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Psychiatric Advance Directive

Similar to a medical advance directive or a health care power of attorney, a psychiatric advance directive is a legal document completed in a time of wellness that provides instructions regarding treatment or services one wishes to have or not have during a mental health crisis, and may help influence his or her care. A mental health crisis is when a person is unable to make or communicate rational decisions.

A psychiatric advance directive allows you to specify considerations about your mental health care treatment and appoint an agent who may make decisions about your treatment in the event of a mental health crisis. In some cases, you may also give further background information about how you have reacted to past treatment.

Despite these benefits, a survey of mental health experts concluded the underuse of psychiatric advance directives in the United States; this study surveyed 1,011 people with serious mental illness receiving public-sector treatment in 5 cities.

Why do you need a psychiatric advance directive?

When you are hospitalized for a mental health condition, you might get too sick to stay in charge of your treatment. At those times, doctors and other people may make decisions about your care and treatment that you do not want.

However, you can create a legal document when you are well that spells out your wishes in times of a mental health crisis. Called an advance directive, it is a written document that expresses your wishes in advance about what types of treatments, services and other assistance you want when you are sick and unable to take part in decisions about your care.

A psychiatric advance directive is an advance directive you prepare for use during a personal mental health crisis, which may help influence your care. The directive provides a clear statement of your medical treatment preferences and other wishes or instructions. You can also use it to grant legal decision-making authority to another person who will serve as your advocate and health care agent until the mental health crisis is over.

When you have a mental health crisis, you may become too sick to fully understand what treatment the doctor recommends or to make decisions about your treatment. At such times, you lack "capacity" to make informed decisions about your care. You might be unable to comprehend information, to make decisions or unable to communicate your desires. Psychiatric advance directives take effect during these times. The doctor may take into consideration your wishes as expressed in your psychiatric advance directive or by the instructions of the person you appointed to speak for you as your advocate/health care agent.