Advance Choice Document Implementation
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Advance Choice Document Implementation.
- Who it may be relevant to
- Registry conditions: Detention Under the Mental Health Act. Basic parameters: from 16 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United Kingdom
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Overview
Advance Choice Documents (ACDs) are statements of preferences for mental health care and treatment made when service users have capacity to do so. This is done with their care team and others as desired, e.g. carers/supporters or advocates. In addition to improving therapeutic relationships, ACDs have been shown to reduce compulsory psychiatric admissions by 25%. South London and Maudsley is currently implementing ACDs into routine practice across its services and the Advance Choice Document Implementation (ACDI) project, run by researchers at King's College London, is supporting the development of related resources and the evaluation of the effectiveness of the implementation. Advisory groups will also guide the study approach throughout. The project comprises four work packages. Work Package 1 involves focus groups with stakeholders (service users, carers, staff) to inform implementation for Older Adults and CAMHS services. This is to understand the barriers and facilitators for ACD implementation in these services; and learn what adaptations are needed to the ACD resources and procedures for use in these services Work Package 2 is a prospective study of ACD completion and use throughout all directorates. This will comprise interviews with service users after ACD creation and after an event where the ACD is expected to have been used; interviews with their care-team during expected use events; and interviews/focus groups with staff facilitating the creation of ACDs to understand the integration of their role in SLaM. Work Package 3 is a retrospective study examining the impact of ACD creation on health service use and routinely collected outcomes. Work Package 4 is a prospective study of ACD use and its relationship to ACD content. Work Packages 3 and 4 will use de-identified data collected via South London an Maudsley's Clinical Records Interactive search System (CRIS). For more information on ACDI, the people involved, and related publications, please visit: https://www.kcl.ac.uk/research/acdi
Interventions
- Other Advance Choice Document Implementation
Creation and application of Advance Choice Documents
Primary outcome measures
- Number of admissions under the Mental Health Act sections 2, 3, 135 and and associated bed days [Time frame: 18 months]
Secondary outcome measures (10)
- Number of Home Treatment Team events [Time frame: 18 months]
- Number of events of acute mental health and emergency service use [Time frame: 18]
- Rates of restraint [Time frame: 18]
- Number of days spent in seclusion [Time frame: 18 months]
- Number of events of involuntary medication [Time frame: 18 months]
- Number of safety events recorded (violence, self-harm, consequences of self-neglect and other serious untoward incidents) [Time frame: 18 months]
- Number of events of contact with police related to use of mental health services [Time frame: 18 months]
- Number of events of General health service use [Time frame: 18 months]
- Number of community mental health team events [Time frame: 18 months]
- Number of psychiatric liaison team events (in emergency departments) [Time frame: 18 months]
Eligibility criteria
Inclusion criteria
WP1: Focus Groups Service users-Young people Aged ≥ 16 Experienced detention under the MHA while in the care of CAMHS Currently under the care of community mental health services (CAMHS / EI / CMHT)
Older adults
- Experienced detention under the MHA while under services for Older Adults
- Currently under the care of older adult community mental health services
Carers / Informal supporters Aged ≥ 16 years A relative or friend of a service user who is eligible for the study
Professionals Professional potentially involved in supporting the completion of ACDs (i.e., community mental health team (CMHT) staff, advocates, peer workers) SLaM professionals potentially involved in referring to ACDs (i.e., inpatient and emergency department liaison mental health staff, home treatment, place of safety and street triage staff) Approved mental health professionals (AMHPs) and Section 12 (MHA) approved doctors involved in detention.
Ambulance, prison mental health and Emergency Department staff General Practitioners, including mental health leads, or other primary care professionals who care for people with SMI discharged from secondary services
WP 2: Prospective study of ACD completion and use Service users All service users: accepted referral to an ACD facilitator for ACD creation Young people
- Aged ≥ 16
- Experienced detention under the MHA while in the care of CAMHS
- Currently under the care of community mental health services (CAMHS / EI / CMHT/)
- Accepted referral to an ACD facilitator for ACD creation; including participants who decline to complete and ACD after referral to an ACD facilitator.
Older adults
- Experienced detention under the MHA while under services for Older Adults
- Currently under the care of older adult community mental health services
- accepted referral to an ACD facilitator for ACD creation
General Adult:
- Aged ≥ 18 years
- Previously detained under the MHA
- Under the care of community mental health services (CMHT or EI)
Forensic
- Aged ≥ 18 years
- Experience detention under the MHA into forensic services
- Currently under the care of forensic mental health services
Carers: relative or friend of someone referred to an ACD facilitator
Professionals: SLaM staff involved in the care of a participant with an ACD whose ACD is expected to have been consulted because they were: involved in a transfer of care, placed in zoning, referred for a MHA assessment or to a home treatment team, attended an Emergency Department or Place of Safety, admitted to a psychiatric inpatient unit or imprisoned.
The interviews conducted with service users and staff after the expected use event will also include questions about satisfaction with and perceived value of the process of completing, distributing, accessing, honouring, and reviewing an ACD.
Exclusion criteria
Service users Aged under 16 years Lacking capacity to provide consent and/or is unwilling to do so Currently detained under the MHA in psychiatric hospital Currently under the care of eating disorder services
Carers/informal supporters Aged under 16 years Is not a relative or friend of a service user who is eligible for the study
Professionals Is not a mental health professional or Section 12 (MHA) approved doctor Is not a professional involved in supporting the completion of ACDs Is not a General Practitioner or mental health lead caring for people with SMI discharged from secondary services.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Other
Study locations
United Kingdom · 1 center
- South London and Maudsley/Institute of Psychiatry, Psychology, and Neuroscience-King's Col — London
Identifiers
NCT: NCT07284368 · R&D2025/062 · 2946