WORDING AN ADVANCE STATEMENT
Why make one?
We (Mental Health Network Greater Glasgow) are an organisation run by people with a
lived experience of mental ill-health and we believe that a well-written credible Advance
Statement has the power to both improve your mental health treatment and to protect
your rights. We also believe that this safeguard can tangibly improve your experience of
treatment for serious mental health issues by affording you greater involvement in your
care.
The importance of CREDIBILITY
When you are acutely mentally unwell the people involved in your treatment will be
assessing your behaviour and your capacity to make decisions at that time. Unfortunately
most of these people will never have met you, or know you, as a well person. Therefore it is
really important that your advance statement is well-reasoned and gives your reasons for
your position. This gives it power and credibility. You should view the advance and personal
statements as an opportunity to give people information that you view as important to
promote your recovery from an episode of psychiatric ill-health, “everything you need to
know to work with me when I am unwell”, if you like.
The importance of BALANCE
The Advance Statement is not just about the things you do not want from psychiatric
treatment. If a particular treatment works well for you, this is your opportunity to highlight
this. This may show the people treating you what you think is the best way to help you and
that you are positive about your recovery from an episode of mental ill-health. Think of it as
helping to make the job of treating you easier.
The importance of being CONCISE
This is your chance to say what would actually help you. You may have strong views about
past treatment, but this is not really the best place to put these. It is better to give staff an
indication of what treatments have and haven’t worked for you in the past and to state the
reasons why. However it is best to keep these short and factual, it could that there were
difficult side effects, or that it affected other things like ability to drive, made you drowsy
etc.
So what do I put in it?
The Advance Statement comes into effect when you are deemed to lack capacity and are
seriously mentally unwell, being treated under mental health legislation. It should cover
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your views and wishes in relation to your psychiatric treatment at this time. Having
supported a number of people to make statements we would suggest you think about four
main areas (although if you think there is something important to you is not covered by
these include it also), your wishes in relation to:
1.
2.
3.
4.
Psychiatric Medication;
Electroconvulsive Therapy (if appropriate to you);
Psychological Therapies;
Involvement and nominations of others who support you.
AS Wording Examples:
Below are actual examples of stated wishes from real peoples advance statements. We
intend to use them to illustrate why we feel they are well written.
Psychiatric Medication
Medication is often the principle treatment for people with a serious psychiatric illness, and
one which people often have strong views about. In addition there seems to be a wide
variation in people’s responses to the various psychiatric medications with many people
trying different medications before finding the one that works for them. Finally many
people who have used psychiatric medications (particularly if for some time) report sideeffects associated with their use. An Advance Statement can be used to highlight your views
(both positive and negative) on medication.
Example 1:
“I would rather not be treated with Haloperidol as I had a severe, life threatening reaction to
it. Please see my medical records for more information.
If unwell I would rather be treated with Aripiprazole as I have responded well to this in the
past.”
Position on Treatment:
“I would rather not be treated with Haloperidol”
“If unwell I would rather be treated with Aripiprazole”
Why these are important?
These are the persons stated positions on two types of medication, one positive, one
highlighting an extreme reaction.
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Reason & Impact of Treatment:
“I had a severe, life threatening reaction to it.”
“treated with Aripiprazole as I have responded well to this in the past.”
Why are these important?
These highlight the impact of the treatments upon the person, further information might be
obtained from a person’s medical records.
Example 2:
This example is fairly detailed and gives a lot of information, but it also illustrates several
good points.
“I have previously been prescribed M.A.O.I. anti-depressants and due to the complications
associated with these (i.e. severe dietary restrictions & anaesthetic implications, etc) I do not
wish to be treated with these again. I am aware that there are many other options available
and so do not see this as creating a problem. Although these medications have proven
successful in treating my depression in the past physically I became unwell due to significant
weight loss and being unable to receive other treatments due to anaesthetic implications.
Please also see my comments on medication for chronic back pain below.”
History:
“I have previously been prescribed M.A.O.I. anti-depressants"
Why is this important?
This shows the previous history of the person receiving the treatment; this can also be
checked against a person’s medical records where important. A person who has previously
received a particular treatment may be able to give some degree of insight as to how THEY
FELT the particular treatment affected them either positively or negatively.
Impact of Treatment:
“and due to the complications associated with these (i.e. severe dietary restrictions &
anaesthetic implications, etc)”
Why is this important?
This shows the impact of a particular treatment, again this can be checked against a
person’s medical records and a person may be able to add important personal or contextual
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information. This will often be the primary reason for a person including this treatment
within their advance statement.
Position on Treatment:
“I do not wish to be treated with these again.”
Why is this important?
This is the expression of a person’s wishes relating to a particular treatment.
Reasoning:
“I am aware that there are many other options available and so do not see this as creating a
problem. Although these medications have proven successful in treating my depression in
the past physically I became unwell due to significant weight loss and being unable to
receive other treatments due to anaesthetic implications.”
Why is this important?
This may not always be necessary however it does show the insight and reasoning behind
the decision (in this case there are physical health implications) and illustrates an awareness
of the decision making process within any future psychiatric treatment.
Physical Health:
“Please also see my personal statement for information about my treatment for chronic back
pain”.
Why is this important?
Although the Advance Statement is about your psychiatric treatment, this flags up any
additional health issues that a person feels are important or have implications for their
psychiatric treatment. Information relating to these could be accessed from a person’s
medical records, specialist or their GP. In addition long-term use of many psychiatric
medications can have a severe impact upon a person’s physical health, this is often an
important factor in many people not wishing to receive a particular medication.
Electroconvulsive Therapy (E.C.T.)
E.C.T. is a very emotive treatment that often polarises opinions; some people are
passionately against it whilst others state that they feel that it saved their life. As a general
rule it tends only to be considered for the most severely unwell and there are tight
guidelines around its usage. It may not be relevant for your advance statement, if so, feel
free to exclude it if you do not foresee ever being considered for it. However if you do see
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E.C.T. being a possible treatment option, or the thought of it causes you anxiety, then you
may wish to include your wishes on this topic within the statement.
Example 3:
Electro-Convulsive Therapy:
“I do not wish to receive Electro-Convulsive Therapy (ECT) unless there are no other
treatment options to save my life. This is because I have had ECT in the past and have
suffered from severe short-term memory loss. The thought of receiving ECT also causes me
great anxiety.”
Why is this important?
Again this shows the reasoning and experience behind the stated wish as well as the impact
of the prospect of the treatment upon the person.
Position on Treatment:
“I do not wish to receive Electro-Convulsive Therapy (ECT) unless there are no other
treatment options to save my life.”
Impact of Treatment & Reasoning:
“I have had ECT in the past and have suffered from severe short-term memory loss. The
thought of receiving ECT also causes me great anxiety.”
Named Person & other carers/supporters.
A frequently occurring issue for carers is their being unable to get information about the
person they care for when unwell due to ‘patient confidentiality’. In addition there are
specific formal roles within the Mental Health Act that enable a person to act as a
representative for the person who is unwell. If there is someone you know who supports
you then you may wish to highlight their role in your statement.
Example 4:
“My nominated Named Person is:
J**** B****,
24 A**** Gardens,
Glasgow,
G** **A.
Tel: 0141 *******
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I would like them to be fully involved in decisions relating to my mental health care and
treatment on any admission, even if I attempt to withdraw this nomination whilst unwell.”
Position on Treatment:
“My nominated Named Person is:”
Why is this important?
This identifies someone who is undertaking a formal role to support of the person receiving
treatment.
Emphasis:
“even if I attempt to withdraw this nomination whilst unwell.”
Why is this important?
Context, if a person has changed or withdrawn a nomination whilst unwell previously was
this because they were unwell at the time? If you foresee that you may do this, you may
wish to try to strengthen the nomination in this way.
This document was developed as a general guide on the topic, ALWAYS discuss your views
and wishes with an appropriate psychiatric or medical professional in order to support
and guide the development of your Advance Statement.
By Gordon McInnes
Mental Health Network (Greater Glasgow)
Tel - 0141 550 8417
Email – gordon@mhngg.org.uk
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