Background In German psychiatric practice the use of structured advance care planning-instruments is not very common. Standardised joint crisis plans give patients with mental health disorders the opportunity to think ahead for the event of not being able to give informed consent and to perform their autonomy even in those situations.
Aim We aimed at avoiding and ameliorating critical situations in our psychiatric hospital by giving patients the opportunity to influence their (emergency-)treatment in situations of incapability to consent to medical care. Furthermore, we wanted to gain experiences with the implementation of a joint crisis plan into clinical psychiatric practice.
Methods A joint crisis plan was designed in a trialogic process by psychiatrists, a member of the local clinical ethics committee and deputies of psychiatric patients’ and patients’ relatives support groups. It was offered to selected patients who had experienced periods of incapability to give informed consent due to their psychiatric disease. A quantitative and qualitative evaluation is intended.
Results The first experiences with this clinical tool are encouraging. Patients appreciated being able to keep record of their personal know-how and priorities as to the state of their disease. However, some difficulties complicated the implementation of the joint crisis plans into clinical practice.
Discussion/conclusion Joint crisis plans are promising as part of a structured advance care planning-program in German psychiatric hospitals. Nevertheless, they need to be embedded into a bundle of arrangements, individually composed for each patient and supported by the clinicians.
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