People, process and power: implementing advance choice documents for Black people in mental healthcare

BackgroundAdvance Choice Documents (ACDs) have been recommended for inclusion in new mental health legislation for England and Wales. This is based on evidence-based interventions to reduce compulsory psychiatric admission, with particular benefit for Black people, whose rates of compulsory psychiatric admission in the UK are over three times higher than those of White British people. Our aim was to explore potential barriers and enablers to effective implementation of ACDs for use by Black people with previous experience of compulsory admission. MethodsSeven online and in-person workshops were held with: Black service users who had previously been compulsorily admitted, carers/supporters of Black service users, and mental health professionals. Workshops were recorded and transcribed. ResultsInductive analysis was employed to identify recommendations and determine where there was a lack of consensus. Thematic analysis identified key themes of ‘people’, ‘process’ and ‘power’ pertaining to ACD implementation.DiscussionOur results reinforce the need for independent facilitation for ACD creation and their potential to empower Black service users in relation to their care. They suggest that explicit acknowledgement of, and time spent listening to, the historical and individual poor experiences that underlie the treatment preferences Black people express are important aspects of ACD creation.