Advance statements

[Title: An advance statement is a document that sets out a person's preferences in relation to treatment Mental Health Act 2014, Victoria]

Wanda Bennetts, consumer consultant

So, I've had an advance statement for a long time. Many years ago, when things were really, really bad, I just felt like I wanted to take control. I don't want a substitute decision maker, I don't want a guardian, I don't want any of that. I want to make my own decisions.

Claire Jones, mental health practitioner

So, an advance statement is a document that is being introduced around Victoria. It is a document that allows consumers of mental health services to write down their treatment preferences, so how they see their treatment being, what they want, what they would prefer not to happen during periods of unwellness. It's very important that it is recognised in the [Mental Health] Act because it puts the consumer at the forefront of the treatment, rather than being treated at, or treated to, they're being treated with – having that discussion with your case manager, with your doctor - about what's worked for you, what hasn't worked for you. What you've heard that has helped other people in the past. It's about opening that dialogue and having your opinion count.

Wanda Bennetts, consumer consultant

Sometimes being in hospital was the thing I needed to do, just to, you know, give myself some space and to feel safe for a little bit and not to have to worry about family and work, but also though, sometimes being in hospital was a really traumatic experience. So, having an advance statement, I met with my psychiatrist. We spent a good session or more, working through it, in terms of could offer or not offer. Great, if people agree with what I've written but, if they don't, that's not a critical thing. It's that they respect my wishes. It gives a bit of a sense of what people may notice, if things are going haywire then it has what's helpful, it has what's not helpful. I don't know if every preference has got a reason, but there is an element of that in there because, I think, if you can tell people why, some things is important, they're more likely to take notice of it.When I'm well, and I make my advance statement when I'm well, it gives me more credibility. I don't think I say something different necessarily when I'm not well, but I just think I say it more articulately or credibly when I'm well, so I need to put it down in that way and get somebody to acknowledge the facts. It's what I want – it helps people to understand things the way in the way that works for me because other people might be different. And we are all different and that's the challenge. If we're all the same and if, you know, what the evidence said worked for everybody, was all the same then we probably wouldn't need these either.

Tony, mental health consumer

In my advance statement, I would write that it's dialogue and sharing my experiences and getting in touch with nature that helps me more than medication and a hospitalisation. I think, with the advance statement, it would give the friends and family an insight on how you feel and I do think it'll open up communication with psychiatrists and case workers because when you write, you take your time to think what you're writing. When they're asking questions, it's the spur of the moment and the answer you give often isn't really the answer that you want to give. So, I'd encourage it whole-heartedly that people do it so they have got that foothold and that stability in their mental health recovery.

Dr Richard Newton, Medical Director, Mental Health CSU, Austin Health

An advance statement becomes active if somebody's being treated under the Mental Health Act, under an involuntary patient under a treatment order or a temporary treatment order etc but, in fact, an advance statement could and should be used at all stages, if somebody's carer is away, reflecting and considering on what treatments haven't been helpful before and why and how they want their treatment in the future to progress and it's a nice way of communicating that to their family perhaps and carers so they understand what the treatment preferences might be but also to the treatment team around them as well. So, although it has a legal role under the Mental Health Act, I actually think it has a much wider role to act as an information source about treatment preferences throughout the course of somebody's journey to recovery.

Peer support group

Speaker 1: Advance statements are going to be something that our treatment teams are going to have to take into account. We get to write down what our treatment preferences are for if we're involuntarily admitted. So, do you think it would be good for the group to do something like that? Because I've never written down my treatment preferences, ever.

Speaker 2: No.. so, will this cost anything? So, do we fill this out ourselves?

Speaker 1: It's not going to cost you anything but you do have to get an authorised witness

Speaker 2: So, it's going to be anyone that's a registered medical practitioner or mental health provider or anyone that can sign a stat dec.

Speaker 3: Do you need to put down reasons why you would want someone to follow that course of treatment for you?

Speaker 1: I think it's actually a good idea to do it, then it will be more compelling for the treatment team when they read it.

Speaker 2: So, then you have to come up with some alternatives

Speaker 3: Right

Speaker 1: And also, do you think it's de-stigmatising too, even to have these discussions, because I don't know about you, but I know it my family, we don't talk about it a lot. They don't really know, in detail, what my preferences are. Like, because I've never written it down, I've never discussed with them.

Speaker 3: It empowers you – you're more in control of the sort of treatment you're going to receive.

Speaker 1: Hopefully, getting the treatment that you know works for you.

Speaker 3: Yeah, rather than having to experiment with lots of other different things, you know that something has worked in the past and you follow that plan and hopefully it's going to speed up the process of getting better.

Claire Jones, mental health practitioner

Recovery is what we are all trying to achieve. It's not just recovery in the clinical sense, it's about someone's journey and how they feel they're travelling. It's not about benchmarking it or scoring it against a chart. Clinically, it's about those personal gains that that person feels they have achieved.

Dr Richard Newton, Medical Director, Mental Health CSU, Austin Health

I think the biggest shift is from substitute decision-making to supported decision-making and I see advance statements as being one of the planes in that shift but the big shift is to go from a 'we think this is what treatment you need' to 'come and talk with you about what treatments you think would work for you' and that's the biggest shift.

[Title: Talk to your family or other support people in your life and to your GP or mental health practitioner]