Mental Health Crisis Plans and Psychiatric Advance Directives: Creating a Collaboratively Designed How-To Guide for Autonomous Decision Making

Abstract: Communication during a mental health crisis is important, difficult, and complex. A major challenge for providers in communicating effectively during such crises is the uncertainty that arises when a patient cannot advocate for themselves and their preferences in care. Modeled after healthcare advance directives, PADs (Psychiatric Advance Directives) provide capacitated persons a means to communicate future mental health treatment wishes and preferences in the event of an incapacitating mental health crisis. PADs help patients, providers, and healthcare organizations communicate effectively by prompting and guiding conversations about care provision ahead of crisis. PADs are a form of patient-centered communication (Table, Thomas, Brown 2020) that respects patient autonomy, builds stronger therapeutic alliances, increases commitment to care, thereby reducing the costs of emergency room visits and the number of legal interactions (McArdle 2001; Swanson 2003).

PADs reflect a respect for social justice and what it means to be human by creating a culture of empathy, wellness, and recovery for all with emphasis on persons living with serious mental illness. This presentation continues a narrative of patient advocacy and community engagement by presenting a community engaged project using Community Engagement Studios and UX Design to create a collaboratively designed How-to Guide for completing a PAD. Advocacy requires collaboration by centering the voices of persons living with, supporting, and legislating for individuals living with serious mental illness. PADs serve to make the wishes and preferences for care during a mental health crisis known.