£2.5m to roll-out of Advance Choice Documents

The project will be delivered by a joint team from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London and the South London and Maudsley NHS Foundation Trust. By the end of the two-year project, the team aims to have Advance Choice Document resources in use across mental health services in the South London and Maudsley NHS Foundation Trust. An extensive implementation study will also be delivered which will, alongside tested resources, provide the basis for a ‘recipe book’ for Advance Choice Documents to support other trusts in using them across the country.

Advance Choice Documents are written when someone is well and set out how they would like to be treated during a future mental health crisis or relapse. Their introduction was recommended in the 2018 Independent Review of the Mental Health Act and by the parliamentary committee on the draft of the mental health bill in 2023.  Research has shown they can reduce detentions under the Mental Health Act and improve relationships with mental health professionals.

Addressing inequalities

Black people are disproportionately likely to be detained under the Mental Health Act and there is a lack of trust in mental health services in this community. Wider adoption of Advance Choice Documents has the potential to help address these issues.

The new project builds on the success of the recent Advance Statement for Black African and Caribbean project (AdStAC) where researchers and clinicians at the IoPPN and South London and Maudsley NHS Foundation Trust have been working to improve Black service users’ experiences in mental health services by co-producing and testing resources for the implementation of Advance Choice Documents.

The new project will roll out and evaluate the use of Advance Choice Documents, across the South London and Maudsley NHS Foundation Trust for anyone who has been detained under the Mental Health Act. This includes children and adolescents who will be treated at the new Pears Maudsley Centre for Children and Young People, set to open in south London in 2025.

A much-needed step

Rebecca Gray, Chief Executive of Maudsley Charity said:

“We are absolutely delighted to support this new, large-scale project which builds on the earlier work of this impressive team and has relevant lived experience at the centre of its design. Many people with a severe mental illness report that they have too little control and voice in the care they receive. These concerns are particularly high for Black patients, who are disproportionately impacted by severe mental illness and for whom we know trust in mental health services is not high.

“This project has the potential to address these issues and push the needle forward on the use of Advance Choice Documents across the country.”

Professor Claire Henderson, Clinical Professor of Public Mental Health at King’s IoPPN and Honorary Consultant Psychiatrist at South London and Maudsley NHS Foundation Trust, said:

“Having worked on multiple research projects on these types of documents since the late 1990s, I am very happy to have the support of the Trust and Maudsley Charity to make Advance Choice Documents available to people who have previously been detained under the Mental Health Act, and in particular Black people, who experience disproportionately high rates of detention.”

Nathalie Zacharias, Director of Therapies at South London and Maudsley NHS Foundation Trust, said:

“Reducing detentions of our service users under the Mental Health Act has been a Trust-wide priority, together with the PCREF priorities of reducing racial disparities in detentions under the Mental Health Act, as we know we have a disproportionate number of Black men detained on our inpatient wards. From our work on the AdStAC project, we know that Advance Choice Documents are more than just medical preferences; it’s about capturing the essence of a person—their values, their hopes, their fears. With this new funding from Maudsley Charity, we can get Advance Choice Documents offered to service users Trust-wide.”

Dr Lade Smith CBE, Consultant Psychiatrist and Clinical Director Forensic Services at South London and Maudsley NHS Foundation Trust, Visiting Senior Lecturer at King’s IoPPN, and President of the Royal College of Psychiatrists, said:

“Advance Choice Documents could transform the way we work; they are better for patients, better for clinicians, and better for services. Through use of Advance Choice Documents, we will be able to prevent crisis and develop stronger therapeutic relationships with our patients. If we can reduce the numbers of people detained by up to 25%, not only will it ease NHS excessive workloads, but it will improve service-user experiences of mental healthcare.”

A carer’s experience

Lorna, who is a carer and advocate for her son Ryan, who lives with psychosis said:

“I don’t want my son to be sectioned. I want to keep him well, so an Advance Choice Document is what we need. What will make him unwell would probably be him not taking his medication.

“I’m just hoping for a system where you put my son’s name in and the ideal thing is they’ll know where Ryan lives, that they’ll know to contact me or to contact somebody that will know what the next steps are.

“I think I know my son better than the health care professionals. I’ve felt through the journey I was never listened to. The big thing would be that reassurance that he would be taken care of in the way he wants to be taken care of even if I’m not there.”

Read more about Lorna’s hopes for improved care.