What are Advance Choice Documents?
Advance Choice Documents (ACDs) are written or spoken records that allow people with fluctuating mental illness to say in advance, when they are well, what treatment they would like should they become ill. They provide key information for family, friends and professionals who might treat them if they become unwell.
If you are considering an Advance Choice Document, you might provide information about things like your illness, treatments which work/don’t work and contact details both for family/friends and for health professionals who are familiar with your history. There are lots of different names for Advance Choice Documents – you might also hear them called ‘Mental Health Advance Statements, ‘Advance Choice Directives’, ‘Psychiatric Advance Directives’ or ‘Advance Care/Crisis Plans’. To see all these terms and their explanations, visit our ‘Jargon explained’ page here.
An Advance Choice Document is not a legally binding document – but it can provide important details and guidance, especially for healthcare professionals who are unfamiliar with you and how to care for you when unwell.
When are they relevant?
Advance Choice Documents are relevant for people who have had an episode or episodes of severe mental illness, and who have valuable experience about their illness and how best to treat it. They are written when a person is well, and come into action when that person becomes unwell.
What are your rights if you have an Advance Choice Document?
Although the right to make mental health advance decisions or directives is already part of law in some countries and there is widespread support for their use amongst people living with mental illness, medical professionals and policy-makers, there are differences from country to country. Please see the tab “The law where you live” for more details.
One thing most countries have in common is that there are large gaps between policy and practice. In other words, there may be laws in place which support advance decision making, but in practice there is minimal formal legal provision for people living with mental illness to express advance requests for treatment. A key principle within this project is that people’s personal experience of their own health management is an extremely valuable resource, which is currently being under-used.
We have developed this website so that you can maximise your right to have a say in your treatment, even if you live in an area where taking account of advance requests about treatment is not common. Although Advance Choice Documents are not legally binding documents in most countries, they can provide important details and guidance for carers to advocate for you, and especially for professionals who are unfamiliar with you
Why are we talking about Advance Choice Documents now?
Amongst those living with mental illness and health professionals, both nationally and internationally, there is increasing enthusiasm for people to use their own past experience of severe illness to help guide their future healthcare using ‘Advance Choice Documents’, often known as advance ‘directives’ or ‘statements’. We know that a key factor holding people back from creating or recommending Advance Choice Documents is a lack of awareness and resources. Our aspiration, at Advance Choice, is to fill this gap.
In the UK (where the team is based) at time of writing (2023), revisions to the England and Wales Mental Health Act 1983 are currently underway to enable people receiving mental health treatment to have increased input into mental health decision-making. A key part of this will be giving people the right to make decisions in advance about their treatment preferences. Although the precise form of the new 'Advance Choice Document' legislation or its date of introduction is not yet known, the principle of having some sort of document which records treatment preferences has been well established. We know it can improve treatment outcomes and give people back a sense of some control at a time when they feel they have no control.