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Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany

PURPOSE: Self-binding directives (SBDs) are a special type of psychiatric advance directive in which mental health service users can consent in advance to involuntary hospital admission and involuntary treatment during future mental health crises. This study presents opportunities and risks of SBDs...

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Autores principales: Potthoff, Sarah, Finke, Marleen, Scholten, Matthé, Gieselmann, Astrid, Vollmann, Jochen, Gather, Jakov
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633858/
https://www.ncbi.nlm.nih.gov/pubmed/36339872
http://dx.doi.org/10.3389/fpsyt.2022.974132
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author Potthoff, Sarah
Finke, Marleen
Scholten, Matthé
Gieselmann, Astrid
Vollmann, Jochen
Gather, Jakov
author_facet Potthoff, Sarah
Finke, Marleen
Scholten, Matthé
Gieselmann, Astrid
Vollmann, Jochen
Gather, Jakov
author_sort Potthoff, Sarah
collection PubMed
description PURPOSE: Self-binding directives (SBDs) are a special type of psychiatric advance directive in which mental health service users can consent in advance to involuntary hospital admission and involuntary treatment during future mental health crises. This study presents opportunities and risks of SBDs reported by users with bipolar disorder, family members of people with bipolar disorder, professionals working with people with bipolar disorder and researchers with expertise in mental health ethics and law. METHODS: Seventeen semi-structured interviews with users, family members and professionals, and one focus group with five researchers were conducted. The data was analyzed using qualitative content analysis. RESULTS: Six opportunities and five risks of SBDs were identified. The opportunities were promotion of autonomy and self-efficacy of users, relief of responsibility for family members, early intervention, reduction of (perceived) coercion, positive impact on the therapeutic relationship and enhancement of professionals' confidence in decision-making. The risks were problems in the assessment of mental capacity, inaccurate information or misinterpretation, increase of coercion through misuse, negative impact on the therapeutic relationship due to noncompliance with SBDs, and restricted therapeutic flexibility and less reflection on medical decision-making. Stakeholders tended to think that the opportunities of SBDs outweigh their risks, provided that appropriate control and monitoring mechanisms are in place, support is provided during the drafting process and the respective mental healthcare setting is sufficiently prepared to implement SBDs in practice. CONCLUSIONS: The fact that stakeholders consider SBDs as an opportunity to improve personalized crisis care for people with bipolar disorder indicates that a debate about the legal and clinical implementation of SBDs in Germany and beyond is necessary.
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spelling pubmed-96338582022-11-05 Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany Potthoff, Sarah Finke, Marleen Scholten, Matthé Gieselmann, Astrid Vollmann, Jochen Gather, Jakov Front Psychiatry Psychiatry PURPOSE: Self-binding directives (SBDs) are a special type of psychiatric advance directive in which mental health service users can consent in advance to involuntary hospital admission and involuntary treatment during future mental health crises. This study presents opportunities and risks of SBDs reported by users with bipolar disorder, family members of people with bipolar disorder, professionals working with people with bipolar disorder and researchers with expertise in mental health ethics and law. METHODS: Seventeen semi-structured interviews with users, family members and professionals, and one focus group with five researchers were conducted. The data was analyzed using qualitative content analysis. RESULTS: Six opportunities and five risks of SBDs were identified. The opportunities were promotion of autonomy and self-efficacy of users, relief of responsibility for family members, early intervention, reduction of (perceived) coercion, positive impact on the therapeutic relationship and enhancement of professionals' confidence in decision-making. The risks were problems in the assessment of mental capacity, inaccurate information or misinterpretation, increase of coercion through misuse, negative impact on the therapeutic relationship due to noncompliance with SBDs, and restricted therapeutic flexibility and less reflection on medical decision-making. Stakeholders tended to think that the opportunities of SBDs outweigh their risks, provided that appropriate control and monitoring mechanisms are in place, support is provided during the drafting process and the respective mental healthcare setting is sufficiently prepared to implement SBDs in practice. CONCLUSIONS: The fact that stakeholders consider SBDs as an opportunity to improve personalized crisis care for people with bipolar disorder indicates that a debate about the legal and clinical implementation of SBDs in Germany and beyond is necessary. Frontiers Media S.A. 2022-10-21 /pmc/articles/PMC9633858/ /pubmed/36339872 http://dx.doi.org/10.3389/fpsyt.2022.974132 Text en Copyright © 2022 Potthoff, Finke, Scholten, Gieselmann, Vollmann and Gather. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Potthoff, Sarah
Finke, Marleen
Scholten, Matthé
Gieselmann, Astrid
Vollmann, Jochen
Gather, Jakov
Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany
title Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany
title_full Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany
title_fullStr Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany
title_full_unstemmed Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany
title_short Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany
title_sort opportunities and risks of self-binding directives: a qualitative study involving stakeholders and researchers in germany
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633858/
https://www.ncbi.nlm.nih.gov/pubmed/36339872
http://dx.doi.org/10.3389/fpsyt.2022.974132
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