“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 said them she’d had problems with the medication they were giving her and that another had been more effective for her, no one would listen.
If you live with depression, bipolar disorder, or another mental illness, you may someday require hospitalization. And you may realize that you have very little say to no 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 due to 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 protection type. 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?
Begin by gathering information and considering your preferences.
For example, find out what your doctor’s procedure is for reaching him/her in an emergency. Will you be seen by your doctor or someone on call? What hospital(s) is your doctor associated with?
Get information about your insurance plan. Are there hospitals your project 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 useful for you and have not had problem side effects?
What’s included in a PAD?
A PAD may include any of these and other instructions:
- Designation of agent(s)
- Emergency contacts
- Preference for a court-appointed guardian
- Choice of a treatment facility
- Preference for alternatives to hospitalization
- Preferences about doctors who will treat you if you are hospitalized
- Preferences regarding medications
- Preferences regarding treatments such as electroconvulsive therapy (ECT)
- Who should be notified of your admission to a psychiatric facility
- Who should be prohibited from visiting you
- Choices regarding who should care for your children
Is my PAD legally binding?
Most states permit some form of legal advance directive (AD) for healthcare, but twenty-five states have specific PAD statutes, each with somewhat different requirements. Learn about the laws in your country.
Regardless of state laws, medical staff is more likely to honor your preferences if you have an advance directive.
How do I prepare a PAD?
- Discuss your plan with your family and health care providers.
- Select an agent, a trusted friend, or a family member, to represent you. (Most states require this, and your PAD is more likely to be honored if you have named an agent.)
- Describe your preferences in particular terms.
- Give copies to your agent, alternative agent, friends, family members, and mental health care provider who will make it a part of your medical record. You can also give a copy to the facility where you might be taken in an emergency.
When would I be considered “incapable”?
Incapacity generally means that, at the time, you are not able to make and communicate decisions about your mental health treatment. State laws vary. Incapacity may be determined by a doctor, a qualified psychologist, or a judge.
The Bazelon Center for Mental Health Law provides more information and forms you can download.
If this article have helped, check our latest articles.
This article does not constitute legal advice. Before you assume that the advance directive you create using this form will be legally valid in your state, you should consult a lawyer.
