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Introducing MAPS

In the first of our resources series, we introduce the purpose of MAPS and what they may contain. We create this resource as a result of a series of discussion with people in the community who have lived experience of mental distress and/or support people who may have used mental health services before. You can read more about our research by following the article links below or getting in touch with us a contact@mapmymentalhealth.com.

What is a MAP?


A Mental-health Advance Preferences Statement (MAPS) is a way to let people know what you would like to have happen if you experience an episode of mental distress. It can give you a voice when you might not normally be heard because you are too unwell or not in a position to be able to speak for yourself.

Sometimes MAPS are referred to ‘advance directives’ in Aotearoa.

Why have a MAPS?


MAPS can let your care team know about things important to you and that you believe will help in your recovery. While MAPS does not override the powers to treat provided by the Mental Health Act, or the rules about privacy of health information under the Privacy Act, you generally have the right to be provided with care that takes into account your specific needs, values and beliefs, and your MAPS is a good way of making sure your treatment team knows what these are.

Your MAPS can be used in any situation where you do not feel able to speak for yourself regarding your mental health care treatment.

How are MAPS created?

We invite you to take the opportunity to prepare a MAPS with the support of a person you trust. This support person needs to knows you well enough to confirm that you are making this MAPS voluntarily and that the information it contains reflects what you wish to say to your treatment team.

While it is not required, we encourage you to discuss your MAPS with your clinical team and with family/whānau after you have completed it, so they are aware of your preferences before a crisis occurs.

See our MAPS templates
A map guide for things to think about when creating MAPS
Download MAPS diagram

What can be included in a MAPS?

Our diagram above gives you some ideas that you might want to think about when writing your MAP. You can include statements regarding any or all of the items we suggest or add other ones you think are important to you.

The MAP adds to your existing medical records, so it is not necessary to use it to explain your entire mental health history. It is also important for you to realise that it is not a substitute for an assessment by a healthcare professional but another tool for you and your team to use to understand how you, as an individual, would benefit most from the treatment options available.

Remember this is your personal MAPS

Your MAPS is not a fixed document. Your ideas about what works for you, or who you want to have involved in your care, can change. For the MAPS to be most effective, it should be reviewed and updated regularly (e.g. every 18-24 months), again with the support of with someone you trust. We would also recommend revisiting your MAPS after a crisis – once you feel able to do so.

What happens with completed MAPS?

Your MAPS will become a part of your medical records, but only people who are involved in your care will have access to it. The information in your MAPS will be available to the staff of mental health services.

We recommend you keep one copy for yourself and give copies to other people you believe would be helpful (such as a family/whānau member or support person). If you need to have copies provided, we can help with that.

Download or print this MAP guide

Who looks at my MAP?

A step by step guide to what happens with your MAP once it is submitted to Southern DHB.

When you create a MAP via the Southern Health website

1. Client’s MAP is created online (via the SouthernHealth website)

2. Southern DHB Mental Health IT person then downloads and formats the MAP

3. Consumer Advisor then contacts the client to verify MAP contains their preferences

4. Mental Health IT person uploads MAP to HCS and puts alert on iPM

5. Mental Health clinician accesses MAP when client access crisis service or is admitted

When you create a MAP with your keyworker or other clinician at Southern DHB

1. Mental Health IT person uploads MAP to HCS and puts alert on iPM

OR

1.Key worker or team admin uploads MAP to HCS and puts alert on iPM

2. Mental Health clinician accesses MAP when client access crisis service or is admitted

How to upload a MAP?

A guide submitting a MAP at Southern DHB

Be sure to also refer to the MHAID HCS uploading guide on iLearn, which you can access here:

guide on ilearn

1. Complete MAP with your client, ensuring that it has been signed

2. Scan the document and name it according to the HCS uploading guidelines

3. Save the file into the ‘Care – Treatment – Plans – MAPS – MDT’ upload folder for your team

4. Add and alert on iPM to say that a MAP exists:

  • Open iPM, find patient, select alerts and add alert
  • Category: Advanced directives
  • Alert: MH Care Preferences
  • Text: “Please access MAP on HCS and follow preferences as indicated”

5. Email Amelia ameliajane.needs@southerndhb.govt.nz) with the client’s NHI and which iPM you have put the alert on. Amelia will add the alert to the other iPM

FAQs for consumers

Wondering what MAPS are and how they might help you in times of mental distress? Thinking about how you can create one and what a MAPS might contain? Check out our FAQs and get in touch if you have any questions.

What is a Mental-health Advance Preferences statement (MAPS)?

It is a way for you to let people know what you would like to have happen if you experience an episode of mental distress. A MAPS is a way for you to have a voice when you might not normally be heard because you are too unwell or not in a position to be able to speak for yourself.

Why should I have a MAPS?

This is a good way to make sure you have a say in decisions about your care. It can include information about a variety of things that are important to you.

What should I include in my MAPS?

It should include the things you believe are most important to you in helping you in your recovery. This could be anything from the kind of treatments you feel work best for you, to people you want to have involved in your care, to things about your personal life that you want to make sure get taken care of. The last page of the MAPS document has a list of suggestions of things you might want to include, but these are just helpful prompts and you may not wish to include some, or any, of the items suggested.

Do I need a lawyer to make a MAPS?

No, you can write one by yourself, but it would be best if you write one with help from someone you trust who you feel understands your situation and might be able to talk you through some options. Just remember, a MAPS is about what you want, and what you feel is best for you.

Can anyone help me write my MAPS?

Yes. It could be a support person, or a family member, or your PDN, if you believe that that person knows you best. While you do not need to write the MAPS together with your clinical team, once you have made a MAPS, we would encourage you to discuss it with your clinical team, so they are aware of your preferences before a crisis occurs.

Does my MAPS have to be in a specific form?

No. But we would suggest you follow the form we have given you. You don’t need to fill out everything that is suggested, and you can add any other things that you think are important. It is best if your MAPS is in writing, and you sign and date it. You should also have someone who knows you well sign it to confirm that you understand what choices you are making and are well enough to make these choices at the time you are writing it (such as your mental health support worker).

Can I do my MAPS online?

Yes, if you live within the Southern District Health Board region, you can complete we have a web-based form at http://www.southerndhb.govt.nz/pages/mental-health-advance-preferencesadvance-directives that is submitted directly this district health board.

If you live outside this region, you can download our MAPS template to print, complete and take to your local mental health service. Support for MAPS is growing across Aotearoa and we update new supporters as soon as we can on here.

Download our MAPS template

I don’t have access to a computer? Does this mean I can’t make a MAPS?

No. You can fill out a paper copy with your support person and then give the hard copy to your mental health team and they will scan it into the electronic file. You can then ask to see a copy of what was entered online to make sure that it says everything you wanted it to say.

Who should have a copy of my MAPS?

There will be a note on your medical records to say you have a MAPS. We would suggest that you also keep a paper copy for yourself and give copies to other people you believe would be helpful (such as a family member, a support person, or clinician). If you need to have copies provided, we can help you with that.

How will people know that I have a MAPS?

After you have written a MAPS, it will become part of your electronic medical files. If a doctor or member of your treatment team looks at your notes, they will see a flag telling them you have a MAPS. You may also want to keep a copy of your MAPS where you can find it easily, and give a copy to your whānau, family or support person, and ask them to make sure your clinical care team knows you have a MAPS.

Does my MAPS have to be followed?

No, not always. When deciding whether or not to follow your MAPS, you clinician will need to decide whether you were able to understand what you were asking for when you wrote the MAPS, whether your choices were really yours, and not someone else telling you what to write, whether the choices you made apply to the present situation, and whether or not things have changed so much since you wrote the MAPS that it no longer makes sense. Even if your treatment team does not follow some of your preferences, they should review it and take it into consideration when making decisions regarding your treatment.

What if I change my mind about what I want in my MAPS?

You can make any changes you want when you are well enough to make decisions. We would recommend you review your MAPS with your care team regularly and update it to reflect any changes that might occur.

How do I make change in my MAPS?

Talk to your clinical care team or peer support counsellor. They will help you make the changes to your MAPS and make sure it gets added to your electronic file.

What if I change my mind about treatment preferences when I am unwell?

It depends how unwell you are, and how much it affects your ability to understand your treatment needs. As long as you currently understand the issues regarding your treatment, and you have the right to change your mind and ask for something that is not in your MAPS, or that goes against what you had in your MAPS. However, if you are under the Mental Health (Compulsory Assessment and Treatment) Act, your current wishes might be overridden by the treatment team.

How long in my MAP good for?

There is no specific time-frame, but it should be current enough that people will see that it applies to you now. We suggest that you review your MAPS every 18 months to two years, or after any major life changes (such as starting a new relationship, having children, or the death of someone close to you).

What can I do if my MAPS is not followed, and I think it should have been?

First, talk about this with someone you trust who understands the issues, such as a peer support counsellor or your clinician. If you still believe that your preferences should have been followed, you can complain to the Health and Disability Commissioner

FAQs for service providers

What is a MAPS?

A Mental-health Advance Preferences Statement (MAPS) is a document that allows consumers to have a voice when their voice may not be heard because they were too unwell or not in a position to be able to speak for themselves.

A MAPS is a statement made when a person is well and focuses on what they would like to have happen in the future when a situation arises where they need treatment or help from others. It is similar to an advance directive, but our research has shown that people are less intimidated by the concept of a statement of preferences.

The Code of Health and Disability Services Consumers’ Rights (the Code) specifically gives all consumers the right to use an advance directive, except where any other enactment, the common law, or another provision of the Code provides otherwise. MAPS are not legally binding, in that they do not take precedence over decisions made under the Mental Health (Compulsory Assessment and Treatment) Act.

Why should a consumer have a MAPS?

MAPS are a means of increasing consumer participation in their own care and enabling their views and preferences to be heard. Consumer engagement is well documented as an important step in facilitating mental health recovery. MAPS can inform and guide the treatment team when a consumer is in a mental health crisis, offering a perspective that may not be readily available from clinical notes or current presentation. Even when a consumer is not competent to give informed consent, service providers have an obligation under the Code to take reasonable steps to ascertain what the consumer’s views are regarding their treatment (Right 7). This includes when the consumer is subject to the Mental Health (Compulsory Assessment and Treatment) Act. A MAPS can be an invaluable tool in this regard.

What should a consumer include in their MAPS?

There are no absolutes as to what to include in a MAPS – the key is that the MAPS is personal to the consumer. It should include the preferences that are important to the consumer and relevant for their recovery. It is very important that there is no coercion in the drafting of the MAPS, for instance, from family/whānau, or the clinical team. For some consumers, it may be very important that the MAPS includes:

  • Preferences regarding certain medications;
  • Treatments that have worked in the past;
  • People they wish to have involved in their care or those they would prefer not to have included;
  • People they may like to have notified in case of a hospitalisation, or those they would rather not have visit.

The MAPS may also include information about things not directly related to their mental health treatment, but which may be important to them for their peace of mind, including information about dependents, pets, care of their property, etc. They may also wish to include information about their cultural, religious, or dietary preferences.

What form should a MAPS take?

While there is no legally prescribed form that a MAPS must take to be considered valid, we have developed a template that is currently being used at Southern DHB. This does not mean that everything that is included in the template must be completed, nor does it mean that other things cannot be included if the consumer feels they are important.

View our template

Ideally, the MAPS should be in writing, signed and dated by the consumer, and countersigned by someone who knows the consumer well enough to confirm that the information provided is what the consumer wants.

Even if a MAPS does not meet these criteria, it should be accepted as a valid reflection of the person’s preferences, and every effort should be made to follow these preferences as far as practicable or used as a guide to negotiating options available for their mental health care.

Do consumers need to have a lawyer to create a MAPS?


No, consumers have the right to make a MAPS without involving anyone else in its preparation. However, we strongly suggest consumers consult with someone they trust who understands their situation and might be able to discuss the options with the consumer. This could be a peer support worker, or someone independent of the clinical team who can help ensure that the consumer is making informed choices in the preferences they express. We would then encourage the consumer to discuss their MAPS with their clinical team so they are aware of its content before a crisis situation arises.

How do I know if a person has the capacity to make a MAPS?

Under Right 7(2) of the Code, every consumer must be presumed competent to make an informed choice and give informed consent, unless there are reasonable grounds for believing the consumer is not competent. It cannot be presumed that a person lacks capacity to make a MAPS simply because they are unwell or under the Mental Health (Compulsory Assessment and Treatment) Act at the time. The question that must be asked is do they have the degree of understanding about what creating a MAPS entails?

How can I tell if a MAP is valid?


Validity should be presumed if the MAPS has been properly completed (e.g. signed and dated), witnessed and/or signed off by a responsible (independent) party, until evidence demonstrates the contrary. It is important that the MAPS be taken as a whole – do not assume on the basis of one or two stated preferences that appear to be “unreasonable” or out of the ordinary that the person was not competent and the MAPS is therefore not valid.

While there is no statutory time limit on how long a MAPS is valid, it is reasonable to consider whether life circumstances have changed significantly since the MAPS was drafted. If so, then care should be taken to try and ascertain whether those changes might mean that if the MAPS were to be drafted today, it would be different. We are recommending that consumers be encouraged to revisit their MAPS every 18-24 months to consider whether any changes should be made.

Even if a MAPS was valid when it was drafted, it can cease to be valid in certain circumstances. These could include:

  • The MAPS was revoked when the consumer was competent to do so;
  • The consumer made the MAPS under coercion;
  • The MAPS is not sufficiently clear to cover the current situation;
  • The MAPS does not pertain to the current situation.

If the MAPS is valid, do I have to follow it?

No, not in all circumstances. Even if a MAPS is valid, it is possible that it does not pertain to the current situation. For example, a consumer might state that they do not want any antipsychotic medication, but since the MAPS was written, a new product has become available. Alternatively, if a patient is under the Mental Health (Compulsory Assessment and Treatment) Act and is subject to a compulsory treatment order, the MAPS would not take precedence, at least in so far as the MAPS applies to decisions regarding treatment of the mental disorder that is the grounds for compulsory treatment.

However, this does not mean that other parts of the MAPS could be ignored. The Code requires that consumers are treated with respect, which includes listening to and following the individual’s preferences as much as possible. Under Right 4 of the Code, every consumer has the right to services that minimise potential harm and optimise their quality of life. In addition, the Code requires that services are provided in a manner consistent with the consumer’s needs. As far as possible, service providers have an obligation to ensure that a valid MAP is adhered to.

What if a consumer changes their mind and tells me not to follow what is in their MAPS?

The MAPS is about preferences, and preferences can change. As long as the consumer is competent to make such decisions, they retain complete control over what is in their MAPS and can change it at any time. Any choices they make regarding their treatment will be considered valid, even if those choices directly contradict what was previously stated in their MAPS.

What if a consumer changes their mind about treatment preferences when they are unwell?


It depends how unwell they are at the time, and how this affects their understanding of their treatment needs. If the consumer understands the issues regarding their treatment, they have the right to make the decision and depart from their earlier stated preference. If you do not believe they are competent, then you have an obligation to try and ascertain what their views would have been – and their previous MAPS might be useful in this regard.

Want to read more about our research?

View our library with links to the latest published articles

Our library

  • Lenagh-Glue, J., Potiki, J., O’Brien, A., Dawson, J., Thom, K., Casey, H, & Glue, P. (2020). Help and Hinderances to Completion of Psychiatric Advance Directives. Psychiatric Services. In press.

  • Lenagh-Glue, J., Thom, K., O’Brien, A., Potiki, J., Casey, H., Dawson, J., & Glue, P. (2020). The content of Mental Health Advance Preference statements (MAPs): An assessment of completed advance directives in one New Zealand health board. International Journal of Law and Psychiatry, 68, 101537.

  • ​Thom, K., Lenagh‐Glue, J., O’Brien, A. J., Potiki, J., Casey, H., Dawson, J., & Glue, P. (2019). Service user, whānau and peer support workers’ perceptions of advance directives for mental health. International Journal of Mental Health Nursing, 28(6), 1296-1305.

  • ​Lenagh-Glue, J., O’Brien, A., Dawson, J., Thom, K., Potiki, J., Casey, H., & Glue, P. (2018). A MAP to mental health: The process of creating a collaborative advance preferences instrument. The New Zealand Medical Journal, 131(1486), 18-26.

  • Thom, K., O’Brien, A. J., & Tellez, J. J. (2015). Service user and clinical perspectives of psychiatric advance directives in New Zealand. International journal of mental health nursing, 24(6), 554-560.

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