How to Write a Psychiatric Advance Directive

Reviewed Aug 14, 2016

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Summary

  • Decide what you want and don’t want in emergency treatment.
  • Describe what works for you and what doesn’t.
  • Pick someone to speak for you.

You might face a time when you need medical help for a mental health crisis. Serious situations may happen, even to people who work hard following a regular program of meds, therapy, and support.

Depending on the crisis, you might not be able to properly speak with those trying to help you. If that happens, a psychiatric advance directive (PAD) will let people know what treatments you prefer and what you don’t want. If you write a PAD while you’re well, you will know you have made your wishes clear, no matter what happens.

Important things to remember

  • A PAD is a legal document and can have a big impact on your care.
  • A PAD gives you some control over treatment decisions.
  • As you work on it, you will want to discuss some decisions with your family and treatment providers.
  • You can always change it, if you want to.

If you do find yourself in a mental health crisis, your PAD may prevent your situation from getting worse.

Make decisions in advance

Here are 12 things to ask yourself before you write your own PAD. Your answers can be dropped into a form provided by a state mental health agency, or into one you write yourself. (Look at a few sample forms by clicking on the links below.)

1. What medications do you take? Do you have any allergies? What medications would you prefer in a crisis? Is there anything you would not want to take?

2. Where would you like your care to take place?

3. Do you want your physician, therapist, and/or case worker contacted? 

4. What warning signs come before a crisis, for you?

5. When you have a crisis, what are the symptoms? Be as specific as possible, so you can help someone spot your crisis in its early stages. 

6. What helps you when you’re in a crisis?

7. Have you ever been in a hospital for mental health treatment? How did you react?

8.  How can hospital staff help you stay calm and comfortable?

9.  Will you let people visit you if you’re in a hospital? 

10.  Would you agree to electro-convulsive therapy (ECT) if doctors decide it is necessary?

11. Is there anything else you would want hospital staff to know about you or your needs? Do you have a crisis plan they could read for basic health and contact information? 

12. Can you confirm that you wrote this plan? Some states require the signature of a witness and/or notary public. Find out what your state mental health agency requires before you complete your PAD.

You might want to ask someone you trust to make important decisions for you. Or, you might want to direct the hospital to call your doctor and follow his instructions.

Look at the PAD as your voice in a serious situation in which you cannot speak. Your instructions will make it easier for people to plan your care, even if you are in a busy ER.

Doctors do not have to follow your plan if they think your choices are inappropriate. Still a PAD is a good thing to have, even if it doesn’t guarantee that you will get the treatment you ask for. It will help doctors decide what to do and what not to do when planning your emergency care.

Resource

Mental Health America
www.nmha.org

Advance Directives by Ronald S. Honberg, National Director for Policy and Legal Affairs, National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Public-Policy/Psychiatric-Advance-Directives-(PAD).

Myths and Facts about Advance Directives by the American Bar Association, www.americanbar.org/content/dam/aba/migrated/Commissions/myths_fact_hc_ad.authcheckdam.pdf.

Advance Directives for Mental Health Treatment, North Carolina Division of Mental Health, http://pad.duhs.duke.edu/PAD%20Worksheet.doc.

By Paula Hartman Cohen
Source: Loretta Kearsley, RN, BA, MEd, Psychiatric Nurse, Charlemont, MA; National Resource Center on Psychiatric Advance Directives, www.nrc-pad.org/
Reviewed by Trenda Hedges, BS, CRSS, Recovery Team Manager; Julie Tull, CRSS, Peer & Family Support Specialist, Beacon Health Options

Summary

  • Decide what you want and don’t want in emergency treatment.
  • Describe what works for you and what doesn’t.
  • Pick someone to speak for you.

You might face a time when you need medical help for a mental health crisis. Serious situations may happen, even to people who work hard following a regular program of meds, therapy, and support.

Depending on the crisis, you might not be able to properly speak with those trying to help you. If that happens, a psychiatric advance directive (PAD) will let people know what treatments you prefer and what you don’t want. If you write a PAD while you’re well, you will know you have made your wishes clear, no matter what happens.

Important things to remember

  • A PAD is a legal document and can have a big impact on your care.
  • A PAD gives you some control over treatment decisions.
  • As you work on it, you will want to discuss some decisions with your family and treatment providers.
  • You can always change it, if you want to.

If you do find yourself in a mental health crisis, your PAD may prevent your situation from getting worse.

Make decisions in advance

Here are 12 things to ask yourself before you write your own PAD. Your answers can be dropped into a form provided by a state mental health agency, or into one you write yourself. (Look at a few sample forms by clicking on the links below.)

1. What medications do you take? Do you have any allergies? What medications would you prefer in a crisis? Is there anything you would not want to take?

2. Where would you like your care to take place?

3. Do you want your physician, therapist, and/or case worker contacted? 

4. What warning signs come before a crisis, for you?

5. When you have a crisis, what are the symptoms? Be as specific as possible, so you can help someone spot your crisis in its early stages. 

6. What helps you when you’re in a crisis?

7. Have you ever been in a hospital for mental health treatment? How did you react?

8.  How can hospital staff help you stay calm and comfortable?

9.  Will you let people visit you if you’re in a hospital? 

10.  Would you agree to electro-convulsive therapy (ECT) if doctors decide it is necessary?

11. Is there anything else you would want hospital staff to know about you or your needs? Do you have a crisis plan they could read for basic health and contact information? 

12. Can you confirm that you wrote this plan? Some states require the signature of a witness and/or notary public. Find out what your state mental health agency requires before you complete your PAD.

You might want to ask someone you trust to make important decisions for you. Or, you might want to direct the hospital to call your doctor and follow his instructions.

Look at the PAD as your voice in a serious situation in which you cannot speak. Your instructions will make it easier for people to plan your care, even if you are in a busy ER.

Doctors do not have to follow your plan if they think your choices are inappropriate. Still a PAD is a good thing to have, even if it doesn’t guarantee that you will get the treatment you ask for. It will help doctors decide what to do and what not to do when planning your emergency care.

Resource

Mental Health America
www.nmha.org

Advance Directives by Ronald S. Honberg, National Director for Policy and Legal Affairs, National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Public-Policy/Psychiatric-Advance-Directives-(PAD).

Myths and Facts about Advance Directives by the American Bar Association, www.americanbar.org/content/dam/aba/migrated/Commissions/myths_fact_hc_ad.authcheckdam.pdf.

Advance Directives for Mental Health Treatment, North Carolina Division of Mental Health, http://pad.duhs.duke.edu/PAD%20Worksheet.doc.

By Paula Hartman Cohen
Source: Loretta Kearsley, RN, BA, MEd, Psychiatric Nurse, Charlemont, MA; National Resource Center on Psychiatric Advance Directives, www.nrc-pad.org/
Reviewed by Trenda Hedges, BS, CRSS, Recovery Team Manager; Julie Tull, CRSS, Peer & Family Support Specialist, Beacon Health Options

Summary

  • Decide what you want and don’t want in emergency treatment.
  • Describe what works for you and what doesn’t.
  • Pick someone to speak for you.

You might face a time when you need medical help for a mental health crisis. Serious situations may happen, even to people who work hard following a regular program of meds, therapy, and support.

Depending on the crisis, you might not be able to properly speak with those trying to help you. If that happens, a psychiatric advance directive (PAD) will let people know what treatments you prefer and what you don’t want. If you write a PAD while you’re well, you will know you have made your wishes clear, no matter what happens.

Important things to remember

  • A PAD is a legal document and can have a big impact on your care.
  • A PAD gives you some control over treatment decisions.
  • As you work on it, you will want to discuss some decisions with your family and treatment providers.
  • You can always change it, if you want to.

If you do find yourself in a mental health crisis, your PAD may prevent your situation from getting worse.

Make decisions in advance

Here are 12 things to ask yourself before you write your own PAD. Your answers can be dropped into a form provided by a state mental health agency, or into one you write yourself. (Look at a few sample forms by clicking on the links below.)

1. What medications do you take? Do you have any allergies? What medications would you prefer in a crisis? Is there anything you would not want to take?

2. Where would you like your care to take place?

3. Do you want your physician, therapist, and/or case worker contacted? 

4. What warning signs come before a crisis, for you?

5. When you have a crisis, what are the symptoms? Be as specific as possible, so you can help someone spot your crisis in its early stages. 

6. What helps you when you’re in a crisis?

7. Have you ever been in a hospital for mental health treatment? How did you react?

8.  How can hospital staff help you stay calm and comfortable?

9.  Will you let people visit you if you’re in a hospital? 

10.  Would you agree to electro-convulsive therapy (ECT) if doctors decide it is necessary?

11. Is there anything else you would want hospital staff to know about you or your needs? Do you have a crisis plan they could read for basic health and contact information? 

12. Can you confirm that you wrote this plan? Some states require the signature of a witness and/or notary public. Find out what your state mental health agency requires before you complete your PAD.

You might want to ask someone you trust to make important decisions for you. Or, you might want to direct the hospital to call your doctor and follow his instructions.

Look at the PAD as your voice in a serious situation in which you cannot speak. Your instructions will make it easier for people to plan your care, even if you are in a busy ER.

Doctors do not have to follow your plan if they think your choices are inappropriate. Still a PAD is a good thing to have, even if it doesn’t guarantee that you will get the treatment you ask for. It will help doctors decide what to do and what not to do when planning your emergency care.

Resource

Mental Health America
www.nmha.org

Advance Directives by Ronald S. Honberg, National Director for Policy and Legal Affairs, National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Public-Policy/Psychiatric-Advance-Directives-(PAD).

Myths and Facts about Advance Directives by the American Bar Association, www.americanbar.org/content/dam/aba/migrated/Commissions/myths_fact_hc_ad.authcheckdam.pdf.

Advance Directives for Mental Health Treatment, North Carolina Division of Mental Health, http://pad.duhs.duke.edu/PAD%20Worksheet.doc.

By Paula Hartman Cohen
Source: Loretta Kearsley, RN, BA, MEd, Psychiatric Nurse, Charlemont, MA; National Resource Center on Psychiatric Advance Directives, www.nrc-pad.org/
Reviewed by Trenda Hedges, BS, CRSS, Recovery Team Manager; Julie Tull, CRSS, Peer & Family Support Specialist, Beacon Health Options

The information provided on the Achieve Solutions site, including, but not limited to, articles, quizzes, and other general information, is for informational purposes only and should not be treated as medical, health care, psychiatric, psychological or behavioral health care advice. Nothing contained on the Achieve Solutions site is intended to be used for medical diagnosis or treatment or as a substitute for consultation with a qualified health care professional. Please direct questions regarding the operation of the Achieve Solutions site to Web Feedback. If you have concerns about your health, please contact your health care provider.  ©2017 Beacon Health Options, Inc.

 

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