• Jacqueline M Atkinson, Helen C Garner, and W Harper Gilmour.
• Public Health and Health Policy, Division of Community Based Sciences University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, Scotland. j.m.atkinson@clinmed.gla.ac.uk
• Soc Psychiatry Psychiatr Epidemiol. 2004 Aug 1;39(8):673-80.

ObjectiveThe aim of this study was to examine perceptions of the place of advance directives in mental health care.MethodsPostal survey of stakeholders was carried out to assess their views on different models of advance directives in mental health care. A total of 473 responded.ResultsIn all, 28% of psychiatrists thought advance directives were needed compared to 89% of voluntary organisations and above two-thirds of the other stakeholder groups. There were clear tensions between patient "autonomy" and "right to treatment" which underpin many of the concerns raised. Autonomy provided by advance directive can be contrasted with a co-operative partnership approach to advance planning. The legal status of advance directives is important for some people in relation to treatment refusal. There was general concern about the practical issues surrounding their implementation.ConclusionThere is a wide range of views in all stakeholder groups about the possible form advance directives should take. Although there is a widespread desire to increase patient involvement in treatment decisions, which advance directives could possibly help to realise, they may also have unwanted consequences for mental health services and individuals.

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