Advance Directives in Mental Health Service: A Qualitative Study on Stakeholders' Perspectives.

Abstract

Background: Advance directives in mental health services aim to reduce coercion, enhance adherence, and prevent violence by giving patients a voice during relapses. However, their use is limited due to diverse stakeholder perspectives and insufficient familiarity.

Objectives: To explore stakeholders' perspectives on advance directives in Icelandic mental health services, focusing on potential benefits and implementation challenges.

Methods: Data were gathered via focus groups with purposively sampled mental health service users and providers. Using a multiple category design allowed for constant comparative and interpretive analysis of data collected from these two groups.

Results: The study involved 19 individuals divided into four focus groups, with service users comprising one group (n = 4) and service providers comprising three groups (n = 15). Participants had limited familiarity with advance directives and had not used them. While both service users and providers viewed advance directives favourably, significant differences emerged: users valued the opportunity for self-expression and autonomy, whereas providers, though supportive of user empowerment, struggled with relinquishing control in the therapeutic relationship, thereby preserving power imbalances.

Conclusions: Implementing advance directives in mental healthcare requires in-depth dialogue to align stakeholder expectations. A strategy should focus on education, stakeholder engagement, and co-created interventions to reconcile diverse perspectives.