Thalamos has partnered with Kings College London to explore the feasibility and value of a digital version of an Advance Choice Document.
The research and development project, conducted collaboratively by Thalamos and Kings College London (KCL) and led by Professor Gareth Owen and Dr Lucy Stephenson, brought together existing academic research about Advance Choice Documents (ACDs) and exploratory work into the capability of a digital solution.
As part of the set of end results, which included contributions from subject matter experts such as Dr Shubulade Smith CBE and Professor Claire Henderson, a minimum viable product (MVP) has been generated to use in further implementation studies, which will validate the findings of the joint research.
ACDs support better patient outcomes, a core driver of Thalamos product innovation, in a number of ways – as outlined by the 2018 review of the Mental Health Act.
The research built upon existing work KCL had completed, which included lived experience contributions from a number of individuals – each of who spoke to the importance of ACD capability.
“It makes me feel a little bit more in control…if I’m going to go into a crisis, that I’ve got that sort of as a plan. It makes it a little bit less scary because hopefully my views will be the priority within services if I need support, in A&E or whatever it may be, in the future.”
Service users talking about the importance of their ACDs to them
“Not only will it beneficiate [the Service user] but it will also beneficiate [the Service user’s] environment, like [the Service user’s] family and I, what we will be aware what to do, what are the next steps that we need to follow, and what is the best way. And not only what to do, but as well what not to do.”
A family member talking about the importance of making an ACD to them
The Thalamos and KCL collaboration comes on the back of a joint parliamentary committee on the Mental Health Bill at the start of 2023 urging the government to put ACDs on a statutory footing. Their recommendations will enable all people with experience of detention under the Mental Health Act (MHA) to be supported to create an ACD, and for it to be digitally accessible.
The digital ACD MVP represents more than a digitised version of a paper document. It has been designed to support users through what can be a complex and emotionally profound process of creating preferences for times of crisis using a person’s own experience as a therapeutic intervention with their care team which can then help if required in the future. Furthermore, their creation can be integrated with electronic health records systems, ensuring communication of an individual’s preferences to all those involved in mental health care provision at key points in decision-making. Having a digitised version of ACDs will particularly support better care when patients present themselves in different geographical areas and at locations that won’t necessarily have on-site information about their preferred choices. By digitising and integrating, care professionals can be signposted to an existing ACD.
The Thalamos flagship eMHA software allows all stakeholders involved in care to complete their statutory MHA function and communicate across the organisations involved in care. Thalamos was named as preferred supplier for the Pan-London MHA Digitisation Programme in 2022. This programme, which will roll out across London in 2024 and 2025, will place software in the hands of all mental health professionals across London at the point of assessing a service user. If an ACD were to exist, this platform offers a digital option of surfacing an ACD at the exact point a person is assessed under the MHA providing a very practical opportunity to offer less restrictive methods to removing the person’s liberty at point of assessment.
Since this article was written, the new labour government announced a commitment to modernising the Mental Health Act with a new Mental Health Bill. The draft Mental Health Bill includes a commitment to Advance Choice Documents. Our Client Director gave her thoughts on the announcement in the Kings Speech.
