Who Knows Best? People with mental illness direct own treatment

16/03/2009

People with mental illness who prepare for acute episodes of illness by documenting their treatment preferences can enjoy improved outcomes, according to ‘Advance directives’ advocate and lawyer Vivienne Topp.

Such documents, known as advance directives or living wills do not create barriers to treatment as some health service providers fear, but can assist health professionals and family members in identifying and coping with mental illness.

Speaking at the Victorian Equal Opportunity and Human Rights Commission’s conference in Melbourne, Ms Topp said more and more people with a mental illness were using advance directives to prepare for the event of their decision-making capacity becoming impaired in future.

“People with a mental illness know what treatment works for them, and their advance directives can help doctors better understand the illness, particularly when the doctor may be seeing them for the first time, which is common in the public health system,” she said.

Advance directives, while becoming more popular in Victoria are not legally binding and are easily challenged. Ms Topp argues that advance directives afford people with a mental illness the same rights as others in determining what treatment they want.

“If you have cancer, you can determine if you want chemotherapy or not. Similarly a person with a mental illness should be able to stipulate that in the event of an episode of mental ill health, they do not want Electro-Convulsive Treatment. And these wishes are best articulated in a written document,” she said.

Ms Topp, Vanessa Taylor and Catherine Leslie, all from the Victorian Mental Health Legal Centre presented a paper on the issue. The service has been funded to research Advance directives and the Centre has interviewed 40 people, who have all suffered mental illness at some stage. Most have prepared their own advance directives.

“What is interesting is that not one of the people has used the document to oppose all treatment, which is a common criticism of advance directives. They have used it to help their family, friends and doctors to understand what works best for them. Many have prepared them with support from their doctors,” Ms Topp said.

Ms Topp, coordinator of policy at the Mental Health Legal Centre, cited the example of a woman who has prepared an advance directive for her workplace. It helps her workmates identify when she may be showing symptoms, indicating the onset of an episode. It then directs them what to do – not to let her drive, make contact with the person who will care for her and call her doctor to inform him of her symptoms. Advance directives can be as simple as a care plan, to more complex issues involving treatment, care of children, pets and a house.

Ms Topp called on the Law Reform Commission to investigate advance directives and investigate how they could work in practice, and then make recommendations to Parliament. She does not want advance directives included in the Mental Health Act, which is now under review.

The Mental Health Legal Centre is now working with mental health clinicians to assist them to utilise and respect advance directives.