Advance Choice Document Implementation

NCT07284368 | Enrolling By Invitation

• 2 other identifiers: R&D2025/0622946
• Study Type: observational
• Target: 374
• Locations: 1 country
• Sites: 1

Brief Summary

Advance Choice Documents (ACDs) are statements of preferences for mental health care and treatment made when service users have capacity to do so. This is done with their care team and others as desired, e.g. carers/supporters or advocates. In addition to improving therapeutic relationships, ACDs have been shown to reduce compulsory psychiatric admissions by 25%. South London and Maudsley is currently implementing ACDs into routine practice across its services and the Advance Choice Document Implementation (ACDI) project, run by researchers at King's College London, is supporting the development of related resources and the evaluation of the effectiveness of the implementation. Advisory groups will also guide the study approach throughout. The project comprises four work packages. Work Package 1 involves focus groups with stakeholders (service users, carers, staff) to inform implementation for Older Adults and CAMHS services. This is to understand the barriers and facilitators for ACD implementation in these services; and learn what adaptations are needed to the ACD resources and procedures for use in these services Work Package 2 is a prospective study of ACD completion and use throughout all directorates. This will comprise interviews with service users after ACD creation and after an event where the ACD is expected to have been used; interviews with their care-team during expected use events; and interviews/focus groups with staff facilitating the creation of ACDs to understand the integration of their role in SLaM. Work Package 3 is a retrospective study examining the impact of ACD creation on health service use and routinely collected outcomes. Work Package 4 is a prospective study of ACD use and its relationship to ACD content. Work Packages 3 and 4 will use de-identified data collected via South London an Maudsley's Clinical Records Interactive search System (CRIS). For more information on ACDI, the people involved, and related publications, please visit: https://www.kcl.ac.uk/research/acdi

Conditions

Detention Under the Mental Health Act

Keywords

Advance Statements; Advance Choice Documents; Psychiatric Advance Directives; Mental Health Act; Involuntary hospitalisation; Coercion; Detention rates

Outcome Measures

Primary Outcomes (1)

• Number of admissions under the Mental Health Act sections 2, 3, 135 and and associated bed days

  Mental Health Act sections Section 2, 3, 135 and 136 are a means to detain someone in a psychiatric facility, in England and Wales. Evaluation will be done over different follow-up periods and include participants admitted under all Sections of the Mental Health Act and associated bed-days, compared to number of participants admitted voluntarily (non-Mental Health Act) and associated bed-days.

  18 months

Secondary Outcomes (10)

• Number of Home Treatment Team events

  18 months

• Number of events of acute mental health and emergency service use

  18

• Rates of restraint

  18

• Number of days spent in seclusion

  18 months

• Number of events of involuntary medication

  18 months

Study Arms (1)

ACD holders

service users with a history of detention under the Mental Health Act that create Advance Choice Documents

Other: Advance Choice Document Implementation

Interventions

Advance Choice Document Implementation OTHER

Creation and application of Advance Choice Documents

ACD holders

Eligibility Criteria

• Age: 16 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

People with severe mental Illnesses

You may qualify if:

• WP1: Focus Groups Service users-Young people Aged ≥ 16 Experienced detention under the MHA while in the care of CAMHS Currently under the care of community mental health services (CAMHS / EI / CMHT)
• Older adults
• Experienced detention under the MHA while under services for Older Adults
• Currently under the care of older adult community mental health services
• Carers / Informal supporters Aged ≥ 16 years A relative or friend of a service user who is eligible for the study
• Professionals Professional potentially involved in supporting the completion of ACDs (i.e., community mental health team (CMHT) staff, advocates, peer workers) SLaM professionals potentially involved in referring to ACDs (i.e., inpatient and emergency department liaison mental health staff, home treatment, place of safety and street triage staff) Approved mental health professionals (AMHPs) and Section 12 (MHA) approved doctors involved in detention.
• Ambulance, prison mental health and Emergency Department staff General Practitioners, including mental health leads, or other primary care professionals who care for people with SMI discharged from secondary services
• WP 2: Prospective study of ACD completion and use Service users All service users: accepted referral to an ACD facilitator for ACD creation Young people
• Aged ≥ 16
• Experienced detention under the MHA while in the care of CAMHS
• Currently under the care of community mental health services (CAMHS / EI / CMHT/)
• Accepted referral to an ACD facilitator for ACD creation; including participants who decline to complete and ACD after referral to an ACD facilitator.
• Older adults
• Experienced detention under the MHA while under services for Older Adults
• Currently under the care of older adult community mental health services

You may not qualify if:

• Service users Aged under 16 years Lacking capacity to provide consent and/or is unwilling to do so Currently detained under the MHA in psychiatric hospital Currently under the care of eating disorder services
• Carers/informal supporters Aged under 16 years Is not a relative or friend of a service user who is eligible for the study
• Professionals Is not a mental health professional or Section 12 (MHA) approved doctor Is not a professional involved in supporting the completion of ACDs Is not a General Practitioner or mental health lead caring for people with SMI discharged from secondary services.

Sponsors & Collaborators

• King's College London: lead
• South London and Maudsley NHS Foundation Trust: collaborator

Study Sites (1)

South London and Maudsley/Institute of Psychiatry, Psychology, and Neuroscience-King's College London

London, SE5 8AZ, United Kingdom

Location

Related Links

• Related Info

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: OTHER
• Target Duration: 18 Months
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 13, 2025
• First Posted: December 16, 2025
• Study Start: September 29, 2025
• Primary Completion (Estimated): October 31, 2026
• Study Completion (Estimated): March 31, 2027
• Last Updated: December 16, 2025

Record last verified: 2025-10

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)