The implementation of psychiatric advance directives: experiences from a Dutch crisis card initiative.

OBJECTIVE The crisis card is a specific form of psychiatric advance directive, documenting mental clients' treatment preferences in advance of a potential psychiatric crisis. In this paper, we aim to provide insight into implementation issues surrounding the crisis card. METHOD A Dutch crisis-card project formed the scope of this study. Data were collected through interviews with 15 participants from six stakeholder groups. RESULTS Identified implementation issues are: (a) The role of the crisis-card counselor, (b) lack of distribution and familiarity, (c) care professionals' routines, and (d) client readiness. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The crisis-card counselor appears to play a key role in fostering benefits of the crisis card by supporting clients' perspectives. More structural integration of the crisis card in care processes may enhance its impact, but should be carefully explored.