Physician Orders for Psychiatric Treatment: The Benefit of Using Portable Medical Orders in Mental Health Treatment

Abstract: People with severe and persistent mental illness frequently experience loss of control and paternalistic treatment during mental health crises. Data indicates that psychiatric advance directives (PAD) have the potential to increase respect for the dignity of the person and autonomous decision making, improve the quality of therapeutic alliances, and increase care coordination between clinicians. Effectively implemented PAD result in fewer symptoms, increased empowerment, improved treatment adherence, reduced severity and duration of mental health crises, and higher recovery rates. In spite of these tools and their positive contributions to treatment, crisis mental health care continues to be dominated by paternalistic practices. Physician Orders for Life Sustaining Treatment (POLST) have effectively utilized portable medical orders to facilitate shared decision making resulting in clear treatment plans and improved implementation of individual preferences for treatment near the end of life. Developing a PAD that utilizes portable medical orders, similar to POLST, addresses ethical concerns and barriers to effective implementation associated with current PADs.

Keywords: Mental Health, Advance Directives, Shared Decision Making