Introduction
mental illness, psychiatric, PAD
PAD, BARRETT
Involuntary treatment and care is common and increasing in high-income countries, with variation by country (Wasserman Different models of interventions to reduce compulsory admissions have been developed. Of these, psychiatric advance directives (PADs) or joint crisis plans (JCPs) are written documents that allow adults with mental illness and with temporary decision-making incapacity to state their will and preferences in advance, to be applied if further mental health crises impair their decision-making capacity (Henderson Behind this common objective, PADs and JCPs differ in several ways, including their legal force or with whom they are fulfilled (Atkinson Inherently, PADs promote user’s involvement and dialogue (Murray and Wortzel, The model of PADs that we have experimented in this trial had the originality of being facilitated by peer workers, that is, people with personal experiences of mental distress who are trained to assist users in filling their PAD statement and sharing it with relatives and psychiatrists. We observed that this model of PADs was associated with a significant reduction of over 32% in the proportion of compulsory hospitalized people (main criterion of our trial) (Tinland To our knowledge, and despite its societal importance, PAD interventions have received little attention in terms of costs, and only two of the randomized trials on the topic have explored this parameter, exclusively in the UK (Barrett 