A clinician's perspective: enhancing trust and autonomy
Advance Statements for Black African and Caribbean (AdStAC) is a research project working with collaborates with Black (and mixed with Black heritage) service users previously detained under the Mental Health Act, their carers, and mental health staff to co-produce resources for advance choice documents (ACDs). An ACD allows service users to specify their treatment preferences for future crises, informing professionals of their wishes. The new Mental Health Bill 2024, which was introduced to parliament earlier this month, will help formalise the use of ACDs in UK services.
In part one of this three-part blog, Dr Nadine Keen, a Consultant Clinical Psychologist shares the impact of ACDs on mental health care and her hopes for the future.
“Dehumanising”, “forced”, “lack of choice”, “racism”, “disempowered” – sadly, these are recurring terms I have encountered all too often from individuals striving to overcome their negative experiences of mental health services through therapy. Many people develop post-traumatic stress symptoms because of these experiences. The fear of relapse can be terrifying, not only due to concerns about mental health but also the anticipated adverse treatment.
The AdStAC project felt like an attempt to address this and to empower individuals to have control over their care decisions.
I routinely develop staying well plans and blueprints upon finishing therapy with people, and I had developed advanced statements previously. However, the AdStAC project presented a distinct experience. The comprehensive and thoughtfully written document, coupled with a gentle facilitator guiding the process, was immensely beneficial. It prompted us to examine the situation through a detailed lens beyond the scope of our typical clinical practice.
Having worked closely with my client in therapy, my role was that of a familiar mental health professional; an advocate. It can be extremely daunting for a person to assert a future plan when the prospect of becoming unwell again feels too traumatic to even think about. It can be even harder to do this with someone you haven’t yet developed a trusting relationship with (i.e., the facilitator). I was, therefore, keen to support my client through this if they wanted me to.
Aware of their past experiences and understandable fears, I hoped to provide a helping-hand to support them in reflecting on their unique needs and wants, should they relapse in the future. Having a facilitator guide the process validated the experiences, hopes and concerns that were voiced. The ACD was crafted in a compassionate and personalised manner, distinctly centred around my client’s wishes. The facilitator's commitment to creating a thorough and individualised document underscored the importance of the endeavour – it was more than just a document in the notes, likely to be forgotten. Instead, it provided a robust safety net, a collaboratively developed plan, and a hope that individuals could trust that their wishes would be respected when it mattered most; and that we, as mental health professionals, are striving for better, person-centred and collaborative care.
My hope is that, moving forward, this level of support can be extended to all.
Read the series
Introduction: Empowering Black voices in mental health care: the advance choice journey
Part two: A service user's story: advocating for better mental health care
Part three: Co-production in mental health care: Insights from an advance choice document facilitator
