Psychiatric Advance Directive
A psychiatric advance directive is a written document expressing your wishes in advance about what types of treatments, services and other assistance you want or do not want during a personal mental health crisis. It provides a clear statement of your medical treatment preferences and other wishes or instructions. You can also use it to grant decision-making authority to another person to be your advocate until the crisis is over.
The benefits of having a psychiatric advance directive include:
- Promote your autonomy and empowerment
- Enhance communication between you, your doctor, treatment team and family
- Protect you from ineffective, unwanted or possibly harmful treatment or actions
- Help prevent crisis situations and the use of involuntary treatment or safety interventions, such as restraint or seclusion
An advance directive goes into effect if you are hospitalized and it has been determined that you lack the capacity to make decisions for yourself. By writing your advance directive when your capacity is not in question, you have the opportunity to better influence what happens during a hospital stay. In an emergency situation, however, it is important to understand that doctors retain the authority to make decisions that are deemed necessary to ensure your safety and that of other patients and hospital staff.
A psychiatric advance directive should include:
- The medications and dosages that are most helpful to you and those that you do not wish to receive
- Names of facilities or healthcare professionals you want involved in your care
- People who can help you, such as those who can pay your bills, take care of your children, pets or plants, etc.
- Names of people you do and do not want as visitors if you are hospitalized.
One of the more powerful features of an advance directive is your ability to designate someone else (an agent) to make decisions for you if you are admitted to a psychiatric hospital. You can name that person by stating that only he or she should make decisions for you in the event that you have been determined to lack the capacity to do so.
The person you select as your agent should be someone you trust to advocate for you - a family member or a friend. He or she will tell others what kind of treatment you do or do not want, and supervise your care. You may wish to choose more than one agent, and you can make one a primary agent and designate another as a back-up agent. You can also assign different rights and responsibilities to separate agents. Perhaps you trust one person to make your healthcare decisions and another person to take care of your household matters, provided you are clear about the assignment of duties and responsibilities. Before naming an agent, discuss your plans with the person you want to designate to make sure they understand your request.
Be aware this is a legal document and state laws may need to be considered. To maximize the enforceability of an advance directive, it is suggested you consider consulting with an attorney or someone from your state's protection and advocacy program.
It is important people know you have an advance directive and know where to find it. Put a copy in your home where it can be easily found and another copy in a safe place with your other important papers. Be sure to give copies to people you trust - your agent or a trusted friend or relative. You should also consider to have a copy on file at any hospital where you have been a patient before. You can also be sure to list the existence of the advance directive and the location by entering the details on the appropriate Financial Envelope forms as part of our secure and personalized portal.
