Insufficient evidence on effects of advance treatment directives for people with severe mental illness

Clinical question: 
What are the effects of advance treatment directives for people with severe mental illness?
Bottom line: 
There was no significant difference in psychiatric hospital admissions (voluntary or involuntary), bed days or number of psychiatric outpatient attendances between participants with advanced treatment directives or those receiving usual care. Similarly, no significant differences were found for compliance with treatment, self-harm or number of arrests. Participants with advance treatment directives needed less use of social workers' time than the group receiving usual care, and violent acts were also lower in the advanced directive group. The numbers of people leaving the study did not differ between the 2 groups.
The review contains only 2 trials, and the data available are too limited to make definitive recommendations. While the more intensive joint crisis planning appears to be more effective at reducing involuntary admissions to hospital than a less intensive form of advance directive, there is not enough evidence to evaluate their effectiveness.
An advance directive is a document specifying a person's preference for treatment, should he or she lose capacity to make such decisions in the future. Advance directives have been used in end-of-life settings to direct care but should be well-suited to the mental health setting.
Review CD#: 
June, 2009
Authored by: 
Brian R McAvoy