Psychiatric advance directives among public mental health consumers in five U.S. cities: prevalence, demand, and correlates.


Journal Article

Psychiatric advance directives (PADs) are legal instruments that allow competent persons to document their preferences regarding future mental health treatment and to designate a surrogate decisionmaker in the event they lose capacity to make reliable treatment decisions during an acute episode of psychiatric illness. This study reports the findings of a survey of 1,011 psychiatric outpatients in five U.S. cities about their interest in, and completion of, PADs. Across the sites, only 4 to 13 percent of participants had completed a PAD; however, between 66 and 77 percent reported wanting to complete one if given assistance. Significantly higher demand for PADs was found among participants who were female; were nonwhite; had a history of self-harm, arrest, and decreased personal autonomy; and those who felt pressured to take medication. Actual completion of PADs was more likely among participants with higher insight, those reporting leverage by a representative payee, and those who felt external pressure to keep outpatient appointments for mental health treatment.

Full Text

Duke Authors

Cited Authors

  • Swanson, J; Swartz, M; Ferron, J; Elbogen, E; Van Dorn, R

Published Date

  • 2006

Published In

Volume / Issue

  • 34 / 1

Start / End Page

  • 43 - 57

PubMed ID

  • 16585234

Pubmed Central ID

  • 16585234

International Standard Serial Number (ISSN)

  • 1093-6793


  • eng

Conference Location

  • United States