20 May 2022

The aim of an advance statement  is to provide a guide to anyone who might have to make decisions in your best interest if you have lost the ability to make or communicate decisions.

Black people (defined as people of Black African and Caribbean heritage, including those of mixed ethnicity) with mental illness are more likely to be detained under the Mental Health Act (MHA), than white people with mental illness. Using an advance statement can reduce use of the MHA but there are barriers to their implementation. For example, awareness of the opportunity to make an advance statement is low among service users; most service users want help to compete one; and service users worry about whether the statement will be accessible to staff when needed, and whether the content will be followed, while mental health professionals are concerned about the possibility of content they think should not be followed.

The benefits of advance statements, based on research evidence, including evidence from systematic reviews and meta-analysis, are that they can reduce use of the Mental Health Act, improve therapeutic alliance between service users with severe mental illness and community based mental health professionals, and empower service users in relation to the management of their mental illness.

Project aims

This project aims to co-produce, test and refine for dissemination an advance statements implementation resource for Black people previously detained under the Mental Health Act (MHA).  

The research team will use Quality Improvement methodology to produce a resource for use throughout the South London and Maudsley NHS Foundation Trust and beyond, that addresses identified implementation barriers and maximises Black people’s opportunities to have an advance statement.         

How the project will be carried out

Phase 1: stakeholder workshops

Phase 2: Consensus exercise followed by co-production workshops.

Phase 3. Pilot testing and refinement of the resource using PDSA cycles.

How service users and the public are involved in the study

A Lived Experience Advisory Group, chaired by Steve Gilbert OBE and Staff Advisory Group chaired by Prof Alan Simpson, King’s College London have been convened and are meeting throughout the project. These meetings are also attended by one or more of the research team in addition to the chairs.

Researchers are also working with local government, South London and Maudsley Trust and the police.

Potential benefits of the project

The project aims to initially benefit, Black people in Lambeth and Lewisham previously detained under the MHA. The implementation resource to be produced will then be available for use or adaptation for other people with severe mental illness who risk losing capacity when unwell, including: people in Lambeth and Lewisham; people in other boroughs serviced by SLaM; and people elsewhere in England and Wales i.e. where the new mental health legislation will allow for advance statement completion.

The resource will increase the likelihood that the new mental health legislation will be implemented properly and effectively, aligning evidence-based medicine, policy and the law to provide positive clinical, social and financial outcomes for Black people, the NHS and wider society. Strategies that support successful implementation of advance statements will enable better access and delivery of mental health services for Black people. This knowledge is likely to benefit a wider group of people with serious mental illness. This is because if the most marginalised groups, who are least engaged, can be supported with these strategies, then these strategies are likely to work for other people.  

This project is funded by the Maudsley Charity Covid-19 Strategic Response Fund. It was adopted by NIHR ARC South London in April 2022 and will be completed by February 2023.