Psychiatric Advance Directives: A Must-Have for Us

Families for Depression Awareness

For people living with mental health conditions, advance planning is a “must-do.” When our conditions render us unable to make measured decisions as we would at times when we are not in distress, having delusions, or otherwise not functioning as our usual selves, we want to know that we have made our wishes known, that our family members and support network know what to expect and what are their roles, and that our care team is ready, willing, and able to do as we have specified.

National Healthcare Decisions Day – now a weeklong event from April 16-22 – is the motivation we’ve all been waiting for to talk with our families about healthcare decisions. For readers of Care for Your Mind and supporters of the Depression and Bipolar Support Alliance (DBSA) and Families for Depression Awareness (FFDA), psychiatric care planning is as important as anticipating end-of-life decisions.

The document that records your plans is called a Psychiatric Advance Directive (PAD). As stated by the American Psychiatric Association,

A psychiatric advance directive is a legal document allowing a person to give instructions for future mental health treatment or appoint a person to make future decisions about mental health treatment (also called a health care agent, surrogate, or proxy decision-maker). The document is used when the person who created it experiences an acute episode of psychiatric illness and becomes unable to make or communicate decisions about his/her treatment.

DBSA promotes advance directives as a form of self-advocacy: “Everyone should be allowed to make the important decisions regarding their health care.”

Nuts and bolts
The National Association of Social Workers has a good overview of psychiatric advance directives. Start here if you need some background on PADs or don’t see the reason to have one. Mental Health America launched My Plan, My Life: My Psychiatric Advance Directive, which offers educational videos and information about PADs. You can get a few tips from Psychology Today as well.

The Bazelon Center for Mental Health Law explains that people who have concerns about the possibility of involuntary interventions – treatment or hospitalization – should express their choices about treatment through a PAD.  The Bazelon Center provides a PAD template for consumers’ use (file downloads: .pdf or .doc)

Finally, the real treasure trove is at the National Resource Center on Psychiatric Advance Directives, a joint project of the Bazelon Center and Duke University. There you can find information specifically for people living with mental health conditions, family members and friends, and health and legal professionals.

Advocacy happens at the state level
Advocacy-wise, psychiatric directives are both a federal and state issue. Federal law requires that facilities receiving Medicare or Medicaid funds must offer advance directives, whether for medical or mental health conditions. But states are the policymakers with regard to healthcare directives; currently, about half of the states specifically permit psychiatric advance directives. The National Alliance on Mental Illness (NAMI) “supports the efforts of states to develop processes by which caregivers and service providers work collaboratively with persons with serious mental illnesses to develop plans for treatment, services, and supports that are followed, when, and if, needed in the future.”

Your mission, should you choose to accept it
Here’s the goal for this week: talk with your family (or other support network) and talk with your provider so that they know what you want if you’re not able to make decisions for yourself, then put it in writing in the form required by your state.

And if you’re the family member of a person living with a mental health condition, it behooves you to help your loved one create a PAD. In a crisis situation, you do not want to be stuck between inaction from not knowing what to do and potentially unwanted action if you believe that hospitalization is the only safe option at the time.

This year’s NHDD theme is “It Always Seems Too Early, Until It’s Too Late.” Let’s get our PADs done and make sure that it’s never too late for us to exercise our self-determination.

Your Turn

  • How are you going to talk with the important people in your life about managing mental health care in a crisis?
  • What is in the way of you completing your PAD?

Further reading

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