Does Your Family Know Your Mental Health Care Preferences?

Susan Weinstein
Editor in Chief, Care for Your Mind

Continuing our important conversations about mental health for your family this holiday season, let’s talk about psychiatric advance directives, or PADs. Wouldn’t it be great if you were able to provide instructions for your family in the event your mood disorder renders you unable to advocate for yourself? Here’s the good news: you can!

More than half of the U.S. states recognize psychiatric advance directives, legal documents that detail instructions for mental health care when a person is not otherwise competent to make her or his own health care decisions. Most of the states that have not adopted specific PAD laws do allow health directives that can address physical and mental health. If you have a family member who lives with a mood disorder, or you live with a mood disorder, make it a priority to write a PAD by year end, or a resolution to complete in January.

In drafting the PAD, you’re going to want to include your mental health care provider as well as the family member(s) or others who you will want to implement the PAD. These and others on your care team can provide valuable advice as you make decisions about medications, other interventions like brain-stimulation modalities, inpatient facilities, and more. By engaging with them, you can feel as if you are more in control. You are the one empowered to make these decisions in advance of when they are needed.

It’s important that your care team, and especially your family members, understand what you would like to have happen in your care so they can advocate for your preferred interventions. You will need to be sure that they are dedicated to implementing the PAD and that the PAD can be accomplished practically. Also, because it is a legal document, you will want to ensure that you have the number of disinterested witnesses (i.e., they do not have a role in the PAD) and/or notary’s signature as required by your state law. Find the requirements for your state here.

What to include in a PAD

The contents of a person’s PAD are individualized, reflecting that person’s experiences, preferences, and expectations. But all PADs should address several issues.

  1. When should the PAD be activated? Describe symptoms that may indicate your inability to make decisions for yourself.
  2. To whom are you entrusting your decision-making authority? Having someone local to you is easiest, but you can name someone who is based elsewhere as long as they are able to utilize your local resources. Be specific in naming the person and how to get in touch with them promptly. Also, it’s generally a good idea to name an alternate representative.
  3. If you need to be admitted to a hospital or treatment facility, which do you prefer? List them in the order of preference. Include contact information for the intake department and an address for the facility. Note also the hospitals and facilities that you would not want to go to. You’re not required to provide explanations but it can be helpful to those interpreting the PAD.
  4. Which people would you want to visit you at the facility or hospital? Use your PAD to grant permission to them by name.
  5. What treatments are you willing to undergo and which are you not? Note which medications you are – and are not – willing to take as an inpatient. If you had a significant negative reaction to a medication in the past, it might make sense to exclude it from future use for your mental health. Are you willing to receive electroconvulsive therapy (ECT) while in a treatment facility?
  6. If there are ways of interacting that you know to be helpful or things people can do that will make you more at ease, list them. You want to try to make your facility experience as positive and productive as it can be.

Because a PAD is a legal document, you may want to keep a separate information page that you can regularly update with current information. This might include

  • contact information for your psychiatrist or other prescriber, therapist, and primary care provider
  • an updated list of your medicines, allergies, dietary guidelines or restrictions, other health conditions and treatments, and any special considerations.
  • names and phone numbers of other people you would want to be contacted
  • the name and phone number and email address of the person at your employer who should know about your absence, if any
  • the names of any pets and how they should be taken care of
  • if you have children, information about their school and routine
  • anything else that will need to be taken care of while you are unavailable.

Creating a PAD helps make things smoother – and more to your liking – in the future. Make sure your family knows what you would like to have happen so you can have advocates!

Read our earlier post, Psychiatric Advance Directives: A Must-Have for Us.

Editor’s Note: The New York Times had a story on PADs on December 4, 2018: Giving Patients a Voice in Their Mental Health Care Before They’re Too Ill to Have a Say

Check out the information at the National Resource Center for Psychiatric Advance Directives

What do you think?


  • What advice do you have for people writing their first psychiatric advance directive?

Tell us on Facebook!

Facebook Comments