Discussion
mental illness, psychiatric, ’s mental disorder
Our study is the largest prospective study on PADs including people living with mental illness who were compulsorily admitted during the past year. It is also the first to evaluate the costs and benefits of peer worker–facilitated PADs for the management of a patient’s mental disorder. In our study, for the overall population, PW-PAD was strictly dominant. The intervention was associated with a higher number of QALYs at a lower cost compared to usual care.PW-PAD was associated with a significant decrease in total psychiatric inpatient days/nights and with a significant improvement in compulsory admissions, with no significant reduction in the rate of overall psychiatric admissions (Tinland Few multicentre and randomized controlled studies have evaluated the effectiveness of advance directives in psychiatry, none incorporating facilitation by peer workers (Henderson Over the follow-up period, participants in the PW-PAD group gained more health utilities than their counterparts in the control group, with similar EQ5D-3L scores at baseline and 6 months. This finding could suggest a learning period with PW-PAD, with the effects in terms of quality of life appearing only after the first 6 months following the initiation of the advance directives, suggesting that this could be maintained in the long term. Further investigations are needed to understand the factors that influence the early benefits of the intervention and to help inform decision-making.Even when the PW-PAD intervention was considered to cost double, the intervention still remained dominant compared to usual care. In fact, regardless of the variations considered in cost parameters, the PW-PAD group remained dominant, presenting a 100% chance of being cost-effective at small WTP thresholds for mental health programmes.Such results are important because they inform decision makers and, perhaps more critically, they contribute to international guidelines on the economic efficiency of programmes in mental health. Indeed, cost analyses offer a perspective for policy changes. The PW-PAD is an intervention, which can be implemented in a fairly straightforward manner and can be very quickly cost-effective for the healthcare system.