Bipolar UK’s Director of Research, Dr Tania Gergel answers some of your FAQs about Advance Choice Documents (ACDs).

There’s widespread international evidence showing a lack of awareness about ACDs among people living with mental health conditions. Also, the Bipolar UK community told us they are extremely enthusiastic about the idea of ACDs, but either didn’t know about them, and/or didn’t know how to create one.

That’s why Professor Sally Marlow and I led a research project and, in January 2024, established a website with short educational videos and helpful resources, including a downloadable sample template you can change to suit your needs.

Go to the Advance Choice website

What is an Advance Choice Document?

Advance Choice Documents give people living with severe and recurring mental illnesses, such as bipolar, a chance to state their wishes and instructions and guide healthcare professionals about future treatment and care if people become severely unwell again.

They give you the chance to make your voice heard in mental healthcare decisions during future periods of severe illness, by using knowledge you’ve gained (‘expertise through experience’) through past experiences of illness and healthcare.

Does an ACD need to be an official document?

No. An ACD can take many forms and does not have to be an ‘official’ document. It could be handwritten, recorded as voice notes or memos, or typed up and saved.

What are the benefits of having an ACD?

The idea behind an ACD is that you use your past to plan your future.

You are the expert of your own circumstances. Having an ACD means that your voice when you are well is heard in episodes of unwellness, explaining what the best course of treatment is for you.

Also, by highlighting the signs that may appear when you are first becoming unwell, it allows your family, friends, and healthcare professional to help detect when this may be happening. This can help to stop and give you time to address the issues, with the aim of reducing the risk of harm which may happen when you’re severely unwell, and even preventing the need for sectioning or detention.

ACDs can help to ensure you get timely treatment, can help you to keep safe while you’re unwell and can, hopefully, reduce excessive use of force and involuntary treatment. In fact, as stated in an article in The Guardian, research suggests that the use of ACDs can reduce compulsory detention rates in psychiatric units, often known as sectioning, by 25%, minimising traumatic experiences for people with bipolar, schizophrenia and other psychotic illnesses.

They can also be particularly helpful to reduce some of the inequalities facing people from minoritised racial and ethnic groups.

In the same article, I talk about research and policy surrounding ACDs, and about my own experience of using ACDs to manage bipolar and how, for me, ACDs have been life-saving.

How do I create an ACD?

You can write an ACD by yourself, with family, friends or those you trust, or with a healthcare professional.

Don’t write your ACD while you are still severely unwell – wait until you are feeling well enough and stable to be able to think about previous illness and make future plans. Once it is done, you can update it at any time.

It’s important to tell your family, friends and/or healthcare professional where it is stored, so they can help to ensure that if you become unwell again, the team who treat you is aware that you have an ACD.

Ideally your ACD is stored in your healthcare professional’s notes so other healthcare professionals can see it if you need care.

I have a lot of other questions – where can I find out more?

The website www.advancechoice.org is an online resource that hosts several explanatory videos, alongside educational information, designed to explain the ‘what’, ‘how’ and ‘why’ behind Advance Choice Documents.

This website and videos have been created by a team led by people with lived experience, including researchers and health professionals, as part of a research project partnered with Bipolar UK.

Topics the website covers are:

• How can Advance Choice Documents help? 
• Planning: Who should help you with drafting an Advance Choice Document, and when should you write it? 
• What do include about healthcare 
• Minoritized racial and ethnic groups 
• Perinatal: pregnancy or after birth 
• For older adults 
• Self-binding' directives: What do we mean by them and when might one be appropriate?

You can also find out more by watching the panel discussion Bipolar UK hosted as part of their World Bipolar Week conference in March 2024: ‘Can Advance Choice Documents save bipolar lives?’

 Watch the webinar

Why are ACDs being talked about now?

We know that ACDs can help, but that either both people living with mental illness and healthcare professionals don’t know about ACDs in the first place, or they don’t know how to create and use them.

After the recent Independent Review of the English & Welsh Mental Health Act in 2018, the government came out in support of incorporating Advance Choice Documents, saying that these ‘give individuals the opportunity to record a range of choices and statements about their care and treatment in preparation for a future situation in which they are too unwell to express these decisions themselves.’

The website advancechoice.org has been designed to offer a way for those living with severe mental illness to start to be able to express these choices. 

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Last updated: 24 April 2024