A recent study highlights why mental health clinicians face challenges in engaging in Advance Care Planning (ACP) with older persons diagnosed with schizophrenia and other psychotic illnesses.
ACP is a process that involves making a plan for future health and personal care should a person lose their decision-making capacity. ACP ensures individuals can express their preferences for care towards the end of life, enhancing autonomy and quality of life. This is especially important for older people as physical health conditions and difficulties with day-to-day functioning may become more prevalent with ageing. However, despite its importance, ACP discussions are infrequent among older persons living with mental health conditions due to complex barriers. These include clinician fears of causing distress, the complexity of assessing decision-making capacity, and systemic gaps in training and practical experience.
The study was led by Associate Professor Anne Wand, a senior staff specialist psychiatrist in Older Persons’ Mental Health in Sydney Local Health District, Adjunct Associate Professor in the UNSW School of Medicine, Conjoint Associate Professor, Faculty of Medicine and Health, University of Sydney, and member of the UNSW Ageing Futures Institute. The qualitative research involved focus groups with mental health clinicians, identifying two overarching themes: that 1) clinicians value ACP and want to engage in it but 2) perceive the process as daunting and difficult to engage with due to its complexities. The study also highlighted further subthemes including fear of harming and capacity and legal issues, leaving clinicians uncertain about how to navigate ACP effectively.
“Supporting people living with mental illnesses in planning for their care towards the end of life is essential, but requires systemic support, clear guidelines, and practical training for clinicians. This study emphasises the need to address these barriers to ensure equitable care for some of the most vulnerable populations,” says Associate Professor Wand.
“The research advocates for targeted education, systemic changes, and a multidisciplinary approach to embedding ACP into mental health practices – actionable solutions to improve end-of-life care planning for older persons.”
A companion paper, in press in European Geriatric Medicine, describes the experiences and perspectives of older adults with a psychotic illness and their carers on ACP. The results are currently being triangulated with clinician data to develop an educational intervention for mental health clinicians.
You can access the full study here.
This work was supported by the Moyira Elizabeth Vine Fund for Research into Schizophrenia Program 2023, administered by the Faculty of Medicine and Health, University of Sydney, Australia.