Download Advance Statement of Wishes - Plymouth Mental Health Network

Advance
Statement / Wishes
“What I would like to happen to me
if I become unwell”
Lead: Chris Burchell
Guidelines for people over 18 wishing to make an
ADVANCE STATEMENT or WISHES relating to their
future Mental Health care.
2013
Advance Statement of
Wishes.
Empowering users of our Mental Health Services.
MANAGING YOUR WELL BEING.
CQC view.
• They say, 'Patients should be encouraged to draw up Advance Statements as a
part of care planning...for times when they become unwell or unwilling to
express their views or participate in decisions about their care.'
• 'Patients who have Mental Capacity to do so may also wish to make an
Advance Decision under the Mental Capacity Act, to refuse specified
treatments should they lose capacity at a future point.'
• For example: 'Under an Advance Decision, you may refuse ECT. It is binding.'
• 'However, Advance Statements relating to medication are not binding,
although they should always be considered.'
So what’s the difference?
• Advance Directives and Advance Statements of Wishes.
• The Difference.
• What is an Advance Directive/ Decision?
An Advance Directive is a legally binding document, made
when well (ie.you have Capacity) to refuse certain treatments, medications and request nonresusitation if in
an end of life situation. It must have been witnessed and lodged with a legal authority e.g. your
Solicitor/Doctor/Lawyer etc. It cannot be overruled except in the High Court.
• What is an Advance Statement of Wishes? An Advance Statement of Wishes enables a patient to focus on
getting well. It records a lot of information which will be of help if and when they become so unwell that
they are not able to express themselves coherently. It also records what medication is being taken, the
conditions which might bring on a eopisode of mental illness, how and where treatment might be carried
out. It enables a patient to record their likes and dislikes, diet, religious beliefs, hobbies and favourite
activities.
• It must be remembered that under the Mental Health Act 1983, an Av.St.of Wishes may be overriden by a
Doctor or Consultant in the best interests of the patient, but they must explain this in medical notes.
• Other areas will containg practical details, such as if children are to be cared for, who the landlord is, who
else hold a key to the house and so on. Who is to look after pets.
Identifying the need.
• Plymouth has an Advance Directive document available.
• Available for use in all hospital Services.
• However, we had no Advance Statement of Wishes for MH.
• Need for one for Mental Health Service is emphasised by the CQC who say
'good examples may be seen at SW London and St. George's MH NHS Trust.
Nottingham Healthcare NHS Trust have booklets which can give a
comprehensive account of their preferences at a time of crisis. This includes
their preferences for where the crisis should be managed and the type of
medication or other intervention.'
• They go on to say, 'This work is excellent in helping patients of all abilities to
contribute towards their care planning'.
The Mental Health Act 1983
• Is a very powerful instrument, more powerful than the Terrorism Act, and
therefore needs to be used and monitored with care to avoid Human
Rights issues and also applies to the Police under Section 136.
• Has been amended several times, 2005-2006-2007 etc. etc. but the '83 Act
is the general basis.
• The Act lays down the basis of lawful treatment, patient rights and
detention protocols when dealing with Mental Health.
• Some recent amendments deal with the implication of the 'Human Rights
Act', particularly with reference to Section 3 and what is called Deprivation
of Liberty'. (DOLs)
• Under the MHAct 83, the patient has great autonomy unless the Doctor,
Consultant, Clinician believe that the patient is too unwell to make a
reponsible decision, in which case the RC moves to the MCAct.
The Mental Capacity Act
• Comes into force when the MH Assessment indicates that the patient
lacks the capacity to make a decision about their treatment,
medication, detention, care etc.
• It is revoked as soon as the RC considers that the patient can now
understand and make rational decisions about care, at which point
the MHAct 83 come into play, and clinical decisions are made on that
basis thereafter.
• The Act lays down principles and pathways for statutory NHS funded
aftercare under Sect.117.
My life. My Story.
• The Advance Statement of Wishes booklet enables people to record
their story, who they are, what they do, recreation, family, likes and
dislikes, what makes them ill or can precipitate a MH episode and so
on.
• The table of contents indicates all the areas of important information
for your Doctor, Consultant, Carer, Community Health Team etc. to
tailor your care and treatment to suit you, and help you get better
more quickly.
Your information.Who needs to know?
• In it, you may record as much or as little as you feel comfortable with.
But remember, the aim is to help others to help you get the very best
treatment for your condition.
• It helps you to be 'someone', not just 'another number in the system'.
• Every episode of Mental Illness is slightly different and is closely
associated with your own personality, your experiences and who you
are. It therefore helps your Doctors to know 'YOU' rather that just at
the symptoms you happen to be presenting at the time. This Adv St.
Wsh. booklet will help.
Before, during and after.
• Any one of us can suffer from a MH episode during our lives. Many are able
to work through their illness with help from family, friends and
professionals in the community;
• This booklet can help at this time.
• Sometimes a MH issue may be so serious that the patient requires
hospitalisation. At this time, the patient can be distracted or confused;
• This booklet can help everyone prepare a Care Plan which suits you.
• Once the patient has recovered enough for discharge, particularly if having
been sectioned;
• This booklet will help your Care Team to devise a discharge Care Plan which
will suit you, and help them to devise a plan (particularly under Sect. 117
conditions), to build a programme for your ongoing care.
Can I refuse treatment?
• Not under an AD.St.Whs document. But your Doctors must take note
of your wishes, and try to adapt their treatment to accommodate
you. Where they cannot, they must record this fact at the time, and
explain to you later when you are better.
• If you wish to make BINDING conditions, you must also fill out an
ADVANCE DIRECTIVE, have it witnessed and lodged with your Solicitor
and Doctor. This extra document may be attached to the Advance
Statement of Wishes.
• See NHS Adv. Dir. St.Luke’s Hospice slide.