SDHB proposes advance care plans

THE Southern District Health Board is hoping to implement an advance care directive scheme for mental health patients in the region.

Work on the proposal, set out in the New Zealand Medical Journal published today, is under way, a survey having been carried out to evaluate what should be in any such document.

‘‘The challenge is to create an instrument and a process that will produce an advanced care plan that is meaningful for all service consumers and has sufficient ‘buy in’ from clinicians and service providers,’’ the article, by academics at the Universities of Otago and Auckland and SDHB staff, said.

The directive, which the article proposed calling a ‘‘Mental Health Advance Preferences Statement’’, or Map, was intended to be collaborative and not prescriptive.

Patients often felt marginalised and uninformed, and that they had taken little part in deciding issues about their care, the article said.

The authors hoped the Map would make clear patient preferences if they needed to be treated by mental health services, and hence make them more willing to undertake treatment they had previously agreed to.

However, clinicians and consumers differed on whether the Mental Health Act, which contains numerous provisions for compulsory treatment, should be able to trump a Map.

‘‘Under current New Zealand law, it seems that the Mental Health Act can lawfully override consumers’ preferences regarding their treatment for a mental disorder.

‘‘Partly for that reason, it may be better to avoid suggesting that consumers can direct their future care.’’

The study confirmed all parties supported a more consumerfocused approach to mental health care, but said a balance needed to be struck between individual autonomy and best clinical practice.

Differences in opinion over medications and use of seclusion also needed to be addressed.

Results of the survey would be further examined before a local and possibly national introduction of Maps was considered, the article said.