The content of mental health advance directives: Advance statements in Scotland

Abstract

Background Where advance directives in mental health have been introduced concern has been expressed about their content including inappropriate treatment choices, ambiguity, or the impact of decisions on resources. Aim To examine the content of advance statements in Scotland. Method A thematic analysis of 55 advance statements presented to the Mental Health Tribunal for Scotland. Results The format of statements did not always follow the guidelines and there were considerable differences in the content. A total of 96% of the statements included at least one specific treatment refusal. In contrast 45% named specific medications they were prepared to take. 55% contained wider information than ‘treatment’, including setting and other supports. Conclusions The majority of advance statements contained clear information about preferences as to medical treatment. The additional requests raise questions about what is meant by treatment.