Seminar: Designing the ‘grievous bonds’: A focus group study exploring stakeholder opinions and developing a clinical template and pathway for a Self-binding Advance Directive for Bipolar

Wednesday 27 February, 2019, starting at 12.00 pm.

The Boardroom, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 de Crespigny Park, London SE5 8AF.

Mental Health, Ethics & Law Research Seminar.

Dr Lucy Stephenson and Dr Tania Gergel will be presenting their ongoing research work on Self-binding Advance Directives.

“Designing the ‘grievous bonds’: A focus group study exploring stakeholder opinions and developing a clinical template and pathway for a Self-binding Advance Directive for Bipolar

The concept of advance decision making (ADM) undertaken by people with severe mental illnesses, such as Bipolar, to plan for crises when they lose decision making capacity (DMC) is widely supported but scarcely practiced. This may be due to issues such as lack of knowledge, accessibility, legal and ethical concerns and lack of resources. Therefore, understanding and overcoming process issues in clinical implementation are key to offering service users this much desired tool. We sought to develop an ADM document which could be confidently co-produced by service users, their friends and family and clinicians and which utilises the available provision under the Mental Capacity Act, the current Mental Health Act (MHA) and makes space for potential MHA reforms. A service user with Bipolar could use this document to ‘bind’ themselves to treatment of their choosing, like Ulysses facing the sirens with ‘grievous bonds’.

Eight focus groups were held with key stakeholders: service users, friends and family, psychiatrists, care coordinators, lawyers and AMHPs. In these groups stakeholder experience, ethical and practical concerns were explored. We will present the analysis of these groups and discuss the process of creating a template which incorporates this body of feedback and the care pathway for its creation and use.

The refined template and clinical pathway will be implemented as a quality improvement initiative in a mental healthcare trust in London.

This seminar is open to all and attendance is free. If you plan to come please email Felix Warnock in advance via felix.warnock[at]kcl.ac.uk

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