What are Psychiatric Advance Directives?

What’s a psychiatric advance directive (PAD)? It’s a legal document that allows a person to state preferences for treatment decision-making in advance of a mental health crisis. There are two kinds of legal documents: (1) “Advance Instruction” to list preferences and (2) “Health Care Power of Attorney” to appoint a trusted person to make decisions. A person can have one or both of these documents.

How are they used? If your family member is in mental health crisis, and lacking decision making capacity, medical professionals can refer to the PAD to get a clear description of preferences for treatment and if there is a trusted person who can help with making decisions. PADs are only used temporarily, and only when the person is incapable of making or communicating treatment preferences.

What does “capacity” mean? Capacity is a legal term that indicates a person’s ability to make sound decisions. A physician or psychologist can determine if someone lacks decision-making capacity. Once your family member regains capacity, the PAD is no longer in effect – and the person can make their own decisions again.

What are the benefits of PADs? In research studies, PADs have been found to reduce the need for coercive treatment. The process of creating a PAD helps the person clarify preferences and plan for crises – conversations that can sometimes help to prevent crises from occurring.

What is a health care power of attorney? Your family member can legally appoint another person to represent their interests when incapacitated by giving them power of attorney for health decisions. The person in this role is called a health care agent, and only speaks for the person when they lack capacity.  Having a health care agent may also reduce the need for guardianship, a more restrictive intervention. The health care agent represents the person’s wishes, so trust and good communication are essential.

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