1. Advance Statement / Wishes “What I would like to happen to me if I become unwell” Lead: Chris Burchell Guidelines for people over 18 wishing to make an ADVANCE STATEMENT or WISHES relating to their future Mental Health care. 2013

2. Advance Statement of Wishes. Empowering users of our Mental Health Services. MANAGING YOUR WELL BEING.

3. CQC view. They say, 'Patients should be encouraged to draw up Advance Statements as a part of care planning...for times when they become unwell or unwilling to express their views or participate in decisions about their care.' 'Patients who have Mental Capacity to do so may also wish to make an Advance Decision under the Mental Capacity Act, to refuse specified treatments should they lose capacity at a future point.' For example: 'Under an Advance Decision, you may refuse ECT. It is binding.' 'However, Advance Statements relating to medication are not binding, although they should always be considered.'

4. So what’s the difference? Advance Directives and Advance Statements of Wishes. The Difference. What is an Advance Directive/ Decision? An Advance Directive is a legally binding document, made when well (ie.you have Capacity) to refuse certain treatments, medications and request nonresusitation if in an end of life situation. It must have been witnessed and lodged with a legal authority e.g. your Solicitor/Doctor/Lawyer etc. It cannot be overruled except in the High Court. What is an Advance Statement of Wishes? An Advance Statement of Wishes enables a patient to focus on getting well. It records a lot of information which will be of help if and when they become so unwell that they are not able to express themselves coherently. It also records what medication is being taken, the conditions which might bring on a eopisode of mental illness, how and where treatment might be carried out. It enables a patient to record their likes and dislikes, diet, religious beliefs, hobbies and favourite activities. It must be remembered that under the Mental Health Act 1983, an Av.St.of Wishes may be overriden by a Doctor or Consultant in the best interests of the patient, but they must explain this in medical notes. Other areas will containg practical details, such as if children are to be cared for, who the landlord is, who else hold a key to the house and so on. Who is to look after pets.

5. Identifying the need. Plymouth has an Advance Directive document available. Available for use in all hospital Services. However, we had no Advance Statement of Wishes for MH. Need for one for Mental Health Service is emphasised by the CQC who say 'good examples may be seen at SW London and St. George's MH NHS Trust. Nottingham Healthcare NHS Trust have booklets which can give a comprehensive account of their preferences at a time of crisis. This includes their preferences for where the crisis should be managed and the type of medication or other intervention.' They go on to say, 'This work is excellent in helping patients of all abilities to contribute towards their care planning'.

6. The Mental Health Act 1983 Is a very powerful instrument, more powerful than the Terrorism Act, and therefore needs to be used and monitored with care to avoid Human Rights issues and also applies to the Police under Section 136. Has been amended several times, 2005-2006-2007 etc. etc. but the '83 Act is the general basis. The Act lays down the basis of lawful treatment, patient rights and detention protocols when dealing with Mental Health. Some recent amendments deal with the implication of the 'Human Rights Act', particularly with reference to Section 3 and what is called Deprivation of Liberty'. (DOLs) Under the MHAct 83, the patient has great autonomy unless the Doctor, Consultant, Clinician believe that the patient is too unwell to make a reponsible decision, in which case the RC moves to the MCAct.

7. The Mental Capacity Act Comes into force when the MH Assessment indicates that the patient lacks the capacity to make a decision about their treatment, medication, detention, care etc. It is revoked as soon as the RC considers that the patient can now understand and make rational decisions about care, at which point the MHAct 83 come into play, and clinical decisions are made on that basis thereafter. The Act lays down principles and pathways for statutory NHS funded aftercare under Sect.117.

8. My life. My Story. The Advance Statement of Wishes booklet enables people to record their story, who they are, what they do, recreation, family, likes and dislikes, what makes them ill or can precipitate a MH episode and so on. The table of contents indicates all the areas of important information for your Doctor, Consultant, Carer, Community Health Team etc. to tailor your care and treatment to suit you, and help you get better more quickly.

9. Your information.Who needs to know? In it, you may record as much or as little as you feel comfortable with. But remember, the aim is to help others to help you get the very best treatment for your condition. It helps you to be 'someone', not just 'another number in the system'. Every episode of Mental Illness is slightly different and is closely associated with your own personality, your experiences and who you are. It therefore helps your Doctors to know 'YOU' rather that just at the symptoms you happen to be presenting at the time. This Adv St. Wsh. booklet will help.

10. Before, during and after. Any one of us can suffer from a MH episode during our lives. Many are able to work through their illness with help from family, friends and professionals in the community; This booklet can help at this time. Sometimes a MH issue may be so serious that the patient requires hospitalisation. At this time, the patient can be distracted or confused; This booklet can help everyone prepare a Care Plan which suits you. Once the patient has recovered enough for discharge, particularly if having been sectioned; This booklet will help your Care Team to devise a discharge Care Plan which will suit you, and help them to devise a plan (particularly under Sect. 117 conditions), to build a programme for your ongoing care.

11. Can I refuse treatment? Not under an AD.St.Whs document. But your Doctors must take note of your wishes, and try to adapt their treatment to accommodate you. Where they cannot, they must record this fact at the time, and explain to you later when you are better. If you wish to make BINDING conditions, you must also fill out an ADVANCE DIRECTIVE, have it witnessed and lodged with your Solicitor and Doctor. This extra document may be attached to the Advance Statement of Wishes. See NHS Adv. Dir. St.Luke’s Hospice slide.