Joint Crisis Plans: empowering service users with psychotic disorders


A recent nationwide audit (covered by the Mental Elf) reviewed what progress, if any, had occurred in the treatment of schizophrenia within the NHS since the last major audit in 2012. It transpires that in the two years since, progress has been slow at best, and overall satisfaction among service users has remained low.

One method likely to help remedy this is the encouragement of shared decision-making. Indeed, UK policy directives urge that service users be involved when decisions are made regarding their treatment (Department of Health, 2012). Despite such recommendations, clinicians continue to dominate mental healthcare decision-making (Goss et al., 2008). This may be in part because of clinicians’ doubts regarding the capacity of service users to make informed decisions about their care. Research has found that clinicians express concern that service users will make sub-optimal choices relative to good practice guidelines, or will refuse treatment altogether (Atkinson & Gilmour, 2004).

Advanced statements are a specific tool used to help facilitate shared decision-making (Henderson et al., 2008), wherein individuals with the capacity to do so can provide preferences regarding their care, in anticipation of a future relapse where they may be too unwell to indicate their treatment preferences. This can help reduce unnecessary stress associated with relapse, as well as allow the individual to retain a sense of control. This has obvious benefits in the context of a psychotic disorder like schizophrenia, an often chronic, episodic illness typified by feelings of a lack of control. Advanced statements can also help improve interactions between service users and clinicians by reducing conflicts of opinion.

Joint crisis plans (JCPs, Sutherby & Szmukler, 1998) are a type of advanced statement, and the only one that requires the clinical team to be involved. This way, clinicians can advise service users on any barriers that might occur in the implementation of their proposed care plan, assuaging clinicians’ aforementioned concerns regarding informed decision-making on the part of service users. An independent facilitator is also present to ensure that all opinions are heard, but that the final plan reflects the service user’s choice.

Is this done in the US/elsewhere?


Oh, advance medical directive. I used to have that for other purpose, but not for treatment of schizophrenia.


As far as I know, not in the US!**