1. Crisis Card: Control in times of crisis Lia van der Ham (VU University Amsterdam, The Netherlands) Nel van kempen (Pro Persona, The Netherlands)

2. Advance directives in mental health care: a qualitative evaluation of experiences with the crisis card Advance directives Advance statements Advance agreements a document specifying a person's preferences for treatment, should he or she lose capacity to make such decisions in the future¹ ¹ Campbell & Kisely (2010)

3. Personal data Contact persons Physical/ Psychological information What does the crisis look like What (not) to do in crisis Medication Practical information Agreements Advance directives in mental health care: a qualitative evaluation of experiences with the crisis card

4. Crisis Card UK:1989 Netherlands: 1999 Pro Persona, 2008: 90 crisis cards

5. Advance directives in mental health care: a qualitative evaluation of experiences with the crisis card use of the crisis card in crisis effects of the crisis card implementation of the crisis card

6. Interviews with 15 stakeholders: –4 patients –1 patient-relative –6 care providers (3 out-patient/ 2 in-patient) –1 police representative –1 GP emergency care centre representative –2 Crisis card workers Advance directives in mental health care: a qualitative evaluation of experiences with the crisis card

7. Use of the crisis card Patients: 3 patients out of 4 used the crisis card –Situation: street, supermarket and fun park Hulpverleners PP: None GP emergency centre: None Police: 2 times

8. Patient I used it several times; once in a supermarket. I panicked and gave it to an employee. He stayed with me untill I was allright.

9. Psychosocial effects Insight/Understanding Security Empowerment/ Autonomy Effects of the crisis card

10. Patient Having the crisis card makes me feel more secure when Im on the street. Patient relative It gives more peace of mind. From the outside you cant see what is going on, but with the crisis card people will know.

11. Effects on crisis situation Recognizing crisis Providing information Fast intervention Appropriate intervention Effects of the crisis card

12. Care provider I think it is very important to have a brief overview providing all information that is nessecary in a crisis situation. For example; the first signs, symptoms. It also states what someone explicitely doesnt want in a crisis; that you shouldnt touch someone, or just talk calmly... A lot of things that you can do very wrong if you dont know somebody.

13. Effects on crisis Prevent crisis Prevent escalation Recovery crisis Effects of the crisis card

14. Care provider I dont think you can always prevent a crisis, but you can control it sooner. Because you act in an earlier stage, you can prevent it from getting worse.

15. Effects on hospitalization Prevent hospitalization Shorter hospitalization Client centered care Effects of the crisis card

16. Patient First, when I didnt feel well, I used the TOR-bed (time-out bed) more often, than when I didnt have the crisis card.

17. Implementation of the crisis card Making a crisis card Patients positive about process Process can be confronting for patients Balancing between patient preferences and feasibility

18. Crisis card worker Its not about what we want or what the care providers wants; its about what the patients wants. Sometimes you have to find a balance between; others have to be able to understand information on the card, but for the patient it is important to state it the way he or she wants it.

19. Implementation of the crisis card Role of the crisis card worker Personal experience with crisis important Accessible for patients Embedding in organisation helps

20. Patient What I experience with the crisis card worker, or just people who have experience with a psychiatric condition, is that you dont have to say as much; it is easier to understand each other. Crisis card worker at work

21. Implementation of the crisis card Obstacles Some care providers dont refer to crisis card Crisis card not widely known Embedding crisis card in care?

22. Care provider Its not a conscious decision, maybe its my shortcoming that it doesnt come to my mind; I should think about it more often. Maybe its also partly because I dont know the effect. If I knew the effect I would be more enthusiastic. Patient It would be nice if more people would be familiar with the crisis card. Then, people wouldnt react in such a strange way.

23. Conclusion Positive attitude toward crisis card Positive experiences; various effects Lack of insight in actual use/ effects Dillemma: embedding card in care/ card as patients choice

24. Thank you for your attention! Lia van der Ham (VU University Amsterdam, The Netherlands) E-mail: Lia.van.der.ham@falw.vu.nl Nel van kempen (Pro Persona, The Netherlands) E-mail: n.van.kempen@propersona.nl