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Psych MEQs / SAQsProfessional practice — advocacy

Psych MEQs / SAQs · Professional practice — advocacy

Advocacy, advance planning and the peer workforce (MEQ)

FRANZCP-style modified essay on advocacy at three levels: individual advocacy and advance planning, the evidence for psychiatric advance directives and joint crisis plans, carer confidentiality, and co-production versus tokenism. FRANZCP W01-primary, globally tagged.

20 marks20 min2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Study tools

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the consultant in a community mental health service. A 34-year-old man with schizophrenia and two previous involuntary admissions asks you to (i) write to his housing provider supporting his tenancy, and (ii) ensure that a one-page crisis plan he wrote while well is honoured next time he becomes unwell. His sister, who is his main support, telephones you separately for information; he has not consented to disclosure. Your service is also drafting a new model of care and the executive has asked for a consumer representative to join the final sign-off meeting. (i) Outline your approach to his two requests. (ii) Describe the evidence for advance planning in reducing coercion. (iii) State your response to the sister. (iv) Advise the executive on genuine co-production.
What the marker is looking for

Three levels named (individual, service, system), advance planning evidence quoted honestly (Tinland positive with peer facilitation; CRIMSON null), carer confidentiality handled correctly (receive freely, disclose nothing specific), and co-production distinguished from consultation by power, pay and timing.[4][6][8][16]

(i) His two requests — 6 marks

The housing letter. Write what is clinically true and useful: diagnosis only with consent, functional impact, treatment engagement, and what stable housing does for his outcomes. Do not diagnose the landlord, do not editorialise, and give him a copy.[12]

The crisis plan. Convert it into a real advance statement: written in remission, specific about what helps and what harms, contact preferences named, and — critically — embedded in the record where the on-call clinician will find it at 3am.[5][7]

Offer facilitation rather than paperwork; facilitation is what makes these documents exist at all.[5]

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References20ShowHide
  1. [1]Lloyd-Evans B, et al. A systematic review and meta-analysis of randomised controlled trials of peer support for people with severe mental illness BMC Psychiatry, 2014.PMID 24528545
  2. [2]Cooper RE, et al. The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review BMC Med, 2024.PMID 38418998
  3. [3]Gillard S, et al. Implementing peer support into practice in mental health services: a qualitative comparative case study BMC Health Serv Res, 2024.PMID 39261915
  4. [4]Tinland A, et al. Effect of Psychiatric Advance Directives Facilitated by Peer Workers on Compulsory Admission Among People With Mental Illness: A Randomized Clinical Trial JAMA Psychiatry, 2022.PMID 35662314
  5. [5]Swanson JW, et al. Facilitated psychiatric advance directives: a randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness Am J Psychiatry, 2006.PMID 17074946
  6. [6]Thornicroft G, et al. Clinical outcomes of Joint Crisis Plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial Lancet, 2013.PMID 23537606
  7. [7]Henderson C, et al. Informed, advance refusals of treatment by people with severe mental illness in a randomised controlled trial of joint crisis plans: demand, content and correlates BMC Psychiatry, 2017.PMID 29178895
  8. [8]Farrelly S, et al. What service users with psychotic disorders want in a mental health crisis or relapse: thematic analysis of joint crisis plans Soc Psychiatry Psychiatr Epidemiol, 2014.PMID 24691492
  9. [9]Szmukler G, et al. The UN Convention on the Rights of Persons with Disabilities: 'Rights, will and preferences' in relation to mental health disabilities Int J Law Psychiatry, 2017.PMID 28647294
  10. [10]Hoffman SJ, et al. Is the UN Convention on the Rights of Persons with Disabilities Impacting Mental Health Laws and Policies in High-Income Countries? A Case Study of Implementation in Canada BMC Int Health Hum Rights, 2016.PMID 27836014
  11. [11]Craigie J, et al. Legal capacity, mental capacity and supported decision-making: Report from a panel event Int J Law Psychiatry, 2019.PMID 30389184
  12. [12]Galderisi S, et al. Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs World Psychiatry, 2024.PMID 39279422
  13. [13]Rodolico A, et al. Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis Lancet Psychiatry, 2022.PMID 35093198
  14. [14]Bøgh Jacobsen N, et al. Caregiver burden among relatives of individuals with severe mental illness: a qualitative systematic review Nord J Psychiatry, 2026.PMID 42312619
  15. [15]Sreeram A, et al. Anti-stigma initiatives for mental health professionals-A systematic literature review J Psychiatr Ment Health Nurs, 2022.PMID 35500153
  16. [16]Hopkins I, et al. What Do We Know About Sharing Power in Co-Production in Mental Health Research? A Systematic Review and Thematic Synthesis Health Expect, 2024.PMID 39235102
  17. [17]Åkerblom KB, et al. Peer Workers in Co-production and Co-creation in Mental Health and Substance Use Services: A Scoping Review Adm Policy Ment Health, 2023.PMID 36396756
  18. [18]Sashidharan SP, et al. Reducing coercion in mental healthcare Epidemiol Psychiatr Sci, 2019.PMID 31284895
  19. [19]Giacco D, et al. Interventions for involuntary psychiatric inpatients: A systematic review Eur Psychiatry, 2018.PMID 30118918
  20. [20]Stacey D, et al. Decision aids for people facing health treatment or screening decisions Cochrane Database Syst Rev, 2024.PMID 38284415
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