From the perspectives of human rights and public health, it was critical to reduce the use of coercion in mental health care. Psychiatric advance directives (PADs) are a potential strategy that might lower the number of required hospitalizations. Assessments of PADs have taken into account peer workers’ facilitation but not that of healthcare professionals. For a study, researchers sought to evaluate the effectiveness of PW-PADs, or peer-worker-facilitated PADs, for those with mental illnesses.

Seven French mental health centers participated in a multicenter, randomized clinical investigation. Between January 2019 and June 2020, adults with a DSM-5 diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who had received a mandatory hospitalization during the previous 12 months and had the capacity to agree were enrolled and followed up for a full year.

The rate of mandatory admission 12 months after randomization was the main result. Investigations were also conducted into the general rate of psychiatric hospitalization, therapeutic alliance, quality of life, mental health symptoms, empowerment, and recovery outcomes. In the study, 196 were assigned to the PW-PAD group and 198 to the control group out of 394 allocated subjects (median age, 39 years; 39.3% female; 45% with schizophrenia, 36% with bipolar I disorder, and 19% with schizoaffective disorder). When compared to the control group, in the PW-PAD group, 27.0% experienced obligatory admissions (risk difference, -0.13; 95% CI, -0.22 to -0.04; P=.007). The rate of overall admissions, the therapeutic alliance score, and the quality of life did not differ significantly from one another. When compared to participants in the control group, individuals in the PW-PAD group showed less symptomatology (effect size, -0.20; 95% CI, -0.40 to 0.00), more empowerment (effect size, 0.30; 95% CI, 0.10 to 0.50), and a higher recovery score (effect size, 0.44; 95% CI, 0.24 to 0.65).

PADs facilitated by peer workers successfully reduced required hospital admissions and improved some mental health outcomes (self-perceived symptoms, empowerment, and recovery). The current transition of mental health care from substitute decision-making to supported decision-making was supported by involving peer workers in completing PADs.

Reference: jamanetwork.com/journals/jamapsychiatry/fullarticle/2793222