ACDI V1.0: Advance Choice Documents Implementation
Overview
About the study
We are an independent team of researchers from King’s College London. The main aim of this study is to evaluate the impact of using Advance Choice Documents on the rates of detention under the Mental Health Act (MHA). We will also be evaluating participants' experience of creating and using Advance Choice Documents within South London and Maudsley (SLaM) services.
Advance Choice Documents are statements made when someone is well and set out their wishes and/or refusals of future treatment for when a person is in crisis or lose the capacity to make decisions. Advance Choice Documents help healthcare professionals understand how people would like to be treated if they become mentally unwell. They are used when someone needs to go into hospital or if they’re detained under the MHA. Based on previous studies, the use of such statements can reduce the risk of compulsory admission by 25%. SLaM is now introducing the use of Advance Choice Documents across its mental health services.
The use of ACDs has mainly been studied in general adult service settings. In order to explore how to apply their use in Child and Adolescent Mental Health Services (CAMHS) and services for Older Adults (OA), the first piece of research we are doing is to discuss this with people who use these services, their carers, and mental health professionals who work in them.
What will it involve?
CAMHS Service Users and Carers Focus Groups:
You will be invited to attend a group discussion at an agreed location or on Microsoft Teams. The session will last up to 1.5 hours. It will be facilitated by a member of the research team and a Trust staff member. We will first explain how the Trust is introducing ACDs in general, and the discussion will then focus on what should be considered in offering them to young people under the care of SLaM’s Child and Adolescent Mental Health Services.
OA Service Users and Carers Focus Groups:
You will be invited to attend a group discussion at an agreed location or on Microsoft Teams. The session will last up to 1.5 hours. It will be facilitated by a member of the research team and a Trust staff member. We will first explain how the Trust is introducing ACDs in general, and the discussion will then focus on what should be considered in offering them to people using SLaM’s services for older adults.
Planned end date
31 Mar 2027 15:45Conditions
OtherInclusion Criteria
WP1: Focus Groups
Service users
Young people
a) Aged ≥ 16 - 25 years
b) Experienced detention under the MHA while in the care of CAMHS
c) Currently under the care of community mental health services (CAMHS / EI / CMHT)
Older adults
a) Experienced detention under the MHA while under services for Older Adults
b) Currently under the care of older adult mental health services
Carers / Informal supporters
a) Aged ≥ 16 years
b) A relative or friend of a service user who is eligible for the study Professionals
a) Professional potentially involved in supporting the completion of ACDs (i.e., community mental health team (CMHT) staff, advocates, peer workers)
b) SLaM professionals potentially involved in referring to ACDs (i.e., inpatient and emergency department liaison mental health staff, home treatment, place of safety and street triage staff)
c) Approved mental health professionals (AMHPs) and Section 12 (MHA) approved doctors involved in detention.
d) Ambulance, prison mental health and Emergency Department staff
e) General Practitioners, including mental health leads, or other primary care professionals who care for people with
SMI discharged from secondary services
WP 2: Prospective study of ACD completion and use
Service users
All service users: accepted referral to an ACD facilitator for ACD creation
Young people
a) Aged ≥ 16 - 25 years
b) Experienced detention under the MHA while in the care of CAMHS
c) Currently under the care of community mental health services (CAMHS / EI / CMHT/)
d) Accepted referral to an ACD facilitator for ACD creation
Older adults
a) Experienced detention under the MHA while under services for Older Adults
b) Currently under the care of older adult mental health service
c) accepted referral to an ACD facilitator for ACD creation
General Adult:
a) Aged ≥ 18 years
b) Previously detained under the MHA
c) Under the care of community mental health services (CMHT or EI)
Forensic
a) Aged ≥ 18 years
b) Experience detention under the MHA into forensic services
c) Currently under the care of forensic mental health services
Carers: relative or friend of someone referred to an ACD facilitator
Professionals: SLaM staff involved in the care of a participant with an ACD whose ACD is expected to have been consulted because they were: involved in a transfer of care, placed in zoning, referred for a MHA assessment or to a home treatment team, attended an Emergency Department or Place of Safety, admitted to a psychiatric inpatient unit or imprisoned.
Exclusion Criteria
Service users
a) Aged under 16 years
b) Lacking capacity to provide consent and/or is unwilling to do so
c) Currently detained under the MHA in psychiatric hospital
d) Currently under the care of eating disorder services
Carers/informal supporters
a) Aged under 16 years
b) Is not a relative or friend of a service user who is eligible for the study Professionals
a) Is not a mental health professional or Section 12 (MHA) approved doctor
b) Is not a professional involved in supporting the completion of ACDs
c) Is not a General Practitioner or mental health lead caring for people with SMI discharged from secondary services.