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Being prepared for a crisis
with a psychiatric advance directive
"We know what’s best for you," the doctors and nurses told Amber after she awoke to find she had been admitted to a psychiatric hospital. When she told them she’d had problems in the past with the medication they were giving her and that another had been more effective for her, no one would listen.
If you are living with depression, bipolar disorder or another mental illness, you may someday require hospitalization. And you may find that you have little say about your treatment. Medical staff will make most of the decisions about your care if your symptoms become severe.
But there’s a way to stay in charge. You and your family members should be prepared for the possibility that you could become incapacitated as a result of your illness.
Putting your preferences in writing can allow you to have more control over what happens to you if you become so ill you cannot make decisions for yourself.
A legal document called a psychiatric advance directive (PAD) can provide you with this type of protection. It's a tool for documenting your instructions and preferences regarding future mental health treatment. It can ensure better communication between you and your doctor and may prevent hospitals from giving you unwanted types of treatment.
The time to plan for such an emergency is when you are well and able to think clearly.
What do I need to know?
Find out, for example, what your doctor's procedure is for reaching him/her in an emergency. Will you be seen by your own doctor or someone on call? What hospital(s) is your doctor associated with?
Get information about your insurance plan. Are there hospitals your plan will approve and others it won't? Will you need preapproval? Are there limits on your length of stay?
Electroconvulsive therapy (ECT) may be recommended. Do you know enough about it to specify, in advance, whether or not you want to have it? Do you know what medications have been effective for you and which have not, or have had problem side effects?
What's included in a PAD?
Is my PAD legally binding?
Regardless of state laws, if you have an advance directive, medical staff are more likely to honor your preferences.
How do I prepare a PAD?
When would I be considered "incapable"?
The Bazelon Center for Mental Health Law provides more information and forms you can download.
Page updated October 1, 2010