A clinician's perspective: enhancing trust and autonomy

In part one of this three-part blog, Dr Nadine Keen, a Consultant Clinical Psychologist at South London and Maudsley NHS Foundation Trust, shares the impact of ACDs on mental health care and her hopes for the future.

“Dehumanising”, “forced”, “lack of choice”, “racism”, “disempowered” – sadly, these are recurring terms I have encountered all too often from individuals striving to overcome their negative experiences of mental health services through therapy. Many people develop post-traumatic stress symptoms because of these experiences. The fear of relapse can be terrifying, not only due to concerns about mental health but also the anticipated adverse treatment.

The AdStAC project felt like an attempt to address this and to empower individuals to have control over their care decisions.

I routinely develop staying well plans and blueprints upon finishing therapy with people, and I had developed advanced statements previously. However, the AdStAC project presented a distinct experience. The comprehensive and thoughtfully written document, coupled with a gentle facilitator guiding the process, was immensely beneficial. It prompted us to examine the situation through a detailed lens beyond the scope of our typical clinical practice.

Having worked closely with my client in therapy, my role was that of a familiar mental health professional; an advocate. It can be extremely daunting for a person to assert a future plan when the prospect of becoming unwell again feels too traumatic to even think about. It can be even harder to do this with someone you haven’t yet developed a trusting relationship with (i.e., the facilitator). I was, therefore, keen to support my client through this if they wanted me to.

Aware of their past experiences and understandable fears, I hoped to provide a helping-hand to support them in reflecting on their unique needs and wants, should they relapse in the future. Having a facilitator guide the process validated the experiences, hopes and concerns that were voiced. The ACD was crafted in a compassionate and personalised manner, distinctly centred around my client’s wishes. The facilitator's commitment to creating a thorough and individualised document underscored the importance of the endeavour – it was more than just a document in the notes, likely to be forgotten. Instead, it provided a robust safety net, a collaboratively developed plan, and a hope that individuals could trust that their wishes would be respected when it mattered most; and that we, as mental health professionals, are striving for better, person-centred and collaborative care.

My hope is that, moving forward, this level of support can be extended to all.

The AdStAC team have now received further funding from Maudsley Charity to scale-up the use of ADCs within South London and Maudsley NHS Trust. 

Read part two here.