Mental Health Professionals' Positions in Relation to Advance Statements: A Foucauldian Discourse Analysis

Advance Statements enable mental health patients to have their preferences considered in treatment decisions in the event of losing capacity, but their uptake is poor. This is for complex and often conflicting reasons and factors related to service user, clinician, and institutional priorities, which influence clinical practice. A Foucauldian discourse analysis approach was used to explore how 13 mental health clinicians positioned their role in relation to Advance Statements. Five positions emerged from the data: taking account of peoples' wishes, enabling people to have their say (to a point), we know what's best, firefighting with risk, and leverage and liability. Discursive practices demonstrated and reinforced power relations between patients, clinicians, and wider systems. These findings highlight the challenge of legitimizing the knowledge of patients and need for a cultural shift at a systems level, which recognizes the ways Advance Statements meet the needs of all stakeholders.

Automated summary

The study found that mental health clinicians have five different positions on Advance Statements, ranging from considering people's wishes to believing they know the best course of action. Discursive practices demonstrate and reinforce power relations among patients, clinicians, and broader systems. These findings highlight the challenge of legitimizing patient knowledge and the need for a cultural shift in recognizing how Advance Statements meet the needs of all stakeholders at a systems level.