摘要
A joint crisis plan is a written consensus-orientated agreement between mental health service users and professionals.The instrument is used to regulate a potential future hospital treatment.At the Clinics of Upper Bavaria(kbo-Kliniken des Bezirks Oberbayern)representatives of the clinics,the organized relatives and those affected developed the pilot project“Joint Crisis Plan”in a trialogical process.The pilot project was evaluated between 2015 and 2017.The qualitative study looked at the experiences with the implementation of the instrument medical treatment agreement in different local settings.In doing so it considered the complex effects of“advance directives”on various levels such as the subjective importance and meaning as experienced by the patients,the effects on face-to-face interactions between patients and the medical staff,and the effects on institutional structures.And it considered the local influence—such as medical cultures or economic and institutional conditions—on the implementation process and the use of this instrument.The results showed that patients need numerous competences to complete a joint crisis plan.Likewise the instrument affects self-efficacy and self-images of the patients and the relation between the patients and the clinical staff in a positive way.But if the joint crisis plan is insufficiently implemented,the instrument generates rather a mortification of the self.
