This symposium engages with advance directives in mental health. The context is twofold. Firstly, all panel members were involved in a co-produced research project at RMIT University – “Consumer/survivor thinking about mental health advance directives” – based on interviews with local consumer/survivors, thematic analysis and a review of the international consumer/survivor literature. Secondly, this project began just days before advance statements were introduced into Victorian law (Mental Health Act 2014, (Vic)) and discussion will include the relationship between advance directives and advance statements.

Wanda Bennetts: ‘Contradictions and complexities in advance directives’
The concept of advance directives is incredibly complex. Amongst other things, there is still no shared understanding of what they are, what they can include and what the process should be to create them. Adding to the complexity in the Victorian context is the new Mental Health Act, which acknowledges the concept in the form of advance statements.

This paper highlights inherent tensions and contradictions around advance directives, drawing on examples from the RMIT research project. Participant interviews for this research demonstrated several contradictions on both a personal level and a systems level which will be further unpacked.

This paper will not provide all the answers, but hopes to spark a deeper exploration and dialogue to inform future thinking and development of advance directives.

Merinda Epstein: ‘Who and what is missing from advance statements?’
The new Mental Health Act in Victoria brought with it several new initiatives including Advance Statements, a derivative of Advance Directives, recognised in law but questionable in capacity. This new interpretation of the idea of advance planning and protection for consumers has caused some confusion and there is a fuzziness around how they can be used and by whom. Perhaps the most serious problem remains that such a small percentage of people diagnosed with mental illness on Victoria have a legal right to use these documents at all. This paper draws on thinking that was nourished while working on Advance Directives at the Mental Health Legal Centre in the mid-2000s, elaborated upon over the decade since, and re-visited in the context of this recent research project.

Flick Grey: ‘The consumer/survivor literature on advance directives meets personal experience’
As a research assistant in the RMIT project, I delved into the rich world of consumer/survivor thinking about advance directives: this included wellness and crisis planning, Mad Maps, advance directives as a therapeutic tool, a personal recovery maintenance tool, “a tool to kind of try to sneak Open Dialogue in the back door”, a means to educate clinicians, a tool to systemically reduce coercion, seclusion, restraint and re-traumatisation, an alternative to involuntary treatment altogether and a weapon for individuals to maintain freedom from coercive psychiatric interventions. This presentation will tentatively map this irreducibly diverse terrain. A second thread is woven through – my own personal experience of hospitalisation for an emotional crisis midway through the research. As well-informed about advance statements (and advance directives) as I was, I did not have an advance statement (for complex reasons) nor were the circumstances such that the advance statement provisions under the Act applied. This talk thus explores the interplay between theory and practice, ideas and personal lived experience.

Neil Turton-Lane: ‘You can’t argue with a sick mind - a consumer perspective discussion on facilitating the creation of Advance Statements and other forms of advance planning support’
For many years, I have delivered peer-led training, in collaboration with other consumers, on the creation of advance statements and other related supports. This training has opened up conversations with scores of consumers. Drawing on this experience, and on engagement with the recent RMIT research project, this paper opens up thinking about how to best facilitate these processes.

Associate Professor Penny Weller: ‘Advance directives and positive rights’
A key contribution of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) is its recognition of ‘positive’ human rights. Positive human rights are those that impose a positive obligation on state parties to human rights conventions, such as Australia to take specific ‘positive’ action. For example article 12 Equal Recognition Before the Law includes a positive obligation for ‘support’ in decision making and a positive obligation to ensure that safeguards are in place with respect to the all measures that support legal capacity. Positive obligations also arise with respect to article 17 Protecting the Integrity of the Person and article 25 Health. The emphasis on positive rights in the CRPD invites a re-evaluation of psychiatric advance directives as tool for the promotion for positive rights.

This paper examines tension in the interviews between legal enforceability on the one hand, and the desire for flexibility on the other, arguing that both views are compatible with the CRPD because the overarching human rights principle is recognition of the needs, desires and aspirations of each individual.