ADVANCE CHOICE DOCUMENTS – HOW TO DEVELOP THE DOCUMENT
This module demonstrates the good practice between a member of clinical staff and the person who uses services when introducing and discussing what an advance choice document is.
It is important to note that an Advance Choice Document can contain: information about the person who uses services; information about what happens for them when they are starting to go into crisis; their preferences for treatment and care when they are starting to become unwell and when they need treatment in hospital.
ACDs should be made at a time when the person has the mental capacity to make the decision to make an ACD and to make decisions about their treatment and care or when they are their most well selves.
ACD AND TREATMENT OPTIONS
This video shows a discussion about making advance choices around the treatment the person would prefer to avoid.
Michael is speaking with Lucy a health professional who is supporting him to make an advance choice document. He is remembering a previous conversation he had about treatment with a doctor.
It is important to draw out the underlying reasons behind why people want to record advance choices about treatment they would prefer to avoid. It is also important to understand the person's full range of views around the medication – whether the objection is around giving the medication as one off medication or long term; or whether it is an issue with particular ways of administering the medication. This includes how health professionals could work with the person’s loved ones to support them during times when they are distressed.
A full advance discussion and documentation will make this choice easier for the treating team to understand, manage and give the person who uses services the maximum chance their choices will be respected.
ACD DISCUSSION WITH PATIENT AND CARER
In this series of videos we see the doctor speaking with Ali, a person who uses services and their partner Joe, discussing with the Independent Mental Health Advocate (IMHA) options for her care and treatment in the community.
There are four separate clips demonstrating the various points that need to be considered when meeting to discuss an ACD with a person who uses services, their carer and their advocate.
CRISIS CARE IN THE COMMUNITY
In this clip we see a meeting with an IMHA who has provided support to the person to draft their document, a health professional from the person’s treating team,the person themselves and their partner.
The purpose of this meeting is to share an understanding of the person’s preferences and co-produce some shared recommendations around crisis care to record in the person’s ACD
This segment explores the topic of crisis care in the community and the person receiving treatment at home.
WHEN ADMISSION IS NEEDED
Here the group is discussing their shared understanding of what happens when the person becomes more unwell and may need admission to hospital.
It should be acknowledged that carers and other significant people in a person’s life can find supporting someone going through a mental health crisis very tough and challenging. Jo shares in these videos how he is affected when Ali is unwell.
It is very important when someone is going through a crisis, that their carer or significant other is contacted and able to support them at that time should this be the person’s wish.
MENTAL HEALTH ACT ASSESSMENT AND ADMISSION
This video shows the group discussing compulsory care and treatment:
- How it might be possible to improve the person's experience of a Mental Health Act assessment
- Medication the person would be willing to take, how they would prefer to take it, support that might be required in an emergency and medication they would prefer to avoid and the reasons why
- How the document might be used if the person changes their mind when they are unwell and they lose the capacity to make decisions about their treatment and care
PLANNING THE ADVANCE CARE DOCUMENT
In this clip the group agrees and summarises some shared recommendations for treatment and care that should be recorded in the ACD; discusses care of the home and cultural or spiritual needs; gives advance consent for professionals to contact named loved ones in a crisis and discusses a dissemination plan, i.e. who should have a copy of the document.
SUGGESTED POINTS TO BE INCLUDED IN AN ACD
Research around prototype Advance Choice Documents suggests that people are interested in including the following types of information in their document:
- Personal details
- Information about the person they are when they are well
- Information about the conditions they experience
- Signs they may be becoming unwell
- People they would like to contact in a crisis
- Preferences around treatment and care in the community and in hospital
- Preferences around medication they would prefer and medication they would rather avoid
- Joint recommendations for crisis treatment made collaboratively by the person themselves, their treating team and supporters
- Information about the mental capacity of the person when they are making the document
- Consideration of how the document could be accessed in crisis
- Consideration of when the document should be reviewed
