A psychiatric advance directive (PAD) is a legal tool that allows a person with mental illness to document their preferences for treatment before a point of crisis. Psychiatric advance directives protect a person’s autonomy and ability to self-direct care and can also enable the appointment of a health proxy, specifically focused on mental health.
While psychiatric advance directives have been around for years, many individuals with mental illness, their caregivers, and other health professionals are often unaware that these exist as important planning tools and how to use them. CaringInfo is here to help you learn more about PADs.
Who needs a psychiatric advance directive?
If you or those caring for you are concerned that you may receive care that you don’t want, or will not receive that care that you do want, during a mental health crisis, then a psychiatric advance directive – also called a mental health advance directive – is very useful. You can (and should) appoint a mental health power of attorney using the psychiatric advance directive. By empowering this person and letting them know what you want and don’t want, you have enabled someone to speak for you when you can’t.
Psychiatric or mental health advance directives enable a person to identify treatments specific to their mental issues, for example:
- specifying a provider or an institution,
- detailing what works best if the person is in crisis
- identifying certain beneficial medications, and
- identifying medications that should not be administered.
The forms are similar to living wills and other advance care planning documents.
Standard advance directives have blank spaces that can be tailored to specific circumstances, but most psychiatric advance directives (PAD) are organized to clarify issues concerning the mental health circumstance. This makes them very valuable for anyone wanting to identify specific mental health and mental illness care wishes.
What are the benefits of completing a psychiatric advance directive?
There are numerous benefits to completing a PAD, with the most important one being that it enables proper care and may prevent involuntary treatment. Another benefit is appointing a power of attorney for mental health who is empowered to speak on your behalf.
Individuals can share their psychiatric advance directives with their local hospitals, providers, and police departments, so their preference for care is clear and easy to prioritize. When family members and friends are kept up-to-date on their loved one’s wishes, they can be better advocates for them.
People who complete this specific type of advance directive are more likely to work collaboratively with their clinicians, experience fewer coercive crisis interventions, and feel that their personal needs for mental health services are being met.
When psychiatric advance directives are used correctly, medical providers, local hospitals, police departments and caregivers can provide care that is aligned with an individual’s preference.
Powers of attorney and psychiatric advance directives
Psychiatric advance directives, like all advance directives, ask you to appoint someone to speak on your behalf when you are unable to. If you complete both a standard and a psychiatric advance directive, you should be sure that the same person or persons are granted your power of attorney so there is no confusion.
Just remember that psychiatric advance directives power of attorney and standard health care power of attorney are the same thing: a way to have someone empowered to speak with your doctors about your health and convey your wishes. Learn more about power of attorney and caregiving.
When should a psychiatric advance directive be completed?
Psychiatric advance directives are drafted when a person is well enough to consider preferences for future mental health treatment.
When is a psychiatric advance directive effective?
Psychiatric advance directives are used when a person becomes unable to make decisions for themselves due to a mental health crisis.
For more information on psychiatric advance directives
The Substance Abuse and Mental Health Administration (SAMHSA) has prepared a downloadable pdf with detailed information. In addition, the National Resource Center on Psychiatric Advance Directives (NRC-PAD) provides comprehensive information on frequently asked questions.
The National Alliance on Mental Health (NAMI) provides good information about PADs. In addition to the website, NAMI also has local chapters and a 24/7 helpline (available M-F 10 am to 10 pm Eastern Time 800-950-6264. Text “NAMI” to 62640 or email helpline@nami.org. In a crisis call or text 988 24/7.)
Finding your state’s psychiatric advance directive
Currently, 25 states – including Alabama, Alaska, California, Florida, Iowa, and Virginia – have laws that allow for psychiatric advance directives. The National Resource Center on psychiatric advance directives maintains a website with links to each state’s psychiatric advance directive forms.
In states that do not have laws allowing separate psychiatric advance directives, you can still modify that state’s standard advance directive by adding relevant language.
One approach would be to find a psychiatric advance directive from a state that has them and incorporate the language into your state’s form in the section allotted for individual preferences. That way you can highlight your unique issues of mental health care and treatment. These issues include medication preferences, inpatient treatment considerations and the reality that a person can experience changes in their wellness over time.
If you would like to make more detailed advance care plans regarding mental illness, you should talk to your physician and an attorney about a durable power of attorney tailored to specific mental health needs.
