Why Mental Health Clinicians are Not Engaging in Advance Care Planning with Older People with Schizophrenia and Other Psychotic Illnesses.

Purpose: To explore mental health clinicians' attitudes, experiences, and perceived barriers regarding Advance Care Planning (ACP) with older people (aged 55+) with schizophrenia/other psychotic illnesses. Methods: Qualitative analysis of focus group interviews with multidisciplinary mental health clinicians from public mental health services in Sydney, Australia. A senior external clinician facilitated online focus groups exploring clinicians' attitudes, experiences, and perceived barriers to ACP using a semi-structured interview guide. Transcripts were recorded and transcribed. N-VIVO was used to organise the data, which were subjected to reflexive thematic analysis grounded with an interpretive description framework. Results: Fifteen mental health clinicians were recruited. Two overarching themes emerged from thematic analysis of focus group transcripts: (1) It is important, and I want to do it: and (2) But I do not do it because of the complexity. Subthemes in relation to this complexity included: (i) fear of harming; (ii) families and culture; (iii) systemic barriers; (iv) capacity and legal issues; (v) timing; (vi) lack of knowledge and training; (vii) neither prioritised nor embedded in practice. Conclusion: These clinician-identified attitudes, experiences, and barriers to engagement in ACP with older people with psychotic illnesses highlight avenues of potential intervention to facilitate ACP in this cohort. Given the complexity of issues, clinicians need education and training in ACP combined with clear processes and policies to support practice. Clinician insights should be combined with the perspectives of older consumers with psychotic illnesses and their families to inform implementation of ACP.