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Psychiatric Advance Directives: A Survey of Persons With Schizophrenia, Family Members, and Treatment Providers

Psychiatric advance directives (PADs) allow competent persons to request or refuse specific types of treatment and designate a proxy decisionmaker in advance of a mental health crisis when they may lose capacity to make reliable healthcare decisions. A survey of attitudes and opinions about PADs was conducted in three stakeholder groups with a sample of 104 persons with schizophrenia and related disorders, 83 family members of persons with severe mental illness (SMI), and 85 clinicians who treat persons with severe mental illness. Among the sample of persons treated for schizophrenia, only 7 (6.80%) reported having a PAD, but 62 (67.39%) reported that they would complete a PAD if provided assistance. Respondents in all three stakeholder groups largely expressed great interest in PADs, but indicated that they had little or no experience with these new legal instruments. Patients, family members, and clinicians differed substantially in their opinions about the goals of PADs, the likely effectiveness of these instruments, and who should be legally bound by them. Respondents with schizophrenia perceived significant barriers to completing a PAD. Stakeholders have interest in, and high hopes for PADs; however, significant barriers prevent successful implementation of PADs as intended. It may be necessary to provide resources to assist persons with SMI in completing PADs, configure information systems to make PADs accessible, and educate clinicians about the potential benefits and drawbacks of PADs and their legal obligations regarding PAD compliance.