兰德公司：2025精神科预先指示证据综述报告（英文版）（20页）.pdf

1、ALEJANDRO ROA CONTRERAS,SKYE A.MINER,MELISSA LOUISE HARRIS-GERSTEN,DANIEL SICONOLFI,NICOLE K.EBERHARTPsychiatric Advance DirectivesA Review of the EvidencePsychiatric advance directives(PADs)offer individuals with psychiatric conditions the opportunity to document their preferences for treatment and

2、 interactions during a mental health crisis before that crisis occurs.PADs are typically promoted for persons with seri-ous mental illness(SMI)that is,a mental,behavioral,or emotional disorder resulting in a functional impairment that substantially interferes with or limits major life activities(Nat

3、ional Institute of Mental Health,2024).However,anyone with a history of mental illness,regardless of severity,may benefit from this type of advance planning.In complet-ing a PAD,individuals are encour-aged to identify and document their preferences for medication management,setting of care,points of

4、 contact,a decisionmaking sur-rogate,and ways of interacting with emergency response and health care teams(Braun et al.,2023;Gail-lard et al.,2023).For example,indi-viduals could indicate a preferred hospital or mental health provider.They also may request a hospital-ization alternative(e.g.,outpati

5、ent care)or specific medication(or no medication to be used),or they may express preferences with regard to electroconvulsive therapy or psy-chotherapy(Gaillard et al.,2023).A PAD template recently developed and tested in seven California KEY FINDINGS Many U.S.states and other countries legally reco

6、gnize psychiatric advance directives(PADs).Evidence shows that PADs improve autonomy in decisionmaking,reduce coercion in crisis interventions,and lower involuntary hospi-talization rates.Barriers to the integration of PADs in crisis planning and manage-ment include inconsistent legal recognition ac