What do service users want? A content analysis of what users may write in psychiatric advance directives in India Soumitra Pathare a, *, Laura Shields a,b,1 , Renuka Nardodkar a,2 , Lakshmi Narasimhan c,3 , Joske Bunders b,1 a Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune 411 004, India b Athena Institute, VU University Amsterdam, de Boelelaan 1085, 1081 HV Amsterdam, The Netherlands c The Banyan, 6th Main Road, Mugappair Eri Scheme, Mugappair West, Chennai 600037, Tamil Nadu, India 1. Introduction The United Nations Convention on the Rights of Persons with Disabilities (CRPD) has encouraged a shift from dominant models of guardianship to models of supported-decision making in a number of mental health laws worldwide. Central to the notion of supported decision making is Article 12 of the CRPD, which states that all persons with disabilities should be provided support, where needed, to exercise their legal capacity in all domains of civil, political and judicial life. This includes the right to make decisions about health care and treatment processes, and have them respected by professionals. Psychiatric Advance Directive (PAD) is one tool to facilitate supported decision-making. PADs are a tool for recording and implementing service user preferences in advance of periods of decisional incapacity throughout the course of mental illness (Campbell and Kisely, 2009; Henderson et al., 2008). PADs can either be instructional (e.g. specify treatment and personal decisions while in a period of decisional incapacity) or elect a nominated representative (proxy decision maker) to take decisions during this period of incapacity. Furthermore, preferences can be expressed and articulated independently or via facilitator (typi- cally a health worker or peer support worker). PADs can enhance dialogue between health care professionals, family members, and service users, improve treatment adherence and continuity of care, and reduce the likelihood of hospitalisation and coercive care (Elbogen et al., 2007; Jankovic et al., 2010; Srebnik et al., 2005; Swanson et al., 2006). Globally, although a sizeable evidence base exists on the benefits and barriers to PAD implementation and use (Henderson et al., 2008; Shields et al., 2014) we know very little about the content of PADs (Srebnik et al., 2005), with only two studies conducted in the US (Amering et al., 2005; Srebnik et al., 2005) and one study in India (Kumar et al., 2012) which detail the content of PADs. Understanding the information provided in PADs is important for anticipating future service user needs, as well as Asian Journal of Psychiatry xxx (2014) xxx–xxx * Corresponding author. Tel.: +91 9370 666 191. E-mail addresses: spathare@cmhlp.org (S. Pathare), l.s.shields@vu.nl (L. Shields), renuka@cmhlp.org (R. Nardodkar), Lakshmi.narasimhan@thebanyan.org (L. Narasimhan), j.g.f.bunders-aelen@vu.nl (J. Bunders). 1 Tel.: +31 20 5987 031. 2 Tel.: +91 9370 666 191. 3 Tel.: +91 9940175915. A R T I C L E I N F O Article history: Received 21 August 2014 Received in revised form 7 October 2014 Accepted 19 October 2014 Available online xxx Keywords: Psychiatric advance directive Care preferences India A B S T R A C T Although psychiatric advance directives give service users control over their care, very few studies exist on the content of PADs. This paper aims to contribute to this evidence base by presenting the content of psychiatric advance directives in India. Participants were 75 clients seeking outpatient care at a mental health services organisation in Tamil Nadu, India, who agreed to draft a PAD. Most clients were comfortable with appointing a representative (usually a family member) to make decisions on their behalf during a period of decisional incapacity or relapse, were willing to accept admission to the hospital/clinic and take medication if required, wanted to have a trusted person to discuss their mental health problems. No client used the opportunity to outright refuse treatment. This study highlights an important first step in improving the quality of mental health care by documenting user preferences for care in India. More in-depth research is needed to elicit rich descriptions of experiences of care and user-centred understanding of rights. ß 2014 Elsevier B.V. All rights reserved. G Model AJP-655; No. of Pages 5 Please cite this article in press as: Pathare, S., et al., What do service users want? A content analysis of what users may write in psychiatric advance directives in India. Asian J. Psychiatry (2014), http://dx.doi.org/10.1016/j.ajp.2014.10.006 Contents lists available at ScienceDirect Asian Journal of Psychiatry jo u rn al h om epag e: ww w.els evier.c o m/lo cat e/ajp http://dx.doi.org/10.1016/j.ajp.2014.10.006 1876-2018/ß 2014 Elsevier B.V. All rights reserved.