Advance Statements
This information has been designed by LPFT Carers Council to assist carers and relatives to understand advance statements.
What is an advance statement?
An advance statement sets out a person's treatment preferences and may include information about:
- Treatment a person finds effective
- Treatment that has been less effective in the past
- The person's views and preferences about electroconvulsive treatment and restrictive interventions
Non-treatment related preferences can also be provided with the advance statement and can be discussed with the person, their nominated person, carer and other support people. However, there is no legal obligation for the authorised psychiatrist to follow these preferences.
An advance statement does not expire unless a new advance statement is made or the person revokes their advance statement.
It is recommended that a person considers whether the preferences expressed in their advance statement remain current. An advance statement cannot be amended. If a person’s treatment preferences have changed, they must make a new advance statement. If a person prepares a new advance statement, they should make relevant people, including their treating team aware of the new advance statement.
How is it used?
An authorised psychiatrist must have regard to a person’s advance statement whenever they make treatment decisions.
An advance statement will help the authorised psychiatrist make decisions that better align with a patient’s treatment preferences.
Who can make an advance statement?
A person can make an advance statement at any time provided they understand what an advance statement is and the consequences of making or not making one.
The authorised psychiatrist must have regard to the views and preferences of the patient about their mental health treatment expressed in their advance statement. The person must also have the mental capacity to make the advanced statement.
An advance statement must:
- Be in writing
- Be signed and dated by the person making the advance statement
- Be witnessed by an authorised witness
- Include a statement signed by an authorised witness stating that in their opinion;
- The person understands what an advance statement is
- The person understands the consequences of making or not making an advance statement
- The witness observed the person sign the advance statement
- The witness is an authorised witness
An advance statement will be valid if it meets the requirements outlined above.
A template to make an advance statement is available.
The Mental Health Act 2014 does not require that a person make an advance statement in consultation with his or her treating team, carer or family. However, it is good practice for a person’s treating team, family and carers to be involved in the process of making an advance statement so that they are aware of the person’s treatment preferences.
The treating team may also help the person to understand the consequences, advantages and disadvantages of what the person is proposing. They can also help the person to phrase their wishes, as to avoid making unclear statements that could raise doubts about its applicability in the future.
Overriding an advance statement
An authorised psychiatrist may make a treatment decision that is not consistent with the patient’s
treatment preferences as recorded in the advance statement. The authorised psychiatrist must be
satisfied that the treatment specified in the advance statement is not clinically appropriate or is not a
treatment ordinarily provided by the designated mental health service.
If the authorised psychiatrist overrides a patient’s advance statement, they must tell the person,
explain their reasons and advise the patient that they can request written reasons for the decision.
If requested the authorised psychiatrist must provide written reasons within 10 business days after
the request has been made.
Revoking an advance statement
Revocation of an advance statement means that the person’s advance statement has no further
effect.
A person can revoke their advance statement at any time provided they understand what an advance
statement is and the consequences of revoking it.
A revocation must:
• be in writing and state that the advance statement is revoked
• be signed and dated by the person revoking the advance statement
• be witnessed by an authorised witness
• include a statement signed by an authorised witness stating that -
• in their opinion, the person understands what an advance statement is and the
consequences of revoking it
• the witness observed the person revoking the advance statement
• the witness is an authorised witness
A revocation will be valid if it meets the above requirements. A template to revoke an advance
statement is available.
An advance statement must not be amended. Instead, if a person wants to change his or her
preferences expressed in their advance statement they must make a new advance statement.
Making a new advance statement automatically revokes any earlier advance statements made by that
person.
What is the role of an authorised witness?
An authorised witness is required to state that the person making or revoking an advance statement understands what the advance statement or revocation is and the consequences of making or revoking the advance statement.
The authorised witness should check the identity of the person making or revoking the advance statement by asking them if they are the person who is making the advance statement.
Who can access a person's advance statement?
A person making an advance statement should ensure that the people involved in their treatment and care know that they have made an advance statement and where that advance statement can be located. A person may wish to give a copy of their advance statement to their nominated person, carer and family.
The mental health service provider is responsible for ensuring that the existence of an advance statement is recorded on the patient record.
