Opportunities and challenges of joint crisis plans in mental healthcare: a qualitative interview study with mental health professionals

Abstract Background: Psychiatric advance directives (PADs) and joint crisis plans (JCPs) are documents that allow users of mental health services to state their preferences for treatment for a future situation in which they are unable to give consent. In Germany, both PADs and JCPs are legally binding in the context of mental healthcare. Objectives: The objective of this study was to examine mental health professionals’ views on PADs and JCPs, identify challenges in their application in clinical practice, and derive recommendations for their implementation. Methods: We conducted semi-structured interviews with 14 mental health professionals with experience in JCPs in Germany. We analyzed the interviews following qualitative content analysis. Results: Participants identified several opportunities associated with JCPs, including strengthening the therapeutic relationship and building trust, promoting self-determination and participation, fostering therapeutic progress, reducing coercion, and enhancing the attitudes of mental health professionals. They also recognized a number of challenges, such as limited resources, insufficient knowledge and interest among service users, uncertainty and skepticism among mental health professionals, and the infrequent updating of JCPs. In addition, participants offered suggestions for improving the implementation of JCPs at both organizational and practical levels. Conclusions: Mental health professionals describe a variety of opportunities and challenges of JCPs in clinical practice. To address these challenges and enhance the implementation of JCPs, further research and targeted training for mental health professionals are needed, alongside the development of institution-specific policies.