Currently, only 25 states feature laws regarding psychiatric advance directives—yet one in 25 adults will experience a serious mental illness each year, according to the National Alliance of Mental Health. A psychiatric advance directive is a legal document that outlines an individual’s preferences regarding future mental health care, services, and support if they should become unable to make decisions regarding their care needs/preferences in the future. The individual can also name someone in their psychiatric advance directive to make those treatment decisions should a future need arise. Often, individuals who are just beginning to experience symptoms of mental illness or have been newly diagnosed will consider creating this type of document, but even people without current symptoms may choose to put their treatment plans into the creation of a legal document in order to preserve their autonomy and individual preferences.
What Is a Psychiatric Advance Directive?
A psychiatric advance directive (PAD) is a legal document that states a person’s preferences regarding mental health treatment, services, and support. It may list another individual who is authorized to make care decisions. In the event of a mental health crisis, medical caregivers can rely on this document’s directives when deciding on a treatment and support course. The PAD does not normally go into effect until the individual in question is hospitalized and has been medically determined to be incapable of making decisions for themself.
The PAD enables the person to determine their care should they ever lack the capacity to make those important decisions about their treatment and health. While legally speaking, physicians retain medical authority to make most decisions “deemed necessary,” according to Mental Health America, to safeguard the individual’s safety as well as the safety of caregivers, the PAD certainly impacts many of the decisions that will govern the person’s care. Other similar legal documents, like a psychiatric power of attorney, can also detail a person’s care directives and name an individual who is authorized to make decisions for them (in the event of a serious mental health episode or emergency).
When Might a Psychiatric Advance Directive Be Helpful?
Serious mental illnesses can be unpredictable. A person suffering from a mental disorder such as schizophrenia or psychosis may experience a crisis with little to no advance warning. One day they feel in command of their condition and the next, they don’t and may require hospitalization. In those times of crisis, the individual is incapable of making treatment decisions for themselves.
With a psychiatric advance directive, the individual can state clearly what they want and don’t want regarding treatment—when they are in their right mind. During a crisis when they become incapacitated, they may not be able to communicate their wishes to busy clinicians who may not know them or their mental health history. Certainly, medical care providers want to help each patient achieve recovery, but mental illness is complex. Without the patient’s voice or a designated individual who can enact the patient’s choice, clinicians must make care decisions in the absence of full information.
In this way, the PAD empowers patients, speaking for them when they are incapacitated. They provide psychiatrists and doctors with the information they need as they make decisions guiding that individual’s care and support.
5 Situations that Merit a Psychiatric Advance Directive
There are numerous reasons to create a psychiatric advance directive. The following five are among the most popular reasons that people choose to obtain legal documents that state their care preferences:
1. Clarify Treatment Preferences
A person who has a serious mental health condition such as dementia or schizophrenia may experience a time when they do not possess the cognitive function to make decisions about their own care. By creating a psychiatric advance directive before a crisis occurs, they can clarify their treatment preferences in order to guide the doctors’ decisions.
2. Protect against Unwanted or Harmful Treatments
There are many treatments and methods employed for caring for individuals suffering from a mental health crisis. Some of these treatments can adversely affect patients. With the psychiatric advance directive in place, the individual can clearly state which treatments they are opposed to, such as certain medical procedures/medications.
3. Streamline Communication
A psychiatric advance directive provides clear communication about a patient’s treatment wishes or lists a designated individual who can communicate on a patient’s behalf. Clear, direct communication saves time and confusion when it comes to providing treatment for a person experiencing a mental health crisis.
4. Enhance Recovery
Psychiatric advance directives can enhance a person’s recovery journey by outlining that person’s treatment preferences. These treatments may have worked well for the individual in the past or they may reflect what the patient is most comfortable with regarding their medical care—and that can often lead to a more efficient course of treatment for the individual in question.
5. Promote Autonomy
The idea of possibly becoming incapacitated and unable to make sound decisions can be terrifying. Creating a psychiatric advance directive allows its creator a level of autonomy should they experience a crisis. The document carries their wishes even when they are unable to communicate them in person.
How Does a Person Create a Psychiatric Advance Directive?
Many people begin the conversation about creating a psychiatric advance directive or mental health power of attorney with their own clinicians. Psychiatrists, doctors, or even therapists can direct individuals to clinics or hospital social workers who can help facilitate the process of creating a PAD. They can also help patients understand the rules or laws governing these documents in their state. If the patient doesn’t know of an attorney who handles these types of documents, the healthcare facility may also be able to provide a listing for several in the area.
An attorney can draw up the directive or mental health power of attorney in accordance with the state’s mandates. Before granting someone with power of attorney to make healthcare decisions for them, the patient should discuss their plans and wishes beforehand to ensure that this person agrees to provide this service and understands the individual’s preferences.
Once drawn up, the document should reflect the individual’s treatment preferences. It may also direct physicians to consult with certain family members about treatment in the event of a crisis. Unfortunately, states differ when it comes to these documents. Many patients worry that they’ll experience a crisis and have no way of telling medical providers that their psychiatric advance directive exists. Of course, many behavioral health specialists will contact close family in the event of an emergency and request information such as this. Patients without family or friends listed on their directive may carry a card that directs doctors about where to obtain this document (i.e. attorney, social worker, etc…). Patients may also request that their area hospital or routine care providers keep a copy in their files.
Seek Help When You Need It
If you need a schizophrenia power of attorney, mental health power of attorney, or psychiatric advance directive, you can discuss your wishes with your care facility so they can help you facilitate the creation process of these legal documents. Even if you’re not certain about the severity of your condition or aren’t sure you’ll ever need such a document, it’s important to consider it carefully. While you may never need this document, having it on file ensures that medical caregivers understand your wishes regarding treatment and support.
If you haven’t been diagnosed with a mental health condition but are experiencing distressing symptoms, don’t delay in consulting a doctor or licensed mental health professional. Advances in treatment allow a vast majority of people with mental illnesses to live a healthy, normal life. Medications and therapies can ward off crises before they occur. The key is to get evaluated and treated at a behavioral health provider you can trust. At FHE Health, our counselors are available 24/7 if you need us.
