Advance Choice Documents (ACDs) are statements of preferences for mental health care and treatment made when service users have capacity to do so. This is done with their care team and others as desired, e.g. carers/supporters or advocates. In addition to improving therapeutic relationships, ACDs have been shown to reduce compulsory psychiatric admissions by 25%. South London and Maudsley is currently implementing ACDs into routine practice across its services and the Advance Choice Document Implementation (ACDI) project, run by researchers at King's College London, is supporting the development of related resources and the evaluation of the effectiveness of the implementation. Advisory groups will also guide the study approach throughout. The project comprises four work packages. Work Package 1 involves focus groups with stakeholders (service users, carers, staff) to inform implementation for Older Adults and CAMHS services. This is to understand the barriers and facilitators for ACD implementation in these services; and learn what adaptations are needed to the ACD resources and procedures for use in these services Work Package 2 is a prospective study of ACD completion and use throughout all directorates. This will comprise interviews with service users after ACD creation and after an event where the ACD is expected to have been used; interviews with their care-team during expected use events; and interviews/focus groups with staff facilitating the creation of ACDs to understand the integration of their role in SLaM. Work Package 3 is a retrospective study examining the impact of ACD creation on health service use and routinely collected outcomes. Work Package 4 is a prospective study of ACD use and its relationship to ACD content. Work Packages 3 and 4 will use de-identified data collected via South London an Maudsley's Clinical Records Interactive search System (CRIS). For more information on ACDI, the people involved, and related publications, please visit: https://www.kcl.ac.uk/research/acdi
Study Type
OBSERVATIONAL
Enrollment
374
Creation and application of Advance Choice Documents
South London and Maudsley/Institute of Psychiatry, Psychology, and Neuroscience-King's College London
London, United Kingdom
Number of admissions under the Mental Health Act sections 2, 3, 135 and and associated bed days
Mental Health Act sections Section 2, 3, 135 and 136 are a means to detain someone in a psychiatric facility, in England and Wales. Evaluation will be done over different follow-up periods and include participants admitted under all Sections of the Mental Health Act and associated bed-days, compared to number of participants admitted voluntarily (non-Mental Health Act) and associated bed-days.
Time frame: 18 months
Number of Home Treatment Team events
The number of Home Treatment Team events and days spent under the care of Home Treatment Teams will be assessed for participants with advance choice documents and those without advance choice documents
Time frame: 18 months
Number of events of acute mental health and emergency service use
The number of events use of acute mental health and emergency services will be evaluated for participants with advance choice documents compared to those without advance choice documents
Time frame: 18
Rates of restraint
The number of events where restraint is used will be evaluated for participants advance choice documents compared to participants without advance choice documents, across each follow-up period. As these events are not recorded in structured fields, free-text entries will be searched to identify all events containing the words: Restrained' and/or 'restraint'
Time frame: 18
Number of days spent in seclusion
The number of days spent in seclusion will be evaluated for participants with advance choice documents compared to those without advance choice documents. As these events are not recorded in structured fields, free-text entries will be searched to identify all events containing the words 'Seclusion' and 'supervised confinement'
Time frame: 18 months
Number of events of involuntary medication
The number of events where involuntary medication is used will be evaluated for participants advance choice documents compared to those without advance choice documents
Time frame: 18 months
Number of safety events recorded (violence, self-harm, consequences of self-neglect and other serious untoward incidents)
The number of safety events recorded will be evaluated for participants with advance choice documents compared to those without advance choice documents
Time frame: 18 months
Number of events of contact with police related to use of mental health services
The number of events of contact with police related to use of mental health services will be evaluated for participants with advance choice documents compared to those without advance choice documents
Time frame: 18 months
Number of events of General health service use
General health service use will be measured through data linkage with Hospital Episode Statistics (HES). These data will be obtained at a national level for all service users. Physical health service use outcomes will include: inpatient admissions and associated bed days (this will include Healthcare Resource Group codes, associated primary and secondary diagnostic codes, admission category, and treatment specialty code), Emergency Department (ED) attendances (this will include Healthcare Resource Group codes, diagnosis classifications, investigations codes, treatment codes, arrival mode, and attendance disposal codes), and outpatient appointments (this will include appointment information such as first appointment. We will extract routinely collected outcomes such as the Health of the Nations Outcomes Scales (HoNOS)
Time frame: 18 months
Number of community mental health team events
Number of community mental health team events will be evaluated for participants with advance choice documents compared to those without advance choice documents.
Time frame: 18 months
Number of psychiatric liaison team events (in emergency departments)
The number of psychiatric liaison team events will be evaluated for participants with advance choice documents and those without. The number of events will be requested for all follow-up periods within 18 months. (ie participants will have varying follow-up periods)
Time frame: 18 months
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.