Advance Statements in Scotland: What Student Nurses Need to Know

A patient is admitted to a mental health ward during a period of serious illness. They are too unwell to explain which treatments helped before, which side effects they found unbearable, or who they want involved in discussions.

An advance statement can help bring their earlier voice into the room.

In Scotland, advance statements have a specific legal meaning. They are not simply any note about future care, and they are not the same as an Advance Decision to Refuse Treatment used in England and Wales.

What Is an Advance Statement?

Under the Mental Health (Care and Treatment) (Scotland) Act 2003, an advance statement records how a person wishes to be treated, or not treated, for a mental disorder if their ability to make decisions about that treatment later becomes significantly impaired because of mental disorder.

It may describe:

• treatments that helped during a previous episode
• medicines the person would prefer or wish to avoid
• side effects that were particularly difficult
• approaches that help them feel safe
• treatments or environments they found distressing

The statement is made while the person is able to make these choices. It gives future clinicians important evidence about the person’s wishes at a time when they could express them clearly.

What Makes It Valid?

An advance statement must meet the requirements in the 2003 Act. It needs to be in writing and signed by the person making it.

It must also be witnessed by a prescribed person who confirms that the individual has the capacity to make the statement and is not acting under undue influence.

The person can later change or withdraw it, provided the legal requirements for doing so are met.

The Mental Welfare Commission for Scotland recommends reviewing an advance statement after an episode of illness or at least every three years, while the person has the capacity to do so. This helps make sure it still reflects what they want.

Is It Legally Binding?

An advance statement is not an absolute instruction that clinicians must follow in every circumstance.

The Mental Health Tribunal for Scotland and anyone giving treatment under the 2003 Act must have regard to it. That means it cannot simply be ignored, but it may be overridden when the legal requirements for treatment are met and the decision can be justified under the principles of the Act.

An advance statement also cannot force a clinician to provide a particular treatment. A preference for a medicine is important information, but it is not the same as a prescription or consent given at the time of treatment.

What Happens If It Is Overridden?

If treatment is given or authorised in conflict with an advance statement, the reasons must be recorded in writing.

The written record should be kept in the person’s case record and provided to the person who made the statement. Copies must also go to the relevant people specified by law, which may include the person’s named person, welfare attorney or guardian, and the Mental Welfare Commission.

The Commission advises that the explanation should be clear, individualised and written in a way the person can understand.

This safeguard matters. It makes the decision visible and accountable rather than allowing the person’s earlier wishes to disappear without explanation.

Where Is the Statement Kept?

Health boards must place an advance statement, or a document withdrawing one, with the person’s medical records. The Mental Welfare Commission must also be notified and maintains a register.

In practice, the exact way it appears in an electronic record can differ between NHS boards and services. A student should not assume that no statement exists simply because it is not visible on the first screen they open.

If the patient or someone involved in their care says there is an advance statement, tell the registered nurse and make sure the relevant clinical team checks.

Advance Statement, Personal Statement or Physical-Health Refusal?

These can sound similar, but they do different jobs.

A statutory Scottish advance statement under the 2003 Act concerns treatment for mental disorder when decision-making ability becomes significantly impaired because of mental disorder.

A personal statement may record wider matters such as caring responsibilities, pets, cultural needs, routines or the people the person trusts. It can be very useful, but it does not have the same legal status.

An advance refusal concerning physical healthcare is a separate issue. Scotland does not use the statutory Advance Decision to Refuse Treatment framework found in the Mental Capacity Act 2005 in England and Wales. Any physical-health advance refusal must therefore be checked under the law and policy that applies in Scotland rather than being treated as an English or Welsh document.

What Might This Look Like on Placement?

A patient with bipolar disorder is admitted during a manic episode. Their record contains a valid advance statement written while they were well.

It explains that one medicine previously caused severe side effects, identifies another treatment that helped, and asks for their sister to be involved in discussions where possible.

The statement does not decide the entire treatment plan. The responsible medical officer still has to assess the patient, consider current risks, apply the law and use clinical judgement.

But the statement gives the team something they would not otherwise have: the patient’s own account from a time when they were able to think through the decision.

The Student Nurse’s Role

You are not expected to decide whether an advance statement can be followed or overridden.

You can still help by:

• recognising the term when it appears in a care plan or handover
• checking that the registered nurse knows a statement may exist
• listening when the patient discusses their earlier wishes
• supporting the person to access independent advocacy
• documenting relevant conversations accurately within your role
• avoiding language that treats the statement as either meaningless or an automatic treatment order

People with a mental disorder have a right to access independent advocacy in Scotland, whether or not they are subject to compulsory measures. Advocacy can help someone understand their rights and express what matters to them.

The Bleepbook Takeaway

An advance statement lets the person speak from a time when they could make and explain the decision.

It must be taken seriously. It can be overridden, but not quietly. The reasons must be justified, written down and shared through the proper process.

For a student nurse, the safest approach is simple: notice it, tell the registered professional, listen to the patient’s wishes and follow the Scottish procedure used in your placement area.

References

Legislation.gov.uk. Mental Health (Care and Treatment) (Scotland) Act 2003.

Mental Welfare Commission for Scotland (2024). Advance statements.

Mental Welfare Commission for Scotland (2024). Supported decision-making: good practice.

Mental Welfare Commission for Scotland (2026). Consent to treatment.