What is a Psychiatric Advanced Directive?
The Psychiatric Advanced Directive (PAD) is a legal tool that allows a person with mental illness to state their preferences for treatment in advance of a crisis. They can serve as a way to protect a person’s autonomy and ability to self-direct care. They are similar to living wills and other medical advance planning documents used in palliative care.
If you ever been hospitalized for mental health treatment, you know that doctors can often override your wishes, including forcing you to take medications (depending on circumstance). A PAD gives you power over your treatment even when you’ve been ruled unable to make your own decisions.
To create a PAD, check out this guide from SAMHSA. A PAD goes into effect when a person is found to lack decision-making capacity. A treating physician or psychologist makes the decision about mental capacity based on how the person behaves at the time of examination. Some examples of periods when a person may lack capacity include acute psychosis, mania, catatonia, delirium, or unconsciousness. In a crisis situation, if a person has been deemed incapable, the PAD goes into effect and treating medical professionals can refer to the PAD to get a clear description of the person’s preferences for treatment, who to contact in their support network, and how best to support the person in crisis.
For more information about PADS, check out the National Resource Center on Psychiatric Advanced Directives. They provide both forms and FAQs about PADs for the State of California (and other states as well). Disability Rights California also provides resources on created Advanced Healthcare Directives.
Some key things to consider:
- Make sure your current therapist and/or psychiatrist are aware of your PAD and what is in it. For example, if you refuse certain medications or treatments, discuss this with them as you create the PAD and enlist their support.
- Discuss fully your intentions for your treatment with the person you name the healthcare proxy. This is the person who will make decisions on your behalf. Choose someone you trust who will honor and respect your concerns and wishes regarding your treatment.
- Once signed and/or notarized (if required by your state) make sure EVERY member of your care team has one on file – primary care physician, psychiatrist, therapist, family members, and any emergency contacts.
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