This paper presents the first empirical data regarding the rates and predictors of using psychiatric advance directives. Directives were accessed in only 20% of crisis events for the 69 participants selected on the basis of frequent use of psychiatric emergency and hospital services. Directives were 10 times more likely to be accessed when a surrogate decision-maker was involved in the crisis event. Directives were also more likely to be accessed over time and for people who had repeated crises, fewer prior hospitalizations, no substance use, and no prior outpatient commitment orders. Creation of more directives to increase clinician and system familiarity and more consistent appointment of surrogate decision-makers could increase use of directives.
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