Background Documents like psychiatric advance directives (PADs), crisis plans (CPs) and joint crisis plans (JCPs) are not widely used in Germany. Some experts suggest precluding people with mental health problems from advance care planning (ACP) presuming they are not using such instruments in their best interest.
Aim To describe experiences of mental health services users with ACP in mental health (e.g. documents, experiences with counselling, treatment preferences and experiences in subsequent crises).
Methods Semi-structured interviews with former mental health services users who already had documents (PADs, CPs or JCPs); transcribed and analysed using qualitative content analysis.
Results We interviewed eight former mental health service users. Some reported traumatic experiences that they intended to prevent in the future through ACP. A few had developed psychiatric ADs on their own after engaging in ACP for end-of-life care; others filled out forms with the help of peers or hospital staff. Participants most often refused restraint and certain pharmaceuticals. They preferred treatment continuity by requesting specific medication (type, doses). They asked for more communication, chose surrogates that they considered suitable to enforce their wishes against hospital staff. They had differing experiencers and varying expectations regarding the adherence to their plans.
Discussion We found slight inconsistencies between the interviews and the documents. Overall, the plans were rather elaborate but specific counselling could improve their intelligibility.
Conclusion Former mental health service users in our study conduct reasonable ACP for future mental health crises. We suggest integrating this group in the field of ACP.
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