Psychiatric Advance Directives: Plan Your Treatment Before a Mental Health Crisis

Psychiatric Advance Directives (PADs), like advance directives for health care, let a person with a mental illness lay out in advance the mental health care they want during a crisis that may require hospitalization.

Hospitals are required not only to include in a patient’s medical record a PAD if the patient has one, but also to follow it, unless medical professionals document in writing that specific treatment preferences aren’t in a patient’s best medical interest.

A PAD would have helped Steve Singer, a man with bipolar and borderline personality disorder. According to a 2018 New York Times story, Singer went to a hospital to seek help as he recognized he was experiencing the early symptoms of a psychiatric episode. The hospital took his phone and placed him in a locked ward for 20 hours before he was able to talk with a mental health worker about his psychiatric illness and the crisis he was experiencing. Deeply upset, Singer completed a PAD afterward to prevent the same thing from happening again.

While 27 states have laws that allow PADs, many mental health patients and their families are not familiar with them.

What Is a PAD?

PADs are written legal instruments that document the treatments, services, or other help a  patient wants — or does not want — during a mental health crisis. A PAD can also grant legal decision-making authority to an agent and mental health care advocate when the person is determined to be incompetent.

When Is a PAD Needed?

A PAD goes into effect when a person is hospitalized and determined to lack the capacity to make decisions for themselves. With a PAD that was written when capacity was not in question, a person can influence what happens during their stay in the hospital and the care they receive. Doctors retain the authority to make decisions deemed necessary for the person’s safety and care.

What Should a PAD Include?

A PAD can include the medications and dosages that are most helpful and the ones a patient does not want to receive. Consent can be given in advance for treatments that are specified and the ones that are not, as well as when hospitalization should occur, based on a patient’s history.

The names of preferred treatment facilities, hospitals, and mental health professionals for a person’s care should also be included.

Who Should Have a Copy of the PAD?

It’s important that an individual’s trusted friends, family members, agents, and mental health care providers know there is a PAD, and where they can find it.

Who Should Be Chosen as the Agent or Advocate?

Choosing someone the patient trusts to make mental health care treatment decisions for them is the primary consideration. It might be a family member or friend who knows the treatment a patient prefers and can supervise care during hospitalization. It can also be one person who is chosen as the primary agent, with another as the backup, each with different responsibilities.

Before naming an agent, be sure to discuss the treatment plan and services with the patient to make sure they understand the preferences listed in the PAD.

Is a Lawyer Needed to Prepare a PAD?

PAD laws vary from state to state. Consulting a lawyer or someone from a state protection and advocacy agency (P&A) who can assist with preparing a PAD may maximize the PAD’s enforceability. To find a special needs planner in your area to learn more about a PAD, visit SpecialNeedsAnswers.com. To find a state’s P&A system, visit the National Disability Rights Network.