Implementing an Advance Choice Documents resource for Black African and Caribbean people with experience of compulsory psychiatric admission

Background: Advance Choice Documents (ACDs) have been recommended for use in England and Wales based on evidence from trials that show that they can reduce involuntary hospitalisation, which disproportionately affects Black African and Caribbean people. Our aim was therefore to develop and implement an ACD resource for Black people who have previously been involuntarily hospitalised and the people that support them. Methods: Resource co-production workshops were held to inform the development of the ACD template and two types of training for all stakeholders, comprising a Recovery College course and simulation training. An ACD facilitator developed ACDs with service users and mental health staff over a series of meetings. Interviews with service user and staff participants were conducted after ACD completion and analysed to document their experience of the process and opinions on ACDs. Other implementation strategies were also employed alongside to support and optimise the development of ACDs. Results: Nine ACDs were completed and were largely reported as appropriate, acceptable, and feasible to staff and service users. Both reported it being an empowering process that encouraged hope for better future treatment and therefore better wellbeing. Uncertainty was also expressed about the confidence people had that ACDs would be adhered to/honoured, primarily due to staff workload. The information provision training and the skills training were generally considered to be informative by attendees. Conclusions: The project has developed an ACD development resource that was reported as agreeable to all stakeholders; however, the generalisability of the findings is limited due to the small sample size. The project also highlights the importance of staff and ACD facilitator capacity and good therapeutic relationships in ACD completion. Further research is needed to determine the adjustments needed for large scale use, including for those under age 18 and those under the care of forensic mental health services; and how to include carers/supporters more in the process. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study is funded by Maudsley Charity. ACD films funded by Health Education England. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethnics Committee of Bradford Leeds National Health Service Research Authority have ethical approval for this work (REC reference number: 22/YH/0012) on 07/02/2022. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes ACD resources are available on request from CH at claire.1.henderson@kcl.ac.uk Quantitative data are available on reasonable request; however, qualitative data and ACD content are not due to risk of reidentification.