Implementing Psychiatric Advance Directives: The Transmitter and Receiver Problem and the Neglected Right to Be Deemed Incapable.
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2020-12-18
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Abstract
Psychiatric advance directives (PADs) can help adults with serious mental illnesses preserve their autonomy and avoid involuntary interventions during an incapacitating mental health crisis. A PAD is a legal document prepared while mentally competent and states the person's treatment preferences to be implemented during a future crisis, ideally with the advocacy of an authorized proxy decision maker. PADs have been available in the United States for more than three decades but have yet to be robustly implemented in practice. This Open Forum describes PADs metaphorically as a device for remote communication among the person with mental illness, a proxy decision maker, and health care providers. Barriers to PAD usage occur on both "transmitter" and "receiver" sides and must be addressed to advance PAD implementation.
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Swartz, Marvin S, Jeffrey W Swanson, Michele M Easter and Allison G Robertson (2020). Implementing Psychiatric Advance Directives: The Transmitter and Receiver Problem and the Neglected Right to Be Deemed Incapable. Psychiatric services (Washington, D.C.). p. appips202000659. 10.1176/appi.ps.202000659 Retrieved from https://hdl.handle.net/10161/21950.
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Scholars@Duke
Marvin Stanley Swartz
My major research interest is in examining the effectiveness of services for severely mentally ill individuals, including factors that improve or impede good outcomes. Current research includes: the effectiveness of involuntary outpatient commitment, psychiatric advance directives, criminal justice outcomes for persons with mental illnesses, violence and mental illness and antipsychotic medications.
I also served as member of the MacArthur Foundation Research Network on Mandated Community Treatment. In this and related work we are examining the role legal tools such as Psychiatric Advance Directives may play in improving outcomes for persons with severe mental illness. In this regard, I served as Co-PI with Jeffrey Swanson of a NIMH study examining the effectiveness of Psychiatric Advance Directives and a MacArthur Foundation grant supporting their dissemination. We are also evaluating New York's Assisted Outpatient Treatment Program (Kendra's Law) and estimating the cost of criminal justice involvement in severely mentally ill individuals.
I am also involved in clinical trials in schizophrenia and served as Co-PI of the NIMH funded Clinical Antipsychotics Trials of Intervention Effectiveness study investigating the role of antipsychotics in treatment outcomes in schizophrenia and Alzheimer’s Disease.
Jeffrey W. Swanson
Jeffrey Swanson is Professor in Psychiatry and Behavioral Sciences at Duke University School of Medicine. He is a faculty affiliate of the Wilson Center for Science and Justice at Duke Law School, the Center for Firearms Law at Duke Law School, and the Center for Child and Family Policy at Duke Sanford School of Public Policy. Swanson holds a PhD in sociology from Yale University. He is a social scientist researcher who collaborates across disciplines to build evidence for interventions, policies and laws to improve outcomes for adults with serious mental illnesses in the community, and to reduce firearm-related violence and suicide. He is an author of over 250 publications on subjects including the social environmental context of violence in mental illness, implementation of state firearm restrictions related to mental health adjudications, effectiveness of involuntary outpatient commitment, and psychiatric advance directives. Swanson led the research group that published the first empirical evaluations of risk-based, temporary firearm removal laws in Indiana and Connecticut, precursors to Extreme Risk Protection Order laws that were later adopted in many states. He received the 2020 Isaac Ray Award from the American Psychiatric Association and the American Academy of Psychiatry and Law for outstanding contributions to the psychiatric aspects of jurisprudence. He received the 2011 Carl Taube Award from the American Public Health Association for outstanding contributions to mental health services research. Swanson serves on the Executive Steering Committee of the Consortium for Risk-Based Firearm Policy. He previously served as a member of the John D. and Catherine T. MacArthur Foundation Research Network on Mandated Community Treatment and the Methods Core of the Robert Wood Johnson Foundation Public Health Law Research Program. He has delivered numerous endowed lectures including the P. Browning Hoffman Memorial Lecture in Law and Psychiatry at the University of Virginia School of Law and the Raymond W. Waggoner Lecture on Ethics and Values in Medicine at the University of Michigan. Swanson frequently comments on gun violence in the national media and serves as a consultant to policymakers at the federal and state levels.
Michele Easter
At the Services Effectiveness Research Program, I am a co-investigator, analyst, and manager for projects on mental health/substance use services and policy research. Our group conducts longitudinal studies of criminal justice outcomes and crisis-driven service utilization to assess the effects of policies (e.g., mental health-based firearms disqualification) and services (e.g., medication-assisted treatment for substance dependence). As the Behavioral Health Core of the Wilson Center for Science & Justice at Duke School of Law, our research agenda focuses on reducing criminal justice contact among people with mental illness and substance use disorders. We also collaborate with community partners to study and promote the use of psychiatric advance directives. Currently, my research interests center on people with mental illness, substance use, and/or unmet social needs who are stuck in a 'revolving door' of incarceration, crisis care, and detox; I hope this work will make a positive difference in the lives of people in Durham and beyond. I am also interested in the conceptualization of illness and recovery by people with behavioral disorders, specifically the extent to which they endorse and identify with biologically-based explanatory models. My dissertation was on how women with eating disorders understand and interpret the idea that genes play a role in eating disorders.
Allison Gilbert
Research interests include mental health and substance abuse services and policy; links between mental illness, substance abuse and criminal justice involvement; effectiveness of criminal diversion and prison re-entry programs for adults with serious mental illness; and other legal and policy mechanism as mental health interventions.
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