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National Share the Experience 2018

Improving Person-Centered Outcomes Through

Collaboration

October 23–26, 2018Bloomington, Minnesota

Destigmatizing Mental Health Advance DirectivesNICKY LEWIS, LMSW

ADVANCE CARE PLANNING COORDINATOR

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Disclosures

•Conflict of InterestNo conflict of interest to report

•Off Label UseOff-label use of any products will not be discussed

•Commercial SupportThere is no commercial support for this program

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Learning Objectives

1. Summarize the Michigan legal statutes regarding Mental Health Advance Directives.

2. Explain the general treatment decisions listed in the Mental Health section of the Making Choices Michigan Advance Directive.

3. Make use of Mental Health Advance Directive Guide to assist patients with document completion.

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Mental Health in the U.S.

44.7 million people or 1 in 5 adults in the U.S. in 2016 lives with mental illness

10.4 million adults lives with a serious mental illness*

Public stigma** remains a pervasive issue for people with mental illness

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*Serious mental illness is defined as a condition resulting in serious functional impairment which substantially interferes with or limits one or more major life activities

**Stigma is a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid and discriminate against a particular group

Impact of Mental Health Stigma

Fear of stigma can lead people with mental illness to avoid seeking assistance – including Advance Care Planning

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Stereotypes • Negative belief about a group (e.g., dangerous, incompetent, character weakness)

Prejudice • Agreement with belief and/ or negative emotional reaction (e.g., anger, fear)

Discrimination• Behavior response to prejudice (e.g. avoidance,

withhold employment and housing opportunities, withhold help)

Stigma consists of three components:

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Attitudes Towards Mental Illness

Fear and Exclusion

Persons with severe mental illness should be feared and therefore kept

out of most communities

Authoritarianism

Persons with severe mental

illness are irresponsible,

so life decisions should be made by others

Benevolence

Persons with severe mental

illness are childlike and need to be cared for

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Patient-Centered Care (PCC)

Patient – Provider Communication

Entering the World of the Patient

Patient Expertise

Patient Empowerment

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PCC: The Role of Mental Health/Psychiatric Advance Directives (MH/PAD)

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Addressing Loss of

Decisional Capacity

Confronting Stigma

Mental Health/

Psychiatric Treatment

Preferences

Normalizing the

Conversation

Preserve Patient

Autonomy/ Avoid Care

Delays

States with MH/PAD Statues

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Mental Health/Psychiatric Advance Directive (MH/PAD): General Requirements

•The National Resource Center on Psychiatric Advance Directives (www.nrc-pad.org) is an excellent resource for information specific to your state.

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Appointment of an Agent &

Specific Psychiatric Advance Instructions

Appointment of an Agent &

General Advance Instructions

Appointment of an Agent Only

•Vary from state to state

Advance Directives in Michigan

Public Act 386 of 1998: The Estates and Protected Individuals Code (a.k.a. EPIC)

In general authorizes Patient Advocate to make medical and mental health treatment decisions

Includes specific provisions regarding mental health/ psychiatric decision-making

Certain decisions require “clear and convincing evidence”

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EPIC: Specific Mental Health Provisions

Designate specific physician/provider

to assess

Consent to Inpatient

Hospitalization/ Psychotropic Medications

Consent to Electro-convulsive

Therapy

30-day Revocation

Waiver

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MH/PAD Form

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Conversation Guide

Guide discussion of MH Tx

preferences/ goals

Address patient fears

Educate facilitator/ Address concerns

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MH/PAD Options

Outpatient Therapy

Voluntary Hospitalization

Involuntary Hospitalization

Psychotropic Medications

Electro-convulsive Therapy (ECT)

30-day Revocation Waiver

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Questions

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References

• Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16-20. Retrieved July 16, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/

• Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the Public Interest, 15(2), 37-70. doi:10.1177/1529100614531398

• Dingfelder, S. F. (2009). Stigma: Alive and well. Monitor on Psychology, 40(6), 56. doi:10.1037/e542802009-028

• Making Choices Michigan. (2017, May 18). MCM advance directive: Durable power of attorney for healthcare. Retrieved August 6,2018, from https://makingchoicesmichigan.org/wp-content/uploads/2018/08/MCM-AdvanceDirective-051817-fillable.pdf

• Michigan Estates and Protected Individuals Code, Michigan Complied Laws §§ 700.5506-700.5520 (1998)

• Michigan Mental Health Code, Michigan Complied Laws §§ 330.1400-330.1422 (1974)

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References

• Mental Illness. (2017, November). Retrieved July 16, 2018, from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

• National Resource Center on Psychiatric Advance Directives. (2018). Retrieved July 16, 2018, from https://www.nrc-pad.org/

• Code of ethics of the National Association of Social Workers. (2017). Washington, D. C.: National Association of Social Workers.

• Parcesepe, A. M., & Cabassa, L. J. (2012). Public Stigma of Mental Illness in the United States: A Systematic Literature Review.Administration and Policy in Mental Health and Mental Health Services Research, 40(5), 384-399. doi:10.1007/s10488-012-0430-z

• Van Dorn, R. A., Scheyett, A., Swanson, J. W., & Swartz, M. S. (2010). Psychiatric Advance Directives and Social Workers: An Integrative Review. Social Work, 55(2), 157-167. doi:10.1093/sw/55.2.157

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