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Adm Policy Ment Health. 2013 May;40(3):232-9. doi: 10.1007/s10488-011-0401-9.

A survey of stakeholder knowledge, experience, and opinions of advance directives for mental health in Virginia.

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Services Effectiveness Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 905 West Main Street, Box 54, Durham, NC, 27701, USA.


An innovative Virginia health care law enables competent adults with serious mental illness to plan for treatment during incapacitating crises using an integrated advance directive with no legal distinction between psychiatric or other causes of decisional incapacity. This article reports results of a survey of 460 individuals in five stakeholder groups during the initial period of the law's implementation. All respondents held favorable views of advance directives for mental health care. Identified barriers to completing and using advance directives varied by group. We conclude that relevant stakeholders support implementation of advance directives for mental health, but level of baseline knowledge and perception of barriers vary. A multi-pronged approach will be needed to achieve successful implementation of advance directives for mental health.

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