Can peer-facilitated psychiatric advance directives decrease involuntary commitment and improve clinical outcomes among individuals with serious mental illness?

While the benefits of psychiatric advance directives (PADs) in decreasing involuntary commitment, improving crisis planning, and mitigating the negative impact of coercive interventions have been well documented, less is known about the efficacy of peer-facilitated PADS. Peers are uniquely positioned to elicit an individual’s preferences while promoting autonomy and self-determination by virtue of their shared experience with mental health diagnosis and services, and their adherence to core values such as empathy, respect, and mutuality. This article describes the promising results of a randomized clinical trial in which completion of a peer-facilitated PAD was associated with a significant decrease in involuntary commitment and a significant increase in mental health outcomes such as recovery and empowerment among individuals with serious mental illness and prior involuntary commitment.

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