How do Our Patients Respond to the Concept of Psychiatric Advance Directives? An Exploratory Study From India

• Published in: Indian journal of psychological medicine Vol. 40; no. 4; pp. 305 - 309
• Main Authors: Tekkalaki, Bheemsain, Patil, Veerappa Y., Patil, Sandeep, Chate, Sameeran S., Dhabale, Ramling, Patil, Nanasaheb M.
• Format: Journal Article
• Language: English
• Published: New Delhi, India SAGE Publications 01.07.2018; Wolters Kluwer India Pvt. Ltd; Sage Publications Ltd. (UK); Sage Publications, New Delhi India; Medknow Publications & Media Pvt Ltd; SAGE Publishing
• Subjects: Advance directives; Attitudes; Bipolar disorder; Care and treatment; Caregivers; Decision making; Feasibility; Hospitalization; Medical law; Mental disorders; Mental health; Mental Health Care Act; Mental health services; Mentally ill persons; Original; Patient compliance; Patients; Physical restraints; psychiatric advance directives; Psychiatry; Questionnaires; Schizophrenia; Sociodemographics; Statistical analysis; Studies; India; Mental Health Care Act; psychiatric advance directives; Feasibility
• ISSN: 0975-1564; 0253-7176; 0975-1564
• DOI: 10.4103/IJPSYM.IJPSYM_10_18

Background: Psychiatric advance directives have been incorporated in the Mental Health Care Act 2017 despite strong concerns about their feasibility and utility in the Indian patient population. Data on its utility in India is very scarce. Aims: To determine the possible treatment options our clients make as a part of psychiatric advance directives. Materials and Methods: Fifty consecutive individuals with severe mental illness were interviewed using a self-designed semi-structured tool to find out the possible choices they make as part of advance directives and the factors affecting their choices. Results: About 10% of the participants failed to understand the concept of advance directives. Of those who understood, 89% were willing to make advance directives, 15% refused future hospitalizations, 47% refused future electroconvulsive therapies (ECTs), and 62% refused physical restraints in future. Conclusion: The majority of the participants agreed to make advance directives. The majority of those who agreed to make advance directives refused to undergo ECTs and physical restraints in future episodes of illness. Approximately 10% of the patients could not understand the concept of advance directives.