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Informed, advance refusals of treatment by people with severe mental illness in a randomised controlled trial of joint crisis plans : demand, content and correlates
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Henderson, Claire, Farrelly, Simone, Flach, Clare, Borschmann, Rohan, Birchwood, M. J., Thornicroft, Graham, Waheed, Waquas and Szmukler, George (2017) Informed, advance refusals of treatment by people with severe mental illness in a randomised controlled trial of joint crisis plans : demand, content and correlates. BMC Psychiatry, 17 (1). 376. doi:10.1186/s12888-017-1542-5 ISSN 1471-244X.
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Official URL: http://dx.doi.org/10.1186/s12888-017-1542-5
Abstract
Background
In the UK, crisis planning for mental health care should acknowledge the right to make an informed advance treatment refusal under the Mental Capacity Act 2005. Our aims were to estimate the demand for such treatment refusals within a sample of service users who had had a recent hospital admission for psychosis or bipolar disorder, and to examine the relationship between refusals, and service user characteristics.
Methods
To identify refusals we conducted content analysis of Joint Crisis Plans, which are plans formulated by service users and their clinical team with involvement from an external facilitator, and routine care plans in sub-samples from a multi-centre randomised controlled trial of Joint Crisis Plans (plus routine mental health care) versus routine care alone (CRIMSON) in England. Factors hypothesised to be associated with refusals were identified using the trial data collected through baseline interviews of service users and clinicians and collection of routine clinical data.
Results
Ninety-nine of 221 (45%) of the Joint Crisis Plans contained a treatment refusal compared to 10 of 424 (2.4%) baseline routine care plans. No Joint Crisis Plans recorded disagreement with refusals on the part of clinicians. Among those with completed Joint Crisis Plans, adjusted analyses indicated a significant association between treatment refusals and perceived coercion at baseline (odds ratio = 1.21, 95% CI 1.02–1.43), but not with baseline working alliance or a past history of involuntary admission.
Conclusions
We demonstrated significant demand for written treatment refusals in line with the Mental Capacity Act 2005, which had not previously been elicited by the process of treatment planning. Future treatment/crisis plans should incorporate the opportunity for service users to record a treatment refusal during the drafting of such plans.
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RC Internal medicine | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
| Library of Congress Subject Headings (LCSH): | Mental illness -- Treatment, Crisis intervention (Mental health services), Capacity and disability, Great Britain. Mental Capacity Act 2005, Involuntary treatment | ||||||
| Journal or Publication Title: | BMC Psychiatry | ||||||
| Publisher: | BioMed Central Ltd. | ||||||
| ISSN: | 1471-244X | ||||||
| Official Date: | 24 November 2017 | ||||||
| Dates: |
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| Volume: | 17 | ||||||
| Number: | 1 | ||||||
| Article Number: | 376 | ||||||
| DOI: | 10.1186/s12888-017-1542-5 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 9 April 2018 | ||||||
| Date of first compliant Open Access: | 9 April 2018 | ||||||
| RIOXX Funder/Project Grant: |
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