Advance directives are commonly used to plan for future healthcare decisions if someone becomes unable to make or communicate those decisions themselves.
A psychiatric advance directive has a more specific purpose. It allows someone to plan ahead for mental health treatment in case a future crisis makes it difficult or impossible to make those decisions at the time.
Often called a PAD, a psychiatric advance directive can explain treatment preferences and, in some cases, name someone to make certain mental health decisions on the person’s behalf. The details depend on state law.
What Is a Psychiatric Advance Directive?
The American Psychiatric Association describes a psychiatric advance directive as a legal document that allows someone to state which mental health treatments they would or would not want. A person may also use a PAD to appoint an agent to make mental health treatment decisions for them if they cannot make those decisions themselves.
The basic idea is simple. Someone makes decisions ahead of time, while they can think through their choices and discuss them with people they trust.
Later, if a mental health crisis affects their ability to make treatment decisions, the PAD can give the treatment team more information about their wishes.
What Can a Psychiatric Advance Directive Include?
A PAD can address several parts of mental health care.
For example, someone may want to say where they would prefer to receive treatment or whom they want contacted during a crisis. They may have preferences about hospitalization, medication, other treatments, or which healthcare professionals they want involved in their care.
The APA also notes that a person can use a PAD to identify an agent who can make mental health treatment decisions on their behalf.
A PAD can therefore do more than simply list treatments someone wants or does not want. It can provide a fuller picture of how the person would like others to handle a mental health crisis. That information may be especially useful when the individual cannot explain those preferences at the time.
When Does a PAD Take Effect?
A psychiatric advance directive is not intended to replace someone’s ability to make their own decisions.
According to the APA, a PAD takes effect when a healthcare provider determines that the person lacks decision-making capacity. The APA gives examples such as periods of acute psychosis, mania, catatonia, or delirium.
Once the person regains decision-making capacity, they can again take part in decisions about their care.
That distinction matters. Creating a psychiatric advance directive does not mean giving someone else control over your current treatment. It creates a plan for a future situation when you may not be able to make those decisions yourself.
How Is It Different From a Medical Advance Directive?
Both documents help someone plan ahead for future healthcare decisions. The difference is what they address.
A medical advance directive may cover broader healthcare decisions and may name an agent to make medical decisions. A psychiatric advance directive focuses specifically on mental health treatment.
The APA explains that general medical advance directives can also have limits when it comes to psychiatric treatment. State laws may restrict what an agent can authorize in certain mental health situations. That is one reason some states have laws that specifically address psychiatric advance directives.
Because the rules vary, someone interested in creating a PAD should look at the requirements in their own state.
Choosing an Agent
A psychiatric advance directive may allow you to choose an agent to make certain decisions if you cannot make them yourself. That person should understand your wishes and be willing to speak on your behalf during a difficult situation.
The APA recommends choosing someone you trust who can be reached during an emergency. The person should also understand your mental health needs and be prepared to advocate for the care you want.
Talk with the person before naming them. Explain what matters to you, what treatment has helped in the past, and any concerns you have about future care.
A written document can provide important instructions. A conversation can give your agent additional context.
Do All States Have the Same Rules?
No. State law plays an important role in psychiatric advance directives.
The American Psychiatric Association says 25 states have laws specifically addressing PADs. However, that does not mean mental health planning is unavailable in every other state.
Most states allow people to leave some type of advance instruction about future mental health treatment. Nearly all states also allow someone to appoint an agent to make at least some mental health treatment decisions. In states without a law specifically for PADs, a person may be able to include those instructions under the state’s broader medical advance directive laws.
There can still be limits. For example, some state laws restrict whether an agent can authorize certain psychiatric treatments. The requirements for creating a valid document also vary by state. For that reason, anyone creating a psychiatric advance directive should check the rules that apply in their state.
Who Should Have a Copy?
Creating a psychiatric advance directive is only part of the planning process. The document also needs to be available if a crisis occurs.
The APA recommends letting trusted loved ones know that the PAD exists and where to find it. It also recommends giving copies to the agent and keeping copies on file with healthcare clinicians, preferred hospitals, or other treatment centers.
That step is easy to overlook. A PAD may contain valuable instructions, but those instructions cannot help much if no one can find the document.
If you later update the PAD, make sure the people and providers who received the earlier version have the new one.
Planning Ahead Matters
A mental health crisis can make an already difficult situation even harder for the person experiencing it and for the people trying to help.
A psychiatric advance directive gives someone a chance to think through certain decisions before that happens. It can identify treatment preferences, name an agent, and give healthcare providers useful information about the person’s wishes.
It can also give family members and other trusted people a clearer understanding of what the person wanted.
A PAD will not answer every question that can arise during a crisis. Still, it can provide direction at a time when the person may not be able to provide it themselves.
Keeping a Psychiatric Advance Directive Accessible
The usefulness of any advance directive depends partly on whether people can access it when they need it.
Legal Directives stores members’ healthcare directives so they can be accessed 24 hours a day, seven days a week.
Members can download their documents or have them sent by fax or email when a copy is needed. They also receive an Emergency Wallet Card that helps identify that their healthcare directives are available.
If a member updates a healthcare directive, the new version can be added to the account so the documents available through the service stay current.
Planning ahead doesn’t mean predicting every situation. A psychiatric advance directive simply gives someone another way to make their wishes known before a mental health crisis makes those decisions harder.
Source
American Psychiatric Association, “Psychiatric Advance Directives,” Read the full article here.