What Is a Psychiatric Advance Directive?
One of the most complicated situations that caregivers face is trying to get their loved one care during a mental health crisis. Sometimes, people who live with mental health conditions become incapacitated. In that state, they are practically and legally unable to make decisions for themselves. This can happen, for example, when a person is in a manic state, is experiencing psychosis, or is suicidal. Caregivers may hesitate to take action when there is uncertainty. The person in crisis may not have been clear about what they would want to happen if they are unable to make decisions for themselves. Caregivers do not want to do the “wrong” thing or upset their loved one. They often have to guess what their loved one would prefer with regard to hospital, treatments, and who they would want involved in making decisions. Fortunately, this situation can be avoided with some advance planning while the person is well and execution of a Psychiatric Advance Directive (PAD)*.
What is a Psychiatric Advance Directive?
A Psychiatric Advance Directive is a legal document for a person who lives with a mental health condition. In it, they describe their preferences for care in the event that they are not able to make decisions for themselves. It is used only when the person is unable to make their own decisions. The PAD authorizes a named person to act on their behalf to secure the care they would want if they were capable of making decisions.
What are the benefits of having a Psychiatric Advance Directive?
The person living with the mental health condition is much more likely to have their preferences respected than if they didn’t have a PAD. This can include the preferred type of care, location, and providers. With a PAD in hand, caregivers can avoid a variety of problems. The PAD relieves the stress of having to remember their loved one’s priorities in the midst of a crisis. Caregivers don’t have to deal with their loved one contradicting what they had said when they were not impaired. And the PAD provides a legal foundation for caregivers to act on their loved ones’ behalf.
What is included in a Psychiatric Advance Directive?
Every PAD is different because it reflects that individual’s preferences, priorities., and circumstances. However, every PAD should cover certain issues, including these:
- What are the indicators that the person is unable to make decisions for themselves so that the PAD becomes effective?
- Who is the person designating to have decision-making authority?
- Which hospital or treatment facility would they prefer to use?
- Who do they want involved in their care or visiting them at the facility?
- Which medications and treatments do they prefer and which do they want to refuse?
- What information would help the hospital staff provide the best experience for them and provide appropriate care? Are there ways of interacting that are reassuring or that help them remain receptive to treatment?
- What information will help with creating the discharge plan and offer the best chance for achieving mental wellness?
What else is helpful for planning crisis mental health care?
The PAD carries the force of law. This is essential when designating a person to act as an agent for the person currently unable to make decisions for themselves. A person can also execute another legal document, a durable power of attorney. This document authorizes someone else to make financial and legal decisions when the person is incapacitated.
But there are issues that should be addressed outside of the legal documents. Honest conversations between caregivers and their loved ones about crisis care helps caregivers be prepared for those situations. Maintaining an information sheet that does not need to be notarized enables people to give instructions about practical and day-to-day issues and concerns.
This information sheet might include
- contact information for their mental health and medical providers
- contact information for others they want to be aware of their situation
- a current list of medications, health conditions, allergies, dietary restrictions and preferences, and any special considerations
- information about who to contact at their employer about their absence
- information about pets and their care
- information about their children, such as their school and routine
- anything else that will need to be taken care of while they are unavailable.
Planning for a mental health crisis enables a caregiver and their loved one to work together toward getting the person the mental health care that they need and prefer.
*This blog post is not intended to be, and should not be construed as, legal advice. If you would like to draft or enforce a psychiatric advance directive or other legal document, please contact a qualified attorney with relevant experience in your state. Your mental health provider may also have templates and suggestions.