To Make Another Goal or to Dream a Different Dream—A Mixed Method Study of Experiences of People Using Mental Health Advance Care Planning

Advance statements are instruments under the Mental Health Act (2014) (Vic) (the Act) in Victoria, Australia that support advance care planning, should a person become a compulsory patient under the Act. Advance care planning supports consumers to have their values and preferences known to the service and other decision makers. Uptake of advance statements in mental health has been poor, and minimal literature is available that explores direct experiences of these instruments by consumers. Feminist Standpoint theory was used in this study as it centres the experience of the marginalised person within the study. This study comprised four in-depth interviews and a survey with 59 responses that explored consumers' direct experiences of using advance statements in Victoria. Results are consistent with past research identifying that many mental health advance statements were consenting documents, although some issues remained with locating the advance statement and identifying the most beneficial staff members to notify. Analysis of the interviews identified four main themes in people's experiences: not being read, working/not working, the use of advocacy and adjusting expectations. Consumers suggested how advance statements could be improved. Specific examples of advocacy by nurses were identified, and as the largest body of mental health workers, nurses have a key role in supporting consumers throughout their journey. Nurses are best placed to enact supported decision making, a key factor in advance care planning. With greater understanding of advance statements, and better resourcing of supported decision-making mechanisms, there is potential for advance statements to contribute to an improved experience for consumers in mental health services.