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NIMH funds $1.98 million study of advance directives for patients with mental illnesses

DURHAM, N.C. -- The National Institute of Mental Health has awarded a Duke University Medical Center team $1.98 million in research funding to study the use and effectiveness of "psychiatric advance directives (PADs)" -- legal documents created by patients who have planned ahead for their preferred course of treatment during a mental health crisis. This is the first major study funded by the U.S. government to evaluate PADs from initiation to outcomes, said the researchers.

Despite the spread of laws that authorize the use of advance directives in the care of patients with mental illnesses, little research has been done to determine the effectiveness of these legal instruments. Although patients in 16 states have the right to create a PAD, very few take advantage of it, according to researchers at Duke. The four-year study will examine whether psychiatric patients will complete advance directives if they are provided the resources to do so, and will also determine whether or not doctors and hospitals can effectively put the plans into action.

"Americans place a high value on the right to make their own health care decisions, but gravely ill patients sometimes are incapable of deciding for themselves or communicating with doctors about the treatment choices they face," said Jeffrey Swanson, Ph.D., an associate professor of psychiatry and behavioral sciences at Duke and principal investigator on the study. "Patients with a terminal illness often plan ahead using a 'living will,' or appoint someone they trust to carry out their wishes for treatment. People who know they have a serious psychiatric disorder should be able to do the same thing."

The Duke team wants to find out why PADs are in such limited use and whether implementing such directives would help patients gain access to timely treatment during mental health emergencies without the need for involuntary commitment.

"Mental health consumers and advocates are very concerned about
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Contact: Tracey Koepke
koepk002@mc.duke.edu
919-684-4148
Duke University Medical Center
16-Sep-2003


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